Early in the morning, an ambulance is requested to a private residence after a colleague has been unable to reach the patient prior to work. When the door is opened by a family member, the patient is found lying in bed and appears significantly unwell. The patient is a 42-year-old male with a known history of type 1 diabetes mellitus. He is drowsy and difficult to engage but responds weakly to verbal stimuli. He appears pale and diaphoretic, with rapid, shallow breathing. A faint sweet odor is noted on his breath. His airway is patent, and he is breathing spontaneously. Respiratory rate is 24 breaths per minute. Heart rate is 110 beats per minute and regular, blood pressure is 115/70 mmHg, and oxygen saturation is 97% on room air. Capillary blood glucose is measured at 28 mmol/L. Further examination reveals no signs of trauma. The patient has dry skin and dry mucous membranes. According to family members, he has experienced nausea, abdominal pain, and reduced oral intake over the past 24 hours. He uses insulin daily, but it is unclear whether he has administered his usual doses during the past day. Questions 1. Which findings in this case suggest diabetic ketoacidosis, and why? 2. Which prehospital interventions should be prioritized to stabilize the patient prior to hospital arrival?

An ambulance is dispatched on a high-priority response following a call from family members reporting a young woman with seizures and decreased level of consciousness. The patient, a 19-year-old female, was last seen awake approximately 30 minutes prior to being found unresponsive at home. Upon arrival, the patient is found lying on the floor in the hallway. She is unconscious and does not respond to verbal commands or painful stimuli. Her airway is patent, and she is breathing spontaneously with apparently adequate ventilation. Respirations are regular. Heart rate is tachycardic at 130 beats per minute, and capillary refill appears normal. Blood glucose is measured at 6.3 mmol/L. The patient has bilaterally dilated pupils. Glasgow Coma Scale is assessed as 3. No signs of trauma are identified, and secondary examination reveals no trauma-related findings. According to the patient’s father, she has a known history of substance misuse, including benzodiazepines, cocaine, and amphetamine. It is unclear what substances she may have taken on this occasion. Estimated transport time to the nearest hospital is 35 minutes. While being observed in the ambulance, the patient experiences another seizure episode. The seizure lasts approximately 30 seconds to one minute and is described as non–tonic-clonic in nature. The seizure resolves spontaneously. During a focused physical examination, the ambulance crew notes discolored nasal secretions, pink in appearance, without visible white powder. Questions 1. Which differential diagnoses should be considered based on the patient’s presentation and history? 2. Which prehospital interventions should be prioritized to ensure patient safety and prevent further deterioration?

An ambulance is dispatched on a high-priority response following a call from family members reporting an elderly male with difficulty breathing and fever. The caller states that the patient has been unwell for several days, with significant deterioration over the past 24 hours. Upon arrival at a private residence, the patient, a 75-year-old male, is found seated and leaning forward in a chair in the living room. He appears fatigued and unwell, coughing frequently and producing yellow sputum. He is warm to the touch and visibly short of breath. The patient is awake and responsive but appears weak. Respiratory effort is increased. Auscultation reveals coarse crackles over the left lung. He appears flushed and diaphoretic. Heart rate is 115 beats per minute, blood pressure is 90/50 mmHg, respiratory rate is 28 breaths per minute, and oxygen saturation is 89% on room air. Body temperature is 38.9 °C. The patient reports cough, fever, increasing shortness of breath, and marked fatigue. He has a known history of chronic obstructive pulmonary disease and uses an inhaled bronchodilator as needed. He has no known allergies and takes no other regular medications. His last oral intake was approximately six hours prior. He reports that his cough and fever have gradually worsened over the past week. The nearest urgent care clinic is 10 minutes away, while a hospital with acute internal medicine services is approximately 30 minutes away. The patient is prepared for transport. Questions 1. Which findings in this case raise suspicion of sepsis, and why? 2. Which interventions should be prioritized in the prehospital setting to reduce the risk of further deterioration? --- Is the administration of antibiotics permitted in the prehospital setting at your workplace?

Hi All, I am a 40-something Intermediate Life Support (ILS) medic based in Cape Town, South Africa. I began volunteering with the Government Ambulance Service in 2004 and qualified as a Basic Life Support (BLS) Medic in 2005. During this time, I continued volunteering on government ambulances while also working ad hoc for private ambulance services. I also volunteered in the Trauma Unit at Red Cross War Memorial Children’s Hospital, where I served for nine years. In 2012, I qualified as an Intermediate Life Support Medic. From 2012 until 2016, I continued volunteering with the Government Ambulance Service, working on both ILS and ALS ambulances. My experience also includes maritime medivac operations, event medical services, film shoots, and fixed-wing aeromedical operations. Beyond pre-hospital emergency care, I have been involved in Search and Rescue operations, serving as both an On-Scene Commander and Communications Officer. I am also a qualified Electrical Technician, Radio Technician, and Access Control Technician. On this platform I am hoping to meet other Medics from around the world and help share my experience and knowledge.

An ambulance is dispatched on a high-priority response following a report of domestic violence. A neighbor has contacted dispatch stating that a 23-year-old female has been stabbed. Law enforcement has been notified and is en route. Upon arrival, the patient is found sitting semi-upright on the kitchen floor of an apartment. She is awake, anxious, and in visible pain. A smaller kitchen knife remains impaled in the left upper quadrant of the abdomen. There is minimal external bleeding, though blood is visible on a towel she is holding against the wound. The patient has a patent airway and is speaking in full sentences. Respiratory effort is slightly increased but unremarkable. She appears pale and mildly diaphoretic. Her heart rate is 110 beats per minute, blood pressure is 105/65 mmHg, and oxygen saturation is 98% on room air. She is fully alert and oriented with a Glasgow Coma Scale score of 15. She reports severe abdominal pain. She has no known allergies, takes no regular medications, and has no significant medical history. Her last oral intake was approximately one hour prior to the incident. She states that she was stabbed with a knife during an argument with her partner. The nearest urgent care facility is 15 minutes away, while a trauma center is approximately 35 minutes away. The patient is prepared for transport with the knife left in place. Questions: 1. What medical and tactical considerations support leaving the impaled knife in place during prehospital care? 2. Which interventions should be prioritized during transport to reduce the risk of patient deterioration? This case is fictional and used as a reflection case. A proposed solution will be published on Friday, January 9.