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.
一位78歲患有失智症的長期照護機構住民由緊急醫療服務(EMS)送來。她有紀錄的基準線是能辨識人、能對話並能遵循簡單指示。她因慢性尿滯留而留置導尿管(Foley)30天，過去一年有反覆泌尿道感染、第 2 型糖尿病，以及高血壓在常規治療下控制良好。今天她難以喚醒且無法集中注意力，儘管她一如往常地僅能辨識人。生命徵象：血壓86/52、心率118、呼吸頻率24、體溫38.9°C伴寒顫，以及血氧飽和度94%且無呼吸困難。雙膝皮膚斑駁，微血管再充填時間為3秒，且恥骨上方有新的壓痛。引流袋內有混濁尿液，據工作人員稱數週以來未變。EMS報告指尖血糖為164 mg/dL。無臉部下垂或肢體無力。