{"id":805,"date":"2020-10-16T10:54:36","date_gmt":"2020-10-16T17:54:36","guid":{"rendered":"https:\/\/dhs.lacounty.gov\/emergency-medical-services-agency\/?page_id=805"},"modified":"2025-11-12T15:00:31","modified_gmt":"2025-11-12T23:00:31","slug":"case-092025","status":"publish","type":"page","link":"https:\/\/dhs.lacounty.gov\/emergency-medical-services-agency\/home\/emergi-press\/case-092025\/","title":{"rendered":"Cases from the Field &#8211; September\/October 2025 Edition"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_column_text css=&#8221;&#8221;]<strong>CASE OF THE MONTH \u2013 September\/October 2025<\/strong><\/p>\n<p><strong>Case Presentation:<\/strong><\/p>\n<p>DISPATCH INFO\/COMPLAINT: 58-year-old male, Altered mental status SCENE INFO: Responding to a private home, you find a man seated in a recliner in his living room next to a large machine with multiple bags of fluid hanging. The machine is beeping. A small dog is seated nearby and playfully approaches the EMS crew. A middle-aged woman in the room identifies herself as the patient\u2019s wife.<\/p>\n<p>ASSESSMENT: The patient is diaphoretic, skin cool to touch. He opens his eyes and looks at you but is not answering questions appropriately. He is slurring his words. His breath sounds are clear to auscultation and his pupils appear normal and reactive. There are two blood-filled tubes running from the machine to what appears to be a fistula in his left arm. A blood pressure cuff remains attached to his right arm (which you remove and replace with your own equipment).<\/p>\n<p>VITAL SIGNS: HR 117, BP 98\/54, RR 24, SpO2 92%<\/p>\n<p>HISTORY: The woman says that your patient became suddenly confused and began slurring his words during his most recent dialysis session. The patient has a history of end-stage renal disease (ESRD), diabetes and hypertension. He has been on home hemodialysis for one year. In response to your specific questions, the woman reports that the patient has no known allergies and provides a list of medications including: Atorvastatin, Sevelamer, Insulin Glargine, Insulin Lispro, Metformin, and Nifedipine.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_tta_accordion active_section=&#8221;0&#8243; collapsible_all=&#8221;true&#8221;][vc_tta_section title=&#8221;1. What additional questions would you want to ask?&#8221; tab_id=&#8221;1602845351812-84beeeb0-6329&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"252\"><strong>EMS Question<\/strong><\/td>\n<td width=\"372\"><strong>The Wife\u2019s Answer<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"252\">\n<p style=\"text-align: left\">What is the patient\u2019s dialysis history?<\/p>\n<\/td>\n<td width=\"372\">\n<p style=\"text-align: left\">Dialysis for the past 5 years, now on home hemodialysis for 1 year. Typically performs home dialysis Monday, Wednesday, Friday, and Sunday<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"252\">\n<p style=\"text-align: left\">Has he missed any sessions recently?<\/p>\n<\/td>\n<td width=\"372\">\n<p style=\"text-align: left\">Missed his last session due to a machine malfunction.<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"252\">\n<p style=\"text-align: left\">How far into today\u2019s dialysis session is he?<\/p>\n<\/td>\n<td width=\"372\">\n<p style=\"text-align: left\">The patient was about halfway into his session (about 2 hours were completed of a 3.5 hour session).<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"252\">\n<p style=\"text-align: left\">Have any alarms gone off during the session?<\/p>\n<\/td>\n<td width=\"372\">\n<p style=\"text-align: left\">The caretaker heard an alarm earlier but was in the other room and didn\u2019t check the tablet before the alarm stopped.