Here's a great case submitted by "Phil"… As usual, some details have been changed to preserve patient confidentiality.
It's 9 am, and you and your partner are called to an apartment complex for a 46 year old female, injuries from a fall which occurred the previous night. You arrive to find the woman seated in a chair, in some obvious distress. She appears pale and diaphoretic. You ask about the incident, and she tells you that at 11pm last night, she lost her footing on the stairs and fell, bruising her arms and shoulders. She denies hitting her head or any LOC, but is unsure how many stairs she fell down. She considered her injuries "minor".
You ask why she called this morning, and she tells you that her arms and shoulders are still sore, and she awoke at 8am feeling "very weak and sick", with nausea and one episode of vomiting. Your physical exam reveals only minor bruising, although her pulse feels a bit slow. She denies any chest pain or shortness of breath.
Her history is significant for Asthma and Type 1 Diabetes.
Her vitals are as follows:
- HR: 60, weak
- BP: 96/P
- RR: 22, just a bit of increased effort
- skin: cool and diaphoretic
- SpO2: 98% RA, 100% on supplemental O2
- BGL: 423 mg/dl
Meds: Albuterol, Insulin
You put her on the monitor, and acquire a 12 lead:
The patient vomits again, as you begin transport… Enroute, you capture another 12 lead:
12 Lead with V4R has been added:
What do you think is going on with this patient?
How would you treat her?