'Not Like Herself at All' by ProQuest

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									                                Case Review
                                                                                                                                            By James J. Augustine, MD, FACEP



                                 ‘Not Like Herself at All’
                                 A woman’s sudden unusual behavior may have dire origins

                                    The Attack One crew arranged a special lunch for a member who
                                 had to spend his birthday away from his family. After finishing            Initial Assessment
                                 lunch in the restaurant, the crew is waiting for the small cake that     A 64-year-old female acting in an unusual fashion.
                                 will mark the event. But as their waitress approaches the table,         Airway: Intact and uncompromised.
                                 she has no cake in her hands. She asks if one of the crew members        Breathing: No distress.
                                 could step back to the kitchen to help an employee of the bakery
                                                                                                          Circulation: Normal capillary refill, pink skin.
                                 across the street, who had just delivered the cake. The paramedic
                                                                                                          Disability: New and apparently sudden onset of
                                 leaves the table and follows the waitress back to the kitchen area,
                                                                                                          erratic behavior. Patient suddenly became very
                                 where there’s a woman in the employee restroom. The waitress
                                 tells the paramedic, “That lady is just acting strangely—not like
                                                                                                          disoriented, with an erratic speech pattern. She moves
                                 herself at all.” From outside the door, the paramedic can hear           extremities without deficit, and overall is restless,
                                 the woman in the restroom vomiting. Another female restaurant            moving around on the chair and cot.
                                 employee is in there assisting her, and when the vomiting stops,         Exposure of Other Major Problems: Sudden
                                 the paramedic can hear their conversation through the door. The          vomiting.
                                 ill woman makes no sense as she talks to the restaurant worker.          Vital Signs

         “  Any
         delay
                                    The paramedic knocks on the door, identifies himself and asks
                                 if he can help. The restaurant worker invites him in. “This lady,”
                                 she says, “is just not acting like herself at all.” The medic thinks
                                                                                                          Time       HR        BP
                                                                                                          1240 104 180/110 18 98% 92
                                                                                                          1247 100 180/106 20 98%
                                                                                                                                        RR POx BS


                                 it notable that both employees used almost the exact same words.
         would                      The woman has stopped vomiting and now sits restlessly on
                                                                                                          1254 100 174/100 20 97%
                                                                                                          AMPLE Assessment
          have                   the toilet. As the medic interviews her, she intermittently speaks
                                                                                                          Allergies: None.
                                 coherently, then mumbles a few words, then makes no sense at all
      resulted in                before returning to coherence. He asks if she’s diabetic, and she        Medications: None.
                                 says she has no medical problems. She adds she has some pain in          Past Medical History: Intermittent headaches. No
       a terrible                her head, but has a history of headaches.                                history 
								
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