<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;2. Coming to a Provider Impression and Treat Protocol CASE UPDATE&#8221; tab_id=&#8221;1602845351841-ddf4b5e4-9e51&#8243;][vc_column_text css=&#8221;&#8221;]After your initial evaluation, some Provider Impressions that you might consider include:<\/p>\n<ul>\n<li>Alcohol Intoxication<\/li>\n<li>Allergic Reaction<\/li>\n<li>ALOC<\/li>\n<li>Behavioral\/Psychiatric<\/li>\n<li>Carbon Monoxide<\/li>\n<li>Cardiac Dysrhythmia<\/li>\n<li>Chest Pain &#8211; Suspected Cardiac\/STEMI<\/li>\n<li>Fever<\/li>\n<li>Hyperglycemia<\/li>\n<li>Hypoglycemia<\/li>\n<li>Overdose\/Poisoning\/Ingestion<\/li>\n<li>Seizure \u2013 Postictal<\/li>\n<li>Sepsis<\/li>\n<li>Shock<\/li>\n<li>Stroke<\/li>\n<\/ul>\n<p>All the above listed Provider Impressions could be considered in this patient\u2019s presentation. This patient has sudden onset ALOC with abnormal vital signs for an elderly person, including tachycardia, relative hypotension, tachypnea, and hypoxia. His history of ESRD on dialysis also indicates that he is at higher risk for several other conditions, such as spontaneous intracranial bleeding. More evaluation is necessary to hone down to a smaller list of potential Provider Impressions.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;3. What are the next crucial key steps in evaluating\/managing this patient?&#8221; tab_id=&#8221;1602845458608-4656e5d1-9196&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<ul>\n<li><strong>Check a blood glucose level<\/strong><\/li>\n<li><strong>Perform an mLAPSS evaluation<\/strong><\/li>\n<li>Place the patient in spinal motion restriction<\/li>\n<li>Place IV access alongside the fistula<\/li>\n<li><strong>Obtain a 12-lead ECG<\/strong><\/li>\n<li>Administer Narcan<\/li>\n<\/ul>\n<p><em><u>Explanation:<\/u><\/em> The correct answers are bolded above. Assessing blood glucose level, mLAPSS, level of alertness (GCS), and the ECG will assist you in modifying your differential diagnosis for this patient\u2019s presentation while identifying immediate time-sensitive life-threatening etiologies such as hyperkalemia, stroke, and hypoglycemia. There is no evidence of traumatic injury requiring a C-Collar or other SMR. Narcan is indicated for opioid overdose with respiratory depression. Although this patient is hypoxic, his attempts to answer, his tachypnea, and normal pupil exam argue against severe opiate intoxication.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;4. Initiating Management&#8221; tab_id=&#8221;1602845506298-e73a1eec-def6&#8243;][vc_column_text css=&#8221;&#8221;]This patient should initially be managed with TP 1201 \u2013 Assessment and TP 1202 \u2013 General Medical while you try to determine a Provider Impression.<\/p>\n<p>The following are your assessments &amp; treatments:<\/p>\n<ul>\n<li>SpO2 92% on room air &#8211; you start the patient on O2 via NC.<\/li>\n<li>Fingerstick blood glucose is 98<\/li>\n<li>No obvious asymmetry\/unilateral weakness &#8211; you determine mLAPSS as negative.<\/li>\n<li>12-lead ECG: sinus tachycardia, no ST elevations or peaked T waves, QRS intervals &lt;3 boxes (&lt;0.10)<\/li>\n<li>GCS to be E4-V4-M6 = Total of\u00a014<\/li>\n<li>With direct questioning, the patient\u2019s wife denies that patient has history\u00a0of drug or significant alcohol use or of psychiatric illness. She denies the presence of any drugs in the home. She denies any symptoms for herself, including headache (as you might see if the ALOC is due to CO exposure).<\/li>\n<\/ul>\n<p>This narrows the list of possible Provider Impressions for this patient, as shown here.<\/p>\n<ul>\n<li><span style=\"text-decoration: line-through\">Alcohol Intoxication<\/span><\/li>\n<li>Allergic Reaction<\/li>\n<li>ALOC<\/li>\n<li><span style=\"text-decoration: line-through\">Behavioral\/Psychiatric<\/span><\/li>\n<li><span style=\"text-decoration: line-through\">Carbon Monoxide<\/span><\/li>\n<li><span style=\"text-decoration: line-through\">Cardiac Dysrhythmia<\/span><\/li>\n<li><span style=\"text-decoration: line-through\">Chest Pain \u2013 STEMI<\/span><\/li>\n<li><span style=\"text-decoration: line-through\">Fever<\/span><\/li>\n<li><span style=\"text-decoration: line-through\">Hyperglycemia<\/span><\/li>\n<li><span style=\"text-decoration: line-through\">Hypoglycemia<\/span><\/li>\n<li>Overdose\/Poisoning \/Ingestion<\/li>\n<li>Seizure \u2013 Postictal<\/li>\n<li>Sepsis<\/li>\n<li>Shock<\/li>\n<li>Stroke \u2013 less likely<\/li>\n<\/ul>\n<p>With this narrowed list of potential Provider Impressions, you decide to pursue a Provider Impression of ALOC and use <a href=\"https:\/\/file.lacounty.gov\/SDSInter\/dhs\/1040408_1229ALOC2018-04-25.pdf\">TP 1229 \u2013 Altered Level of Consciousness<\/a> for treatment. For altered mental status in <em>this<\/em> patient, there can be a wide range of pathologies including:<\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>Seizure<\/li>\n<li>Hyperkalemia<\/li>\n<li>Hypoxia<\/li>\n<li>Overdose<\/li>\n<li>Uremia<\/li>\n<li>Tumor<\/li>\n<li>Sepsis\/Septic shock<\/li>\n<li>Air Embolism<\/li>\n<li>Stroke<\/li>\n<li>Subarachnoid Hemorrhage<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>While all the listed pathologies are possible for this patient with abrupt altered mental status, given his past medical history of ESRD, uremia and hyperkalemia should be heavily considered. He has missed his last dialysis session, and the accumulation of toxic metabolites may result in altered mental status known as uremic encephalopathy. Additionally, given the abrupt onset during dialysis, machine failures or dialysis related complications such as sepsis (risks for blood stream infections) and air embolism should be strongly considered.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;5. The Case Continues&#8221; tab_id=&#8221;1602845544416-458eea54-abe5&#8243;][vc_column_text css=&#8221;&#8221;]You realize the patient is still plugged into the dialysis machine. Will you need to disconnect him? Can you disconnect him? You will need to obtain additional information. Looking around, you find contact information for a clinical dialysis nurse resting on the table by the tablet.<\/p>\n<p>Patients on home hemodialysis are closely managed by a dialysis service. Home dialysis machines are highly complex; they need user interfaces that enable patients and their families, without formal medical training but with guidance from the dialysis service, to use the machines. The home hemodialysis machine should be accompanied by a tablet that automatically monitors and stores key information about the patient\u2019s dialysis sessions.<\/p>\n<p>On the tablet screen you will be able to see blood pressure and heart rate trends (often checked every 5-10 minutes while the patient is on dialysis) as well as the pressures on the venous and arterial side of the patient\u2019s fistula throughout the recent session. Sudden drops in pressure may indicate fluid shifts or severe hypovolemia that may worsen hypotension and contribute to altered mental status. Often this may happen in dehydration or severe sepsis.<\/p>\n<p>During home hemodialysis, patients connect themselves to a smaller version of the dialysis machine for a 3-4 hour session, up to 4 times per week. The patient must be careful when connecting themselves to ensure that no air enters the line, as this could create an air embolism. An air embolism\u00a0occurs when air bubbles enter the bloodstream, blocking blood flow to vital organs like the brain, heart, or lungs.\u00a0Symptoms of an air embolism vary on where the bubbles get stuck in the body, ranging from stroke-like symptoms and confusion to breathing problems, chest pain, and low blood pressure.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;6. Knowledge Check Question&#8221; tab_id=&#8221;1602845579909-3a9620d7-2355&#8243;][vc_column_text css=&#8221;&#8221;]Where might you find additional information regarding the patient\u2019s dialysis session? <em>Check ALL that apply.<\/em><\/p>\n<ul>\n<li><strong>The dialysis tablet blood pressure trend<\/strong><\/li>\n<li><strong>The dialysis tablet pressure graph<\/strong><\/li>\n<li>The dialysis machine\u2019s settings menu<\/li>\n<li><strong>Evaluation of the dialysis lines<\/strong><\/li>\n<li>Evaluation of dialysis machine motors<\/li>\n<\/ul>\n<p>Explanation: The dialysis tablet hosts a wealth of information regarding a patient\u2019s dialysis session, including blood the patient\u2019s blood pressure and pressure in the tubing connecting the patient to the dialysis machine. Evaluation of the dialysis lines may identify air and suggest air embolism as an underlying pathology. The dialysis settings should be reserved for the patient or dialysis nurse to control and do not frequently provide useful information for an emergent evaluation. EMS personnel should not adjust these settings. Similarly, the evaluation of the mechanical motors which pump blood during dialysis do not help with narrowing a differential or evaluating a patient.