Looking Past Dementia Reveals Hidden Life Threats

You and your partner just went into service when the radio begins to chirp, “Unit 10, respond Code 3 to Seniorville Nursing Facility for an 85-year-old female with altered mental status.” You kick the truck into gear and are quickly on scene. The patient’s nurse tells you that the patient has been at the facility for three days for rehabilitation after a hip replacement that occurred one week ago. The patient was initially OK, but over the last 24 hours has been anorexic (i.e., not eating), agitated and is refusing to allow healthcare providers to assess her. Her condition has become so severe that they believe she might become a danger to herself if she keeps rejecting care. She has been receiving 5 mg of oxycodone PO (i.e., by mouth) every six hours for pain management along with her regular list of medications. The patient has a history of dementia, hypertension, and hypothyroidism. Her baseline mental status is AAOx3/4, calm and “pleasantly confused.” As you walk into the patient’s room, you notice the patient is laying on her right side, moaning, with her oxygen nasal cannula pushed up over her head. She wails as you approach her, and foggily accuses you of trying to hurt her. She can’t tell you her name or where she is, only that she’s in pain. You introduce yourself and your partner, and feel her wrist for a pulse. Her skin is hot and dry, and her pulse is weak, prolonged and significantly tachycardic. Your partner attempts to get a blood pressure, and ...
Source: JEMS Patient Care - Category: Emergency Medicine Authors: Tags: Exclusive Articles Patient Care Source Type: news