Figure 1

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88 YO M called for unresponsive and vomiting. Past medical hx of CVA and currently on warfarin. Last seen normal around 1100-1130 and we were called around 1300. Pt was completely unresponsive to painful stimuli and his last BP at the hospital read 263/139. He was RSIed once at the hospital and taken to CT to find this. His nurse stated they were going to try to keep his pressure around 180 systolic to prevent cutting off complete blood supply to his brain, reverse the warfarin, and hope that he stops bleeding.

Similar cases

26 y/o male found unresponsive by roommate at around 12:00 pm. Roommate last saw him at 2:30 am. Upon arrival, find patient laying supine on living room floor of his apartment and was pale and cyanotic and breathing at 3 times per minute. ORA SpO2 was 14. Pupils were reactive and at 2mm. Pt ventilated via BVM and OPA and SpO2 improved to 100. Line started and pt given all together 2 mg of Narcan via IV. Pt began to breath better and w/o O2 his SpO2 stayed at 100, but his GCS was 7 (1,2,4)at this point. BGL was 56. Pt given 1 amp of D50 and BGL improved to 82. Roommate said that they were out drinking last night and they did a line of cocaine. EKG was done at the hospital and flagged STEMI but not called due to hyperkalemia.

approx 50 y.o. Male pt. family called EMS after he fell off of toilet and couldn't get up. On arrival pt was very lethargic with ams. In route to hospital, put began vomiting and became unresponsive. Pt was intubated and transferred to stroke center. Pt expired 36 hrs later.

82 y/o male, wife called 911 due to pt. going ''unconscious'' at home. EMS arrived on scene (ALS crew) found pt. to be in the living room in a hospital bed lying in semi fowlers position. Wife shares pt. just got home from being admitted to hospital x 6 weeks for ''swollen legs''. Pt. was A/O to verbal stimuli. He appeared lethargic and his eyes were closed while walking toward him. He would not open his eyes when answering yes or no questions on introduction but still answered basic questions slowly. GCS was 14 (E=3 V=5 M=6). A-patent, B-regular, shallow around 12 bpm, C-unable to palpate radial pulses, carotid was weak, brady and regular. Skin was clammy and he was pale. Note pt. was wearing a depend for incontinence issues. Vitals obtained- BP 57/34 (auscultated 58/32) similar in L and R arms. HR was 55, regular on 4 lead ECG. SATS 88% on 2LPM 02 via NC, RR 12, Temp 36.8, BGL was 14.0. Pt. was a negative COVID screen. Lungs were clear x 4 fields. No swelling or edema noted in legs. Pt. able to follow basic CNS commands w/ grips and push/pull in extremities. Good CMS noted as well. Hx- High cholesterol, HTN, CHF (EF of 28%) possible hx of a-fib as well, wife was a poor historian. DNR in place. Meds- Lipitor, Propranolol, ASA NKA 4 lead was sinus bradycardia @ 55. 12 lead was the same but noted inverted T waves in V1-V4 leads (possible ventricular ischemia?) Wife shares she called 911 because pt. went unconscious for about a minute x 1 episode and wouldn't respond to her at all. Wife also explains that pt. was told he may have lung Ca w/ mets to the bone while admitted to the hospital however they have not officially diagnosed him as of yet and he is awaiting more tests.

Further Notes

  1. What are some working diagnosis that come to mind?
  2. What are some prehospital treatments that should be done?