One sunny afternoon in August, I was on what seemed to be a routine call. We were dispatched to a nursing home for a patient who was going to a doctor’s appointment. When we arrived, the nurse at the front desk directed us to the patient’s room. I knocked on the door and I was surprised to see no one in the bed. Confused, I called her by her last name and continued to walk towards her bed. Scanning the room, I then saw a pair of legs in blue pajamas on the ground by the window. After I had rounded the corner, I bent down and introduced myself to the elderly woman sitting against her nightstand with her face turned towards her right side. She turned her head slightly towards me and made eye contact. I shook her left hand and asked her what her name is. While I did this, I used my right hand to palpate a radial pulse. At this time, I knew she was awake, had a pulse, could respond to verbal stimuli, she had some active range of motion in the neck and left arm, she knew her name, and her skin was warm, dry, and pink in her left extremity.
I asked her a few questions to get an idea of what had happened and what her orientation was. When she answered my questions, her responses did not make a whole lot of sense. I took note of this and asked my partner to see if he can gather any information from the primary nurse. I was perplexed as to why she was on the ground. Her bed was not in the lowest position, so I was concerned that she had fallen out of bed. Then, I did a primary assessment on her. She was breathing independently with equal rise and fall of the chest and clear bilateral lung sounds. She was also able to complete sentences without gasping for air and she did not have a cough. After this, I palpated her from head to toe to check for bleeding, fractures, or any other abnormalities. For instance, I looked at her pupils, I looked for signs of incontinence, and I checked her bilateral strength. In this assessment, I did take note that her right side seemed to be weaker when I asked her to squeeze my finger.
I quickly realized that there was something else going on. I asked her to smile and noticed that the right side of her mouth was drooping slightly. My partner had thankfully walked into the room with the nurse at this time. I asked the nurse how long the patient had been on the ground like this. The nurse looked at me with a concerned look on her face and stated, “About four hours, why?”. For a brief moment, I was in disbelief and chills ran down my arms. I asked her when the patient was last seen “normal”. She said that she seemed normal before her fall. I immediately requested that we get her onto the stretcher and to the nearest hospital as fast as we can.
In the ambulance, I performed a Glasgow Coma Scale, took her vital signs, applied oxygen, and had the head of bed at 30 degrees. I had notified the Emergency room of the situation and they were preparing for our arrival in five minutes. I took a look at her face sheet to see if I could find any history of a stroke, TIA, clotting or bleeding problems, diabetes, or any pertinent medications. Upon our arrival to the hospital, I was approached by several medical staff. I gave them my report and I was out of the Emergency room before I knew it.
That day is a constant reminder to me that you always have to be prepared for anything. This experience has also taught me that responsibilities like hourly rounds, is simple, but vital. I do not want to miss something that could have been prevented. I have also grown to learn just how important patient satisfaction and comfort are. Even the seemingly smaller tasks, like getting someone ice cream or an extra blanket, can make a huge difference in a patient’s experience. I know that there may not always be enough time or resources, but I do want to try my best to help and advocate for them. Even though something may not seem obvious at first, I have to stay curious and trust my intuition.