THE NARRATIVE ARC

A Kidney Failure Patient in the Emergency Department With Altered Mental Status

Not at all what I expected

SURPRISE! 😅 Photo by Nathan Bingle on Unsplash

I was the ER Doc on duty when the paramedic call came in.

“We’re three minutes out with an elderly male dialysis patient with altered mental status who was found on the floor of his home. His vital signs are stable. His GCS is 9. Blood sugar 80 and oxygen sat 95%. Monitoring and coming in code 3. The patient is noted to have blood in his right ear canal.”

And, as promised, three minutes later the elderly male kidney failure patient on dialysis with altered mental status became my patient.

Now, a little break for decoding.

The fact that his vital signs — the cardinal signs of life like breathing rate, pulse rate and blood pressure — have been checked a time or two and are either stable/normal or close to normal and are not, in the paramedic’s judgment cause for alarm, is reassuring.

The GCS, shorthand for Glasgow Coma Score, of 9 is way too low. Fifteen is normal. More about this in a moment.

The blood sugar of 80 and the oxygen saturation of 95% are normal. A low blood sugar or a sky-high blood sugar or a low oxygen saturation (a measure of how much oxygen is…