Priority one across town for a "general sick call." We arrived just in time to find the 62 year old man propped up in bed and finishing his supper.
Firefighters already on scene were taking the man's vitial signs, so I took a report from a family member in the hallway. The patient has been feeling "tired" for about 3 weeks now. He is normally fairly active, but as of late he has hardly found the energy to do much more than sit in bed, watch TV, and read. He doesn't have any particular pain or discomfort, no shortness of breath, no problems with appetite, fluid intake, or bowel movements.
I try to scare a complaint other than "tired" out of the story, but despite my probing questions there truly seems to be little else. The man smiles at me and thanks us for arriving so quickly. He apologizes for having to call 911, "but this weakness just wont go away."
The firefighters report the vital signs to me as BP 90/50, HR 60, RR 20. The man looks a little bit pale, but there is nothing that really screams "sick" about his presentation. We get the stair-chair and wheel the man out to the stretcher, telling a few jokes along the way.
Mostly out of boredom, and partly because of the reported blood pressure, I decide on a whim to work the patient up instead of passing off to my BLS partner. It is a 10 minute drive to the hospital, so I decide to do everything en route and we start on our way.
Sitting on the bench seat I take another set of vital signs.
...And then I take them again to make sure I heard right. The blood pressure is more like 76 over 30, and the heart rate rate, well... I'd better put him on the monitor.
I stared disbelievingly at the monitor for a few seconds, turning my head back and forth between the patient and the yellowish screen. The patient looked fine. ...Like anyone you might see walking down the street. And yet the numbers told quite a different picture. Heart rate hovering between 28 and 32, a dangerously low blood pressure.
The patient sat on the stretcher looking at me. He had asked for a few extra bath blankets, and there he was, buried in cloth pulled snug to his chin, watching as I reached for the yellow medication bag.
He clears his throat. "Is there something wrong?"