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 Case
#27 Prison Breakout
As you begin your shift, a guard with a
prisoner, watch as you go by. The guard asks
impatiently: ‘Hey Doc, we been here for two
hours, can you check this guy out and get
him shipped back to jail? I’m off shift in
30 minutes, and I need a replacement if we
have to wait much longer”.
You grab his chart (behind the next in
queue) and get more history.
Patient is a 32 y/o male, with history of
chronic renal failure, dialysis Monday,
Wednesday, and Friday (today is Tuesday). He
also has a history of Hypertension (causing
the renal failure). He was supposed to help
in the kitchen today, but complained he was
too weak to work. The nurse looked in on him
and tried to get him to work, but he
wouldn’t walk very far before sitting on the
ground complaining he was too weak to walk.
The nurse then sent him to the hospital.
Patient states weakness is all over, legs
slightly more than arms. This has never
happened before, just started this A.M., and
he has no idea what it is from. His dialysis
yesterday was uneventful, and the prison
gives him all his medications.
ROS: No fevers, no cough, no SOB, no nausea,
no vomiting, no diarrhea, no rashes. No
recent travel.
PMH: HTN, CRF/dialysis
SH: Smoker (when he has cigarettes), past
drug abuser
FH: Unremarkable
PE: 160/88, HR = 92, RR=20, afebrile. Sat
(RA)=96
HEENT: Unremarkable
Heart: RRR, no murmurs, no gallop
Lungs: Clear bilaterally, no rales
Abd soft, muscular, non-tender
Ext: No rashes, nl tone, strength 4/5 all
extremities. Reflex’s 2+ and normal.
Gait: Patient would take a few steps then
complain and grab the gurney to lie down
again.
1. What is the first concern you need to
have, and what do you need to do?
2. Should you move him from the hallway? Or
can you start the work up there?
3. Is his condition life threatening?
4. If your suspicions are confirmed, how
would you treat?
5. At what level should you treat?
Click here for answers and to respond
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Previous Articles
Pediatric (04/23/08)
Medical Emergency (04/14/08)
Pulmonary (04/08/08)
Neurologic (04/01/08)
Medical Emergency (03/23/08)
Cardiovascular (03/19/08)
Renal (03/12/08)
Pediatric (03/04/08)
Cardiovascular (02/26/08)
Gastrointestinal (02/19/08)
Pediatric (02/11/08)
Trauma (02/06/08)
Pulmonary (01/29/08)
Pediatric (01/22/08)
Neurologic (01/014/08)
Cardiovascular (01/07/08)
Cardiovascular (01/01/08)
Renal (12/26/07)
Cardiovascular (12/19/07)
Pediatric (12/12/07)
Neurologic (12/05/07)
Trauma (11/27/07)
Trauma (11/20/07)
Neurologic (11/13/07)
Pediatric (11/12/07)
Cardiovascular (10/29/07)
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