On April 16th a call was dispatched to Leavenworth County that led a 3 person crew to
Ihop. They arrived at Ihop to police and fire already on scene with what appeared to be an adult
male. The EMS crew parked the ambulance and this male got right in. The guy was falling over,
sweating, looked to be out of breath, and was very pale. He said he needed to go to the hospital
because he was “suicidal and had just taken two xanax with two big beers.” He explained that he
was having an anxiety attack from his mom not letting him leave the house that day, so he took
the two xanax and then climbed out a window after stealing two beers. He said he had a big can
of bud light and a Mike’s Hard Lemonade. This man complained of chest pain, drowsiness,
nausea, and that he couldn’t see straight. The crew noticed that this man had slurred speech,
impaired coordination, and that he wasn’t able to remember anything. The paramedic in the crew,
Heather, decided to do a 12 lead ECG on him because he had complained of chest pain. The 12
lead ECG came back to be normal with no abnormalities. Heather took his vitals next. The heart
rate was 60, respirations at 12, Sp02 at 91 and blood pressure was 142/94. Heather gave him a
nonrebreather at 10 lpm.
This guy was 40 years old and was named Sam. Sam lives with his mom, little brother,
and little sister about two minutes from the Ihop he was found at. He has a past medical history
of depression and anxiety that he has had his whole life. His mental illness has made him
mentally incapacitated to be on his own at his age, so his mother is his legal guardian. Sam had
been hospitalized many times for suicide attempts along with being in a rehabilitation for drug
abuse. All Sam wanted from this EMS crew was to be taken to the psychiatric unit at the hospital
because he didn’t want to be at home with his mom anymore, and because he said he “was too
CASE STUDY ANALYSIS 3
suicidal to be left alone.” The EMS crew was okay with taking him to the hospital, but was
unable to transport him. They couldn’t transport him because his mom was his legal guardian and
they had to have her permission. The police called Sam’s mom and asked her to come down to
the Ihop. Sam continuously asked the police not to call his mom because he didn’t want her to
take away his Royals hat and his new earrings he was wearing. His mother arrived a few minutes
later with his little brother in the car. She came right into the ambulance and took his hat and
earrings off him. His mom told him to get off the ambulance and that she wasn’t going to buy
him the shirt from Target now. His mother said that they could not transport him, so she signed a
refusal saying that the crew did everything they could and that Sam was not transported. Sam
would not get off the ambulance so the police had to come in and remove him and put him in his
mom’s car.
Depression is a mood disorder that impacts how you think about things, how you act, and
impacts what you are feeling. Depression is the world’s most common mental illness.
“According to the Depression and Bipolar Support Alliance, approximately 14.8 million
American adults, or 6.7 percent of the United States population over age 18, are affected by
MDD every year. The disorder also occurs in about one in 33 children and one in eight teens.” It
causes you to feel sad or hopeless for days or even year long periods of time. Some people
experience short periods of depression throughout their lives, but others can experience it
everyday for their whole lives. This long lasting depression is called (MDD) major depressive
disorder. People who typically have MDD have severe suicidal thoughts. This is most likely what
kind of depression Sam had because he has had this his whole life and has ha
CASE STUDY ANALYSIS 4
thoughts that still haven’t ended. Having depression severely impacts your day to day life in
every way.
Depression causes you to feel things such as: guilt, moodiness, hopelessness, angry
outbursts, sadness, and loss of interest in friends, family and favorite activities, including sex
(Depression). It causes you to drift away from the things you love in life because you don’t know
what to do, or what to say, or how to be yourself anymore. People with this mood disorder have
difficulty with concentrating, remembering, and making decisions, which would make your
worklife, school, or just daily tasks very difficult (Depression). They tend to not want to be
around people so they can have terrible attendance in work, school, or social events. Some
physical signs of depression would be tiredness/lack of energy, changes in appetite, aches and
pains, and changes in sleep patterns (Depression). They will either eat a lot or eat very little
causing noticeable weight loss or weight gain. As well with sleeping, they will either sleep
insane amounts or become an insomniac. Depression makes them feel like they are all on their
own with this pain and the feeling of hopelessness makes them feel like they will be like this
forever.
The cause of depression is unknown but there is research that shows many factors that
could influence it. Depression can be caused by genetics that have been passed down to you. If
somebody that had been diagnosed with MDD had a child then there would be a 50/50 chance of
their child inheriting this disorder. Another possible factor could be if you had a very stressful
event happen to you, such as a death of a loved one. Just one stressful event can cause a period of
depression in your life. A imbalance in hormones can also cause depression in certain types of
people. The “Chemicals in the brains of people with MDD seem to function differently than
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those in the brains of those without the disorder (Effects of Depression on the Brain).”
