On arrival the patients wife met us at the door crying and severely agitated, near hysterical. She had a land line phone in her hand and gave it to me as soon as I walked in the door. I didn't even know where the patient was yet or what was going on or who I was talking to. I said hello and heard no answer so just set the phone down on the nearest surface.
I rounded the corner into the kitchen and to my surprise the patient was sitting at the kitchen table. To my next surprise I was pretty sure he was dead. He was so pale and lifeless that the first thing I did was check to see if he had rigor to see if I even needed to work this code. He was an even waxier and a paler shade of white than Bono here, if you can imagine that.
As I checked for rigor and felt for a pulse he moved his arm much to my continued surprise. He actually responded a little bit to my voice as well. I looked at his face and he had a profound facial droop. I called to my captain, who was in the other room dealing with the hysterical wife, to find out if my patient had any previous stroke history. He was trying relatively unsuccessfully to get any meaningful medical history from the wife and I got no response.
The firefighter and I got to work assessing vitals, checking blood sugar, getting an ekg, and setting up for oxygenation and IV access. With all of this manipulation and management going on the patient actually became a little more alert.
Within a few minutes the ambulance arrived and as I was giving them my report I noticed that the facial droop was almost gone. His vitals were all pretty good actually although his blood pressure numbers were questionable and would have to be repeated for verification.
We quickly got him moved to the gurney and to the ambulance to do a couple more tests and determine where he would be transported to, depending on whether there was a cardiac component or if he simply needed a stroke center. As the tests were being performed another family member arrived and I was able to determine that my patient had had a mini stroke just a couple months ago and had a couple of stents put in. Definitely good info to have although I already had a good idea of what was going on.
I popped my head back into the ambulance to update the crew on this new information and found that the patient had zero facial droop and was now talking to the medics. He was still pale and hypotensive but was quite a different picture from the deaths door patient I encountered when I walked in.
It is pretty amazing to see the change in patients like diabetics or those with TIAs (transient ischemic attacks or mini strokes) in a very short period of time with some simple interventions. Sometimes it works against us when we try to explain to the ambulance crew or the hospital that this perfectly normal seeming patient was circling the drain just ten minutes ago. No, really, I swear...I thought he was dead. But I guess he got better.
