Clinical scenario: Man down
A homeless male is found lying on the sidewalk — what’s your treatment plan?
By Patrick Lickiss
Editor's Note: Post your diagnosis in the comment section below, and the person with the best answer will receive one of our exclusive EMS1 Challenge Coins!
“Medic 7, pre-alert. Respond to the bottom of the Interstate 176 overpass above 5th St. We’re on with the caller now, more to follow.”
Before hearing anything else, you and your partner both have a good idea of what you’re responding to. This overpass is frequently used during the winter by the area’s homeless population to keep warm. The weather has been cold, in the 20s at night, and call volume for transient patients has increased.
“Medic 7, an update. Caller reports an approximately 50-year-old male lying on the sidewalk along 5th St. Caller is no longer on scene. This will be a Priority 2 response.”
You are flagged down by two men standing near a third lying on the sidewalk. All three are dressed in multiple layers. You slip on your jacket and hat and step out of the ambulance. Your partner grabs the jump bag from the vehicle as you walk up. “What seems to be the problem today?” you ask.
One of the men standing replies “George is pretty sick; he’s weak and can’t walk.”
You kneel down next to the patient and introduce yourself. George makes and maintains eye contact following verbal stimulus. Although he seems lethargic, he is able to answer your questions. He reports a recent upper respiratory infection and confirms that he has been feeling weak. He has had increasing pain in both legs for several days as well.
George reports a history of hypertension and diabetes. He does not regularly take medications for either. His blood pressure is 152/98, pulse is 116 and respiratory rate is 22. The pulse oximeter is unable to measure a reading.
Your partner brings over the stretcher and you lift George onto it. As you wheel it to the waiting ambulance, ask yourself:
What is your working diagnosis?
What treatment options are you considering?
Does the fact that your patient is homeless present any special challenges during assessment and treatment?
Let us know in the comments, and stay tuned for the conclusion of the case next week.