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;7. Coming to the Diagnosis&#8221; tab_id=&#8221;1602845606079-7dea6c1a-a635&#8243;][vc_column_text css=&#8221;&#8221;]You astutely evaluate the patient\u2019s dialysis tablet and lines. The patient\u2019s blood pressure has been within normal limits, and he has only been mildly tachycardic for a short period, since he became altered. The spouse checks the tablet and notices there was an alarm for air in the line earlier in the session and see several bubbles of air within the dialysis lines. While your differential continues to remain broad, you are suspicious for an air embolism as the cause for this patient\u2019s altered mental status. You contact base and they recommend transport to the nearest most accessible receiving facility. You start preparing the patient for transport and wonder how you may safely remove the patient from his dialysis machine. The wife states that she does not remember how to remove the patient from the machine as he has always done it himself.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;8. Knowledge Check Question: What is the best way to find information to remove the patient from his machine safely?&#8221; tab_id=&#8221;1602845638939-e51a96b3-112a&#8221;][vc_column_text css=&#8221;&#8221;]<\/p>\n<ol>\n<li>Call your assigned base hospital<\/li>\n<li>Contact the patient\u2019s dialysis nurse<\/li>\n<li>Review the dialysis tablet for a manual<\/li>\n<li>Search for a dialysis manual in the house<\/li>\n<\/ol>\n<p>Explanation: The correct answer is B \u2013 Contact the patient\u2019s dialysis nurse. Contacting the dialysis nurse, whose number is frequently located next to the dialysis machine or nearby where the patient is sitting, is the most efficient and accurate way to safely remove the patient from their machine. They may be able to travel to help with removal or discuss the steps for removal for either a family member or for you to follow. The base hospital MICN\/physician is unlikely to have experience with removal of dialysis lines and unlike your microwave, you probably won\u2019t find a manual for the machine in the house. The dialysis tablet is a good resource to identify problems with dialysis; however, it does not contain instructions for connection\/disconnection.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;9. Safely Removing and Transporting the Patient&#8221; tab_id=&#8221;1624923584461-8079633d-d71f&#8221;][vc_column_text css=&#8221;&#8221;]You call the dialysis nurse, and they discuss safe ways to remove the patient from a dialysis machine to facilitate transport. They clarify that the method for removal is different depending on the patient\u2019s point of access. They send a video for you and the wife to review:<\/p>\n<p><iframe loading=\"lazy\" title=\"Disconnecting Patients from Home Hemodialysis Machines_ A Step-by-Step Guide\" src=\"https:\/\/player.vimeo.com\/video\/1127299020?h=79fc5a81f2&amp;dnt=1&amp;app_id=122963\" width=\"1080\" height=\"608\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture; clipboard-write; encrypted-media; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\"><\/iframe><\/p>\n<p><a href=\"https:\/\/vimeo.com\/1127299020\/79fc5a81f2?share=copy&amp;fl=sv&amp;fe=ci\">https:\/\/vimeo.com\/1127299020\/79fc5a81f2?share=copy&amp;fl=sv&amp;fe=ci<\/a><\/p>\n<p>The family member uses this video to remember her previous training and safely removes the patient from the dialysis machine. \u00a0If no family member, nurse, or caretaker is available, you should contact base for the next best steps. You transport the patient to the emergency department and provide handoff.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;10. Knowledge Check Question: Critical information that you should provide to the emergency physicians at the time of handoff includes which of the following?