A Day of Saving Lives- Call #2

Call number 2 comes in right after we've gotten back to the station. It's AMS-(altered mental status). It's also in a neighboring fire district because all of their ambulances are tied-up on calls. It takes us 10 minutes to get there lights and sirens. We requested a first responder since it was going to take us so long to get there, Engine 6 responded. We arrived and went into the house.

Walking into the bedroom turned the amped-up nature of the day into slow-motion movie-scene. The patient was someone I KNOW. Not someone I know well, nevertheless, a professional acquaintance. He has called the ER and told a respiratory therapist that he thought he was having a stroke. His wife is there, and she is a nurse. She is giving one helluva report about her husbands recent history related to this event. He has been dizzy off and on since the preceding day. He had a near-syncopal (fainting) episode the day before. Now, for the last 30 minutes he has had an intense headache and slurred speech. He is completely alert but sounds drunk. His blood sugar is normal, his heart looks good on the monitor and his 12-lead is normal. What is puzzling, is his blood pressure, which is 100/60 lying down and 70/40 sitting up with dizziness. Not even remotely typical for stroke patients. He does not have, nor reports having a fever, but I'm left wondering. Could this be an infection of sorts? My inclination, however, is to go with stroke. If I don't take him quickly to the ER and he is having a stroke, he will have lost precious time for clot-buster therapy. We decided to err on the side of caution. We started an IV (at least this patient had veins) of normal saline and PUHA'd (pick-up, haul-ass) to Duke.

The patient is comfortable and completely understands why we are doing what we are doing. He has no other complaints, just this slurring of speech. He may have been scared, but he didn't show it. He was a trooper.

Presented to the same doctor, who later told me the patients CT was clear, and did not suggest a head-bleed or embolism. What he was thinking was encephalitis, which can be treated with antibiotics. A far better diagnosis than a stroke though I haven't heard a follow-up on his condition.