Clinical scenario: A patient found unresponsive by the road

You are dispatched to a report of a male found down on the sidewalk in a suburban neighborhood


Squad 24, ALS Medic 3, respond Priority 1. This will be in front of the residence at 2446 Maple Rd., the homeowner is saying that there is a man who collapsed by the driveway. Patient is currently breathing and has a pulse.

As you pull up on scene, you see three people standing on the sidewalk and a fourth person lying on the grass in front of a home. There doesn't appear to be any obvious threats to your safety and you don’t immediately notice anything which leads you to believe there has been a traumatic mechanism of injury. A man introduces himself as Josh and tells you that he is the homeowner who called 911.

"This is Peter," he tells you motioning the man lying on the lawn. "He lives down the street and usually runs after work. I came out to get the mail and found him lying here. He’s talking, but not making much sense."

What is your initial impression of Peter's presentation? (Photo/Pixabay)
What is your initial impression of Peter's presentation? (Photo/Pixabay)

As you kneel next to Peter, you notice that he has a patent airway and while his breathing is a little shallow, it appears to be adequate. He has a bounding radial pulse and clammy, diaphoretic skin. As you call his name, his eyes flutter open, but he does not look over to you. Your partner takes Peter’s vital signs and gives you the following:

  • BP: 124/66
  • HR: 64
  • RR: 10
  • SpO2: 92% on room air

One of the first responders places Peter on 2 L/min of oxygen by nasal cannula. Shortly after, Peter’s pulse oximetry reading improves to 97 percent, but his level of consciousness remains unchanged. You determine that Peter is stable for the moment and elect to collect more information before transporting.

Now that you have completed a primary assessment and determined that you can remain on scene for the time being, think about what other information you may need to obtain to proceed. To assist with that decision, think about the following questions:

  • What is your initial impression of Peter’s presentation?
  • What other assessment tools might you use?
  • What things would you like to know about Peter’s medical history?
  • What are some creative ways to obtain that history?

Post your answers in the comments and view the solution for this scenario.

About the author

An EMS practitioner for nearly 15 years, Patrick Lickiss is currently located in Grand Rapids, MI. He is interested in education and research and hopes to further the expansion of evidence-based practice in EMS. He is also an avid homebrewer and runner.

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