Check a glucose early in every altered patient, not only known diabetics.
Before you read
Test yourself first: 4 questions
Question 1 of 4
A 58-year-old with no psychiatric history is suddenly confused, agitated and seeing insects on the walls. After the primary assessment, what should be checked first to find a reversible cause?
Answer: A. New confusion with visual hallucinations in an adult with no psychiatric history is delirium from a medical cause until proven otherwise, and hypoglycemia is the fastest reversible cause to find. Exploring stressors or past counseling is tempting because the behavior looks psychiatric, but it delays finding a treatable medical problem.
Question 2 of 4
A man is shouting, sweating, pulling off his clothes in cold weather, and seems not to feel pain as police hold him. His skin is hot. How should EMS frame this presentation?
Answer: A. Hyperactive delirium with severe agitation, marked by extreme agitation, hyperthermia, sweating, undressing and insensitivity to pain, reflects a medical process, often stimulant use, and can end in sudden cardiac arrest, especially during a struggle. EMS should treat it as a medical emergency and pursue ALS sedation and cooling. Leaving it to law enforcement or calling it simple intoxication delays care.
Question 3 of 4
A combative patient has been physically restrained for transport. Which action matters most for their safety?
Answer: A. Prone restraint of a struggling, acidotic patient restricts chest movement and has caused deaths, so the patient stays face up with airway, breathing, circulation and skin watched the whole way — and a reversible medical cause such as hypoxia, hypoglycemia or head injury is actively looked for rather than assumed absent. A covered face hides the very findings being monitored.
Question 4 of 4
A 79-year-old woman in a care home has become agitated and confused over a day and is pulling at her clothes. Staff report foul-smelling urine. What is the most appropriate interpretation?
Answer: A. An acute change over hours to a day in an older adult is delirium until proven otherwise, and urinary infection is a common trigger that can progress to sepsis. Attributing the change to dementia is the tempting error: dementia progresses over months, and an acute decline always warrants a search for a medical cause, including glucose and vital signs.
Keep the streak going with more questions like these, each with a full rationale.
What is medical & ob/gyn?
It rewards pattern recognition — the discriminating cue that separates two conditions presenting alike — and punishes anchoring, particularly the assumption that an altered patient is simply intoxicated.
Key points to remember
- Check a glucose early in every altered patient, not only known diabetics.
- Anaphylaxis is systemic: airway, circulation, or two or more organ systems.
- Last-known-well time is the single most valuable stroke datum and only you can get it.
- Clear lungs in a breathless patient is a discriminator, not a reassurance.
Field priorities
- Roll a hypotensive late-pregnancy patient onto her left side first.
- Relieve cord pressure and transport for a prolapse.
Coaching the patient
- Saturation can look fine while ventilation fails — trend effort and mentation.
Red flags: act now
- Seizure beyond five minutes
- Fever with neck stiffness and altered mentation
- Rising respiratory rate with falling mental status
Medical & OB/GYN: FAQs
What are the priority actions for Medical & OB/GYN in the field?
Roll a hypotensive late-pregnancy patient onto her left side first. Relieve cord pressure and transport for a prolapse.
What findings in Medical & OB/GYN change your plan or your transport decision?
Seizure beyond five minutes. Fever with neck stiffness and altered mentation. Rising respiratory rate with falling mental status.
What do I need to know about Medical & OB/GYN for the NREMT?
Check a glucose early in every altered patient, not only known diabetics. Anaphylaxis is systemic: airway, circulation, or two or more organ systems. Last-known-well time is the single most valuable stroke datum and only you can get it. Clear lungs in a breathless patient is a discriminator, not a reassurance.
What should the crew communicate or document for Medical & OB/GYN?
Saturation can look fine while ventilation fails — trend effort and mentation.
