Agitation, altered mental status


• Scene – vitals, CBG, TT, 12 lead, assess

• En Route – IV, fluids

• Hospital – unk


• Response to treatment – unknown


Elliot Williams, Paramedic Woodburn Ambulance


David Tauber, EMT Editorial Board

David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Altered mental status

Differential Diagnosis

• Anxiety

• Dehydration

• Hypertension (HTN)

• Urinary tract infection (UTI)

• Transient ischemic attack (TIA)

• Acute MI

• Hypoglycemia

• Psychiatric

• Overdose (accidental vs intentional)

Patient Workup History

• Patient states – that she is not sure what is wrong but wanted to be checked out.

• Daughter states – that she is acting normal and her complaints are not out the norm for her; she gets anxious and feels like she needs to go to the hospital.

Physical Exam

• GCS – 15

• EKG- SR with a RBBB

• Physical findings: HTN, dry mouth

Editor’s Notes

This is part of our pilot series for students: initial assessment of real patients in the field. This particular patient has a known history of CVA. The paramedic instructor states later in the clip that he needs the daughter of the patient to help determine what is baseline for this patient vs. potentially new/acute concerns. This would be the primary teaching point for the student. -Dr. David Spiro The first question asked was leading “are you having diff breathing” suggests to pt to complain of something not bothering her. Good to ask pt to smile but finish the other parts of the stroke exam. Great call to find the pts “normal” baseline from a bystander

~ David Tauber, Director of Paramedic Education, Yale New Haven Sponsored Hospital


• Gender: Female

• Age: 71 years

• Height: Not Available


• Temperature: 98.3 F/36.8 C

• Blood Pressure: 211/129

• Heart Rate: 76

• Respiratory Rate: 18

• Pulse Oximetry: 97% RA

Signs and Symptoms

Shaking; anxiety; difficulty breathing; headache; R-sided radiating neck pain and “heavy arm;” dry mouth.

History Medical

• PMH: HTN, diabetes, CVA, anxiety.

• Allergies: None

• Dispatch info: Difficulty breathing, headache, R-sided numbness, dry mouth, dehydration.


• Lives with daughter; not ambulatory.


• Glipizide, amlodipine, hydrocodone, Ativan, metformin, oxybutynin, lisinopril

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