While we're holding him, I get another lady next door-called in EMS as an overdose. She is screaming and kicking the EMTs- we have to put on limb restraints before we can even move her from the stretcher to the bed. No medical history they're aware of other than some unidentified chronic pain that she's seeing a pain management specialist for. Her husband gets there and tells us it's happened before-she tends to take too much of her pain meds. He gives us her meds and she's taking 40 mgs of Oxymorphone a day and then Dilaudid for breakthrough pain. Holy shit. That pretty well explains it. We do an EKG and I bring the chart to the doctors- we've started a catheter and sent blood, but kind of as an afterthought I think, "Oh, well, we know what this is but I better do a blood sugar." Yeah, It's 37. WOW. I ask her husband- "Does she have Diabetes?" Yeah? Great. I run and grab some D50- as soon as I give it, the lady sits up, looks at me, smiles and says hi, as if this is the first time we have met. I guess for her, it was. She was pretty much totally normal after that. I got the whole story as I took care of her- apparently, she passed out about 5 hours before her husband called EMS. She had just taken her Dilaudid and Insulin and hadn't eaten. Her husband thought it was just the pain pills and planned on letting her sleep it off- when she didn't come around after several hours he decided to call EMS. Luckily, she did great and we discharged her- after a long talk about taking your pain medicine and Insulin with food.
I'm hoping this stuff will start making me think in terms of diagnostics a little differently. It's won't assume it's either this or that, but that it's all of the above until completely proven otherwise.