&#8221; tab_id=&#8221;1762983450282-346c8a54-a266&#8243;][vc_column_text css=&#8221;&#8221;]<em>Select ALL that apply<\/em><\/p>\n<ul>\n<li>Run time of the dialysis session<\/li>\n<li>Last complete dialysis session<\/li>\n<li>History of alarms<\/li>\n<li>Vital sign trend<\/li>\n<li>Finding of air in the lines<\/li>\n<li>Dialysis nurse\u2019s contact information<\/li>\n<\/ul>\n<p><em>Explanation:<\/em> The correct answers are all of the above. Hand-off is a crucial time to pass along important information to facilitate the management of these patient\u2019s moving forward. Any home hemodialysis patient should have a report of the run time of the dialysis session, their last completed dialysis session, a history of alarms and vital sign trends and your physical exam. The nurse\u2019s contact information is helpful as not all emergency departments are equipped to manage these patients immediately. The make and model of the dialysis machine is not as essentially to managing their emergency.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;11. Case Conclusion&#8221; tab_id=&#8221;1762983529200-fed37369-5c09&#8243;][vc_column_text css=&#8221;&#8221;]The patient arrives to the ED where they rapidly move the patient into a left lateral decubitus position with head down. This is known as Durant position and may help prevent additional air embolisms from reaching the brain when suspicion for air embolism is very high. A broad workup for altered mental status is completed, and the patient is diagnosed with a venous air embolism. Hospital staff determine that the patient would benefit from hyperbaric therapy and coordinate transfer to a hyperbaric chamber. It is theorized to be similar to air embolism from dive injuries \u2013 the increased atmospheric pressure of hyperbaric therapy will shrink air bubbles by allowing them to move distally in vasculature, improve oxygen delivery and accelerates air resorption to reduce symptoms and limit progression. Following therapy, the patient\u2019s mental status change resolves and he is discharged home with no persistent deficits.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;12. Learning Points&#8221; tab_id=&#8221;1762983598635-f066b890-cd56&#8243;][vc_column_text css=&#8221;&#8221;]<\/p>\n<ul>\n<li>Los Angeles County has many patients receiving hemodialysis at home, and this number is steadily growing.<\/li>\n<li>Information you collect on scene, and\u00a0from the dialysis nurse and review of the tablet, is crucial to the ED evaluation of home dialysis patients. EMS should bring the patient\u2019s dialysis tablet and dialysis RN\u2019s contact info with patients\u00a0transported to the hospital.<\/li>\n<li>When assessing patients with altered mental status, proceed with your usual evaluation (including blood glucose, ECG, mLAPSS and LAMS) even while the\u00a0patient is attached to the dialysis machine. mLAPSS positive? Transport to the most appropriate stroke receiving facility.<\/li>\n<li>Venous air embolism is a rare, but important, complication of dialysis that should be suspected when a patient suddenly develops altered mental status, chest pain, or dyspnea during dialysis. Look for\u00a0air visible in the lines or if the machine alarms for air.<\/li>\n<li>Family members and their designees are encouraged to remove patients from their home device during an emergency. Work with family and assist them in the disconnection. If no contact is available, discuss with base.<\/li>\n<\/ul>\n<p>[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;References&#8221; tab_id=&#8221;1762983704215-d66625a9-057b&#8221;][vc_column_text css=&#8221;&#8221;]Rope R, Ryan E, Weinhandl ED, Abra GE. Home-Based Dialysis: A Primer for the Internist. <em>Annual Rev Med<\/em>. 2024;75:205-217. doi:10.1146\/annurev-med-050922-051415[\/vc_column_text][\/vc_tta_section][\/vc_tta_accordion][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]<\/p>\n<h2>Acknowledgements<\/h2>\n<p>The author would like to acknowledge Anuja Shah, MD, and the Nephrology team at Harbor-UCLA Medical Center for their invaluable expertise and contributions to the development of this module.[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css=&#8221;&#8221;]Author: Jonathan Warren, MD[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text css=&#8221;&#8221;]CASE OF THE MONTH \u2013 September\/October 2025 Case Presentation: DISPATCH INFO\/COMPLAINT: 58-year-old male, Altered mental status SCENE INFO: Responding to a private home, you find a man seated in a recliner in his living room next to a large machine with multiple bags of fluid hanging. The machine is beeping. A small dog is [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":704,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/template-basic-page.php","meta":{"_oasis_is_in_workflow":0,"_oasis_original":0,"_monsterinsights_skip_tracking":false,"footnotes":"","_links_to":"","_links_to_target":""},"categories":[],"tags":[],"class_list":["post-805","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Cases from the Field - September\/October 2025 Edition - Emergency Medical Services Agency<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dhs.lacounty.gov\/emergency-medical-services-agency\/home\/emergi-press\/case-092025\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cases from the Field - September\/October 2025 Edition - Emergency Medical Services Agency\" \/>\n<meta property=\"og:description\" content=\"[vc_row][vc_column][vc_column_text css=&#8221;&#8221;]CASE OF THE MONTH \u2013 September\/October 2025 Case Presentation: DISPATCH INFO\/COMPLAINT: 58-year-old male, Altered mental status SCENE INFO: Responding to a private home, you find a man seated in a recliner in his living room next to a large machine with multiple bags of fluid hanging. 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A small dog is [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/dhs.lacounty.gov\/emergency-medical-services-agency\/home\/emergi-press\/case-092025\/\" \/>\n<meta property=\"og:site_name\" content=\"Emergency Medical Services Agency\" \/>\n<meta property=\"article:modified_time\" content=\"2025-11-12T23:00:31+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"11 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/dhs.lacounty.gov\\\/emergency-medical-services-agency\\\/home\\\/emergi-press\\\/case-092025\\\/\",\"url\":\"https:\\\/\\\/dhs.lacounty.gov\\\/emergency-medical-services-agency\\\/home\\\/emergi-press\\\/case-092025\\\/\",\"name\":\"Cases from the Field - September\\\/October 2025 Edition - Emergency Medical Services Agency\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/dhs.lacounty.gov\\\/emergency-medical-services-agency\\\/#website\"},\"datePublished\":\"2020-10-16T17:54:36+00:00\",\"dateModified\":\"2025-11-12T23:00:31+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/dhs.lacounty.gov\\\/emergency-medical-services-agency\\\/home\\\/emergi-press\\\/case-092025\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/dhs.lacounty.gov\\\/emergency-medical-services-agency\\\/home\\\/emergi-press\\\/case-092025\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/dhs.lacounty.gov\\\/emergency-medical-services-agency\\\/home\\\/emergi-press\\\/case-092025\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Emergency Medical Services (EMS) Agency\",\"item\":\"https:\\\/\\\/dhs.lacounty.gov\\\/emergency-medical-services-agency\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Emergi-Press\",\"item\":\"https:\\\/\\\/dhs.lacounty.gov\\\/emergency-medical-services-agency\\\/home\\\/emergi-press\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Cases from the Field &#8211; September\\\/October 2025 Edition\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/dhs.lacounty.gov\\\/emergency-medical-services-agency\\\/#website\",\"url\":\"https:\\\/\\\/dhs.lacounty.gov\\\/emergency-medical-services-agency\\\/\",\"name\":\"Emergency Medical Services Agency\",\"description\":\"Just another Network site\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/dhs.lacounty.gov\\\/emergency-medical-services-agency\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Cases from the Field - September\/October 2025 Edition - Emergency Medical Services Agency","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/dhs.lacounty.gov\/emergency-medical-services-agency\/home\/emergi-press\/case-092025\/","og_locale":"en_US","og_type":"article","og_title":"Cases from the Field - September\/October 2025 Edition - Emergency Medical Services Agency","og_description":"[vc_row][vc_column][vc_column_text css=&#8221;&#8221;]CASE OF THE MONTH \u2013 September\/October 2025 Case Presentation: DISPATCH INFO\/COMPLAINT: 58-year-old male, Altered mental status SCENE INFO: Responding to a private home, you find a man seated in a recliner in his living room next to a large machine with multiple bags of fluid hanging. The machine is beeping. 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