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One of the easiest and most often over looked diagnosis tools is the use of glucometer to check the blood sugar. The other screening info in this question do not rule in or out hypoglycemia.
The Cincinnati stroke scale uses arm drift as a diagnostic tool. Ask the patient to lift both arms up in front of them, close their eyes and watch for an arm to drift downward. If there is a drift downward on one arm then assess for a CVA on that side.
A previous attempt at suicide is highly suggestive of a patient's risk for suicide. This is compounded by the depression, which can exacerbate suicidal feelings and willingness to carry out the act to finality. Persons contemplating suicide typically give possessions away and do not store them. Hostility towards family members in and of itself is not an indication of the potential for suicide. While a diagnosis of medical condition can predispose one to consider suicide, these conditions are generally terminal (e.g., cancer, HIV infection). Hypertension is generally treatable with lifestyle modification and medications.
The clinician should never give any patient who cannot swallow anything by mouth because aspiration is a real risk. A patient with an altered mental status with a blood sugar of 80mg/dl should be given glucose to correct the mental status.
Glucophage is a diabetic medication. You may not be able to identify what type of reaction your patient is having without more diagnostic testing but it puts you looking in the correct direction. The Lipitor may come into play later on in long term care but high cholesterol generally has no effect on mental status the way hypo or hyperglycemia will.
Due to the hyperglycemic state, the kidneys try to diereses the glucose out of the blood stream causing the patient to become more dehydrated. As the blood becomes thicker and thicker, the cardiac output lowers and the heart has to work harder. With the excess glucose and incomplete combustion from other fuel sources, the brain is impaired as if the patient is intoxicated.
A known insulin dependent diabetic with the above symptoms is most likely suffering from hypoglycemia. The tachycardia and diaphoresis is from a catecholamine release trying to mobilize more glucose. This patient may very well have hypertension; it just is not the reason for the unresponsiveness.
Often the first signs and symptoms of diabetes onset is diabetic Ketoacidosis. When there is no fuel (i.e., glucose) for the cells to burn, the cells will burn fat and protein which does not burn clean. The incomplete combustion produces acids which are not cleared. These acids will build up and can be fatal if not treated aggressively. Hypertension and cardiovascular disease are long term complications of diabetes.
Epilepsy is medical condition where the patient often suffers seizures. Tonic-clonic and focal motor are types of seizure activity and a postictal state is the period of time after a seizure where the patient is slow to respond and is possibly unresponsive where the brain is resetting and resting.
Most TIAs will resolve within 15 minutes, however for it to be diagnosed as a TIA all signs and effects must be resolved within 24 hours after onset. TIA's are often the precursor to a major stroke.
Anytime there is a restriction of blood flow, the quicker blood flow is returned the better the results. It is well established that if tPa is infused within three hours of the onset of symptoms, there is a greater chance that all deficits will resolve without lasting effects.
Narcotics will cause pupils to constrict making them the classic pin point. All of the other medications mentioned here do not affect the pupils, even though they may cause an altered mental status.
The second type of cerebral vascular accident is a hemorrhagic stroke, also known as a bleed. Thrombotic and embolic strokes are types of ischemic strokes where the blood flow is stopped by a clot. A transient ischemic attack is most often referred as a mini stroke, a prelude to a full on CVA.
The scene survey can lead to some very important clues as to what might be going on with your patient. Medications for specific medical conditions can lead you in the correct direction. Not only does it give you the patient’s past medical history, but it tells where to start your assessment and investigation of the patient’s signs and symptoms. An unkempt house and smells can provide an indication of a patient’s lifestyle and ability to care for themselves.
"This is the worst headache I have ever had." This statement should not be ignored or considered to the dramatic, it should cause the clinician to modify their assessment to include a hemorrhagic stroke in their differential. All of the other statements do classify the intensity of their headache and may not rule out a stroke, however, the statement of the worst headache should alert you to the possibility of more acute findings.