Depression affects the different parts of brain like: the hippocampus, amygdala, and the
prefrontal cortex (Effects of Depression on the Brain). The hippocampus is the part of the brain
“stores memories and regulates the production of a hormone called cortisol (Effects of
Depression on the Brain).” Cortisol is released from the body when you are stressed. A normal
adult that is healthy will have a brain full of neurons that continue to be produced, but a brain
that has been stressed, full of cristol, will have a hard time producing these neurons. Low levels
of neurons in the brain will hurt the hippocampus and can create memory problems. In the very
front of the brain is the prefrontal cortex that is “responsible for regulating emotions, making
decisions, and forming memories (Effects of Depression on the Brain).” The high levels of
cristol also impacts the prefrontal cortex by causing it to shrink up. Another part of the brain that
is affected by cristol is the amygdala. This part of the brain that processes your emotions. The
amygdala is affected by cristol by swelling making the person more sensitive to things like fear.
The swelling of this part of the brain causes other bad things in the body like, sleeping problems
and different amounts of hormones to be put into the body causing more issues. A way to see
how your brain is functioning you can get a PET scan.
If you were to do a PET scan on a person who does not have depression than you would
see that the brain is full of white and yellow colors (Krans, Brian). These colors are showing
brain activity. In a person who has depression a PET scan would show dark areas of blues and
blacks with very little areas of yellow and white (Krans, Brian). These darker colors in the brain
are showing low levels of dopamine and little brain activity. Having depression is really diorder
CASE STUDY ANALYSIS 6
that many people suffer with. Scans with tons of red, yellow, and white on them means that there
is high activity in the brain. This scan would be showing anxiety (Krans, Brian).
Anxiety is a mood disorder that comes in many different forms that causes “feelings of
uneasiness, worry and fear (Tracy, Natasha).” Anxiety disorders can be classified as panic
disorder, social anxiety disorder, phobias, and generalized anxiety disorder. Generalized anxiety
disorder is the most common and this is most likely what Sam had. If a person were to have any
of these disorders than they would be having symptoms of having “cold or sweaty hands or feet,
sleeping problems, shortness of breath, heart palpitations, not being able to be still and calm, dry
mouth, numbness or tingling in the hands or feet, nausea, muscle tension, or dizziness (What Are
Anxiety Disorders).” This disorder is a chronic fear or worry of anything and everything.
This mental disorder can be caused by many things in your life that cause you stress, it
could be a side effect of a medication or drug you are taking, or it could be due to a medical
problem that lacked oxygen to your brain, like a stroke. Anxiety also affects your brain in
damaging ways because anxiety is stress, fear, and worrying which causes cristol to be released
causing problems for the hippocampus and the amygdala like depression does (Anxiety in Your
Brain). Anxiety causes the sympathetic nervous system to be activated making the heart rate,
blood pressure, and respiratory to become elevated. Depression and anxiety can be treated with
medications to help some of the side effects of them.
Medications that are typically used for depression can be used for anxiety as well in
many cases due to the similarities of the two disorders. A lot of the possible medications that
could be given for depression are to help improve your mood or increase your energy
(Citalopram Oral). Many of the anxiety medications are to help decrease muscle tension or help
CASE STUDY ANALYSIS 7
balance out the chemicals in your brain (Citalopram Oral). The most common anxiety
medication would be Xanax (alprazolam).
The mixing of medications and alcohol can result in some critical side effects. Some side
effects of this mixture could be suicidal thoughts, slipping in and out of consciousness, lightheadedness,
severe depression, extreme dizziness, abnormal behavior, tiredness, impaired
coordination, chest pain, and memory problems. These were all the symptoms that Sam was
experiencing when he took the two Xanax with the two beers that day. Sam knew what he was
doing when he did this because he had walked to the IHOP many times before to do the same
thing. The EMS crew involved with this call knew what to do and how to handle him because
they saw him so often. They tried to keep him calm when he knew he wasn’t going to be
transported and that him mom was coming. They treated him like a real person and gave him
understanding when he was telling them his problem. This crew did everything right and
everything they could for him.
Treating people with mental disorders should not be any different than somebody without
a mental illness. It’s all to help the patient and try to help their problems. If Sam’s mom wasn’t
his legal guardian then Sam’s past suicide attempts in the past and his explaining of how he
wanted to do it now should have been a good reason to take him to the psychiatric unit in the
hospital. Knowing these patient’s past should be a very significant part of the patient assessment
because that is likely to give you a good idea of what he could be experiencing. You should also
know how rough of a time these patients are going through and try to be as helpful and nice as
possible. Mental illnesses aren’t any different than medical problems. The way mental illnesses
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affect your brain and body is almost always going to create a medical problem that could
possibly be fixed.
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