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
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%
have the toilet. As the medic interviews her, she intermittently speaks
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