The movie was getting to the good part, you know, where the hero comes through an impossible fight at the end and accomplishes his ultimate end goal. We didn’t quite make it that far…

The station alerting opens up, the printer rolls off a “rip and run” indicating a possible stroke. I always like the little narrative that the CAD computer prints off at the end of address information. “You are responding to a 40 year old patient who has apparently suffered a stroke.” Apparently. You like that word, almost like “almost certainly maybe quite possibly,” which is also a ridiculously long but humorous.

This is a different engine company than you are used to working with, but you normally ride with the EMT on this company when he does his ambulance ride times so it seems less unfamiliar. As a matter if fact, you’ve worked with both the EMT and the driver on ambulances before.

The older engine roars to life and eventually gets out the door, winding its way through residential streets. A differential diagnosis list runs through your mind. Symptoms that mimic stroke, diseases that mimic stroke, even past strokes, overdoses, TIA, and other appears. It all depends on the physical exam and past history. Playing detective is the fun part, treatment most often can be handled by technicians.

The engine squeaks to a stop in front of a small house with A LOT of cars outside. You peel out with clipboard and monitor in hand while the EMT grabs your oxygen and the jump bag. You see a large crowd of well dressed people inside. “Well, can’t be all that bad,” you whisper to yourself.

You are greeted by a family member. The patient’s sister she introduces herself as. She begins telling you the story. “We were having a Bible study and kind of a Christmas party. She was complaining of all the stress she’s been under recently and started having a severe headache, then she suddenly passed out.”

“Did she go completely out, or just get weak?” you query, digging for more.

“She got really weak, then was unable to move very much.” You touch the patient, a 47 year old woman, her skin is warm yet strangely diaphoretic. Her pulse is all over the place. By palpation you guess it around 80 or 90. She is able to answer a few questions about her medical history, which includes hypertension and hypercholestemia.

You instruct the EMT to take a capillary blood sugar while you attach the NiBP cuff and ECG leads. The spO2 reads a slightly hypoxic saturation at 92%. There is profound right sided weakness and total paralysis on the left side. No facial droop is noted but her speech is extremely slurred. There is no possibility of drug or alcohol use. The monitor shows a normal sinus rhythm slowing into a bradycardia, then back up again. “Weird.”

The blood sugar comes back as 97 mg/dL, and the NiBP is unable to capture a blood pressure. You have other priorities. The patient is now coughing up a pink frothy sputum. The corwd inside surprisingly stayed around to watch you and your team administer care. “Lieutenant, we need to clear the room. This is starting to not go so well.” you whisper to the company officer, who turns around to start moving people away from the now more complicated scene and herds them into another room.

The diaphoretic skin is not holding the ECG leads, but this is only a passing thought as both you and your EMT both start IV’s, one in each arm, and secure them with a layer of tape over the commercial dressing.

You hear the front door open and the sound of aluminum strike aluminum. The ambulance crew carrying a cot through the doorway is a relief…


Category: Case Studies

About the Author

Russell Stine is a firefighter/paramedic in a large urban system. He has been employed for 6 years as a street level provider and has delivered care as an EMT and a paramedic across the urban, suburban, and rural settings. He has been in emergency services for 15 years.


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