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EMSWORLD.com | APRIL 2016 31 O n a hot summer afternoon, an ambulance is dispatched to a park to evaluate a patient complaining of weak- ness. The EMS crew finds an adult male sitting on the grass next to a shopping cart filled with miscellaneous items. The on-scene police officer reports that the patient is cooperative and appears to be alert but slightly confused. The EMS crew approaches the patient and begins their assess- ment. The patient says he did not sleep well the prior night, doesn't think he has eaten since yesterday, and feels very weak. He men- tions he has been in the sun all day. The EMS crew finds his skin warm and dry to the touch, with his heart rate slightly elevated. He is wearing a coat, several long-sleeve shirts and pants with boots, despite the temperature and humidity. The patient appears to have been sweating earlier. The assessment reveals the patient is alert and oriented to person; he is confused about the year and can't remember the name of the park. His identification card indicates he is 85 years old, has a history of heart problems and is allergic to "some medications." An empty nitroglycerin bottle is found in his pocket. His primary complaint is generalized weakness. He doesn't think he has sustained any recent trauma and denies having chest pain, shortness of breath, nausea, vomiting or diarrhea. He reported sharing "some drinks and some smokes" with a friend the night before. He also states he has been sitting in the park "most of the day." With the patient sitting, the providers take an initial set of vital signs. His respiratory rate is 20 with clear lung sounds, no obvious signs of distress, regular heart rate of about 102 and blood pressure of 112/80. No jugular vein distention or peripheral edema are noted. Prior to moving him, the crew assesses the patient for orthostatic vital signs. After having him stand from a sitting position, the EMS crew reassesses his vital signs. The patient's heart rate is now 122, blood pressure 102/70 and he has a slightly labored respiratory rate of 26. The patient states that he feels dizzy as the EMS crew helps him sit on the stretcher. The patient asks someone to move his cart behind a bush so he can get it when he comes back to the park. After moving the patient to the ambulance, the crew checks the patient's blood glucose and applies the EKG monitor. The blood glucose reading is 48 and the EKG shows a sinus tachycardia at 108. His blood pressure has risen to 118/78 and respirations are 20 with clear lung sounds. The patient says he still feels weak and tired. The EMS crew establishes intravenous access, initiates a 750-cc bolus of normal saline and administers 25 grams of dextrose intravenously. The patient is assessed and observed in the emergency depart- ment for 6 hours with no subsequent nausea or vomiting. Repeat orthostatic vital signs improve, as do the symptoms of weakness. The patient is diagnosed with a hypoglycemic episode and dehydra- tion and is discharged. Introduction Homeless individuals, including adults and children, can be found in any community. 1–4 EMS providers will likely respond to and care for a homeless individual at some point during their career. Due to this potential, providers should be aware of the unique challenges and more common medical conditions the homeless patient may present. EMERGENCY MEDICAL SCIENCE Paramedic Certifi cation (Hybrid Program) Fully CAAHEP Accredited Hybrid Paramedic program offered through LCC Continuing Education Department. Only four on-site visits required for skills training and evaluations. All coursework is done online. Tuition is $360. Clinicals can be completed in your area. Contact LCC regarding available areas. Different course options that allow currently credentialed EMTs, AEMTs, or individuals with no certifi cation to train for their Paramedic certifi cation. Graduates are eligible for the NCOEMS Paramedic exam and the National Registry Paramedic exam. Associate Degree in Emergency Medical Science — Bridging All degree classes offered 100% online. Currently credentialed state and national Paramedics earn up to 45 credits toward their degree just for being certifi ed! Designed for demanding EMS work schedules. Complete the degree at your own pace! Earn Your Degree Online! 231 Hwy. 58 South, Kinston, NC www.lenoircc.edu (252) 527-6223, ext. 115 jgtilghman38@lenoircc.edu For More Information Circle 26 on Reader Service Card