CASE 003 · Emergency Department · Advanced · 10–14 min
The Patient Who Is Getting Sicker by the Minute
· Patient arriving
78-year-old female — “She's just not herself today.”
12:02 PM — arrives from her assisted-living facility. Dozing mid-sentence. Couldn't say the year.
BP 96/58HR 112RR 26SpO₂ 91% RATemp 101.4°F
You do not get the diagnosis. You get the patient. Reason your way there.
What SHOULD be happening?A — Assess Normal
Pathogen lands in a lung segmentLOCAL immune response walls it offInflammation stays where the infection isPerfusion everywhere else stays normalThe patient feels sick — but circulates normally
Her immune response has stopped being local. The defense system itself is now attacking the circulation. Time matters in this case — she will change while you work.
RUN IT · ACTIVEThis patient deteriorates while you work. Time matters.
Maldek cases are for healthcare education and clinical-reasoning training. They do not replace local protocols, faculty instruction, clinical supervision, or professional judgment.