NREMT Paramedic Cognitive ExamMedicalEasy
A 72-year-old female resident of a nursing home is found by staff to be lethargic, disoriented, and has a temperature of 100.8°F (38.2°C) with a history of recent indwelling urinary catheter placement. Her blood pressure is 90/58 mmHg, heart rate 110 bpm, respiratory rate 24 bpm. Her skin is warm and flushed. Which of the following conditions should the paramedic most suspect?
- AStroke.
- BAcute myocardial infarction.
- CSepsis.
- DDehydration.
Show answer & explanationAnswer & explanation
Correct answer: C. Sepsis.
The patient's presentation, including altered mental status, fever, tachycardia, hypotension, and a history of indwelling urinary catheter (a risk factor for infection), is highly suggestive of sepsis. Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. In the elderly, altered mental status can be a primary sign.
Why the other options are wrong
- A. While altered mental status can occur with stroke, the fever, tachycardia, hypotension, and warm, flushed skin are not typical primary stroke symptoms.
- B. While possible, the systemic signs of infection (fever, catheter history) and warm, flushed skin make sepsis a more likely primary diagnosis than AMI.
- D. Dehydration can cause some similar symptoms (hypotension, tachycardia), but the fever and warm, flushed skin, along with the catheter history, point more strongly to an infection leading to sepsis.
Sepsis in the Elderly
A life-threatening condition caused by the body's overwhelming response to an infection, leading to organ dysfunction. In elderly patients, atypical presentations like altered mental status may be prominent.
- Often presents with subtle or atypical signs (e.g., confusion, weakness) in the elderly.
- Common sources of infection include urinary tract, pneumonia, skin.
- Early recognition and aggressive management (fluid, antibiotics) are critical.
Memory trick: Elderly Sepsis: Slow Onset, Confused Mind, Infection Signs.