Case Presentation: Chief Complaint
A 67-year-old male is transported via ambulance from a primary care clinic to the nearest
emergency room (ER) with a severely elevated blood pressure of228/120 mmHg accompanied
by confusion.
The emergency medical responders report that the patient has a long-standing history of
uncontrolled hypertension (HTN), type 2 diabetes mellitus(DM), and hypercholesterolemia. He
was seen by his primary care nurse practitioner(NP) who noted the patient had an elevated blood
pressure of230/120 associated with acute confusion. An ambulance was called to transport the patient to the nearest ER.
General Survey
The patient’s vital signs, on admission to the ER are: blood pressure 228/1 I 6 mm Hg, heart rate 78 beats per minute(bpm), normal sinus rhythm on the monitor, a respiratory rate of 18/ min, and a room air oxygen saturation of 96%. He is lethargic but easily arousable, disoriented to time and place and therefore unable to give a reliable history. Further data will be gathered from his wife and electronic medical record(EMR).
History of Present Illness
The patient’s wife denies that the patient experienced weakness, paresis, or paralysis of extremities, dysarthria, aphasia, or other signs that may indicate a stroke, but notes that the patient started crying “strangely” at approximately 8pm the night before admission. This morning, he was confused about the day and year, and forgot many of the details about his daughter’s recent wedding. She was concerned so took him by taxi to the primary care office, where the NP called 911. She reports there is no recent history of falls or trauma, or substance abuse. She endorses that the patient has hypertension and diabetes, as reported by the primary NP, and denies any history of cancer or heart disease. She also reports that he stopped taking his blood pressure medications approximately 6 months ago because they caused excessive fatigue. She is unsure if he is taking his other prescribed medications.
Past Medical History