NREMT Emergency Medical Technician (EMT) Cognitive ExamMedical EmergenciesHard
A 68-year-old male is found unconscious with a strong odor of alcohol on his breath. His wife states he is a diabetic and took his insