A 78-year-old long-term-care resident with dementia is brought in by EMS. Her documented baseline is alert to person, conversational, and able to follow simple directions. She has an indwelling Foley for chronic urinary retention placed 30 days ago, recurrent UTIs over the past year, type 2 diabetes, and hypertension controlled on her usual regimen. Today she is difficult to arouse and cannot hold attention, although she is oriented to person only, as usual. Vital signs: BP 86/52, HR 118, RR 24, T 38.9 C with shaking chills, and SpO2 94 percent without dyspnea. There is mottled skin over both knees with capillary refill of 3 seconds, and there is new tenderness above the pubic bone. The drainage bag holds cloudy urine, unchanged for weeks per staff. EMS reported a fingerstick glucose of 164 mg/dL. There is no facial droop or limb weakness.
A 78-year-old long-term-care resident with dementia is brought in by EMS. Her documented baseline is alert to person, conversational, and able to follow simple directions. She has an indwelling Foley for chronic urinary retention placed 30 days ago, recurrent UTIs over the past year, type 2 diabetes, and hypertension controlled on her usual regimen. Today she is difficult to arouse and cannot hold attention, although she is oriented to person only, as usual. Vital signs: BP 86/52, HR 118, RR 24, T 38.9 C with shaking chills, and SpO2 94 percent without dyspnea. There is mottled skin over both knees with capillary refill of 3 seconds, and there is new tenderness above the pubic bone. The drainage bag holds cloudy urine, unchanged for weeks per staff. EMS reported a fingerstick glucose of 164 mg/dL. There is no facial droop or limb weakness.