Friday, 17 December 2010

78 year old female CC: Headache

Here's a case submitted by a faithful reader by the name of Nick Mercer.

EMS is dispatched to "possible heart attack" in rural Montana.

On arrival they find a 78 year old female lying on the couch where her friends found her in the morning.

The patient is awake and oriented but not alert. Speech is clear and appropriate but sluggish. She states that she has been lying on the couch for less than 1 hour.

The paramedics determine that she is complaining of a headache.

From bystanders they learn the patient as a past medical history of CVA, CHF, and MI.

The patient is cool, pale and diaphoretic.

During a neuro exam paramedics discover right-sided facial palsy and left-sided arm drift.

The patient starts to vomit.

Because they are 50 minutes from the hospital, the paramedics call for aeromedical transport.

The patient's head appears to be atraumatic. She denies recent falls. She denies chest pain or shortness of breath.

Vital signs are assessed.

RR: 24
Pulse: 90
BP: 216/134
SpO2: 98 on oxygen via NRB @ 15 LPM

BGL: 168

A 12-lead ECG is captured.

The patient is more lethargic by the time aeromedical transport arrives although the other neurological symptoms have resolved. She still looks acutely ill.

The patient has vomited a total of six times but stops after being treated with IV Zofran.

Repeat vital signs are assessed.

RR: 20
Pulse: 88
BP: 164/110
SpO2: 99 on oxygen via NRB @ 15 LPM

An additional 12-lead ECG is captured.

What is your impression of this patient?