Dispatch: Welfare check on a 59 yo M, earlier unit got a ref | Figure 1

Synapse10

Paramedic

Dispatch: Welfare check on a 59 yo M, earlier unit got a refusal, but daughter still insisting something’s wrong.

Late morning. Doors were locked and police had to gain entry, the daughter lived far away and the brother couldn’t be reached.

The male was cold, damp, asystolic with lividity present, a moderately obese man lying next to his bed in his pajamas. He looked like he’d slid off the bed, no sign of injury or foul play. On the nightstand was a cell phone with numerous calls from an out-of-town area code.

Medications were in the kitchen, along with a pill organizer (yesterday’s pills taken), and notes on his blood sugar and blood pressures. He was a hypertensive insulin-dependent diabetic with gout. On the table was also an envelope of paperwork from a funeral home with the deceased’s surname on it.

I perused the family photos... Graduation pictures of his daughter... Near the photos, the deceased’s wife rested in a dusty urn on a shelf.

“Where’s the patient copy of the refusal from the last unit? What kind of blood sugar did they get?” I wonder out loud.

I walk outside again. Stuffed in the mailbox on the porch was the crumpled document. The crew forgot to hand it to the patient, so they came back and put it in the mailbox.

Reading the refusal, I realized something wasn’t right.

Similar cases

Here we have a 46-year-old male coming in complaining of pain in his toe and top foot. He is diabetic does not take his insulin regularly. Sugar levels were very high when he got to the ER, treated him for his high sugar level levels with insulin. Glucose was 357 and 4 cc were given for insulin. x-ray was given and found to not be able to rule out infection of bone so MRI was done and no infection was found in the MRI. Patient was admitted and given IV antibiotics. Blood pressure was elevated, but is normal now.

Do anyone see this being an amputee case? Patient has been dealing this with for about a month and finally was seen. Cleanout was advised but worried about diabetes being an issue for Complete healing.

I was at work this evening and had a patient with DM controlled with insulin. Daily they take Lantus 16 units in the morning and then Apidra 7u with meals. This evening their BG was 81 and they refused their apidra, also, prior to being seen by the endocrinologist there were parameters in the apidra - hold of BG less than 90. So that being said I faxed the endocrinologist and asked them if they would like to reinstate the parameters of the apidra, and also made them aware she refused her dinner dose. His response was that she should still get it (yes, but she refused) and then he stated that if her BG is less than 80 to give her 15g of sugar and then give her her apidra dose. Is this common practice to bump up a diabetic just to give them insulin? And if so, why? Her BG at HS was 188 even without the dinner apidra. Just curious why she should be given sugar just to get insulin. Thoughts?

29 yo Male with a PMH of IDDM, BIBA to the ED in cardiac arrest. ROSC after 20 min. As per wife pt refused to check his blood sugar or take insulin for the last 3 days. Pt was complaining of thirst before LOC.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.

He had a history of hypertension, long-term smoking, and a sedentary lifestyle.

On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.

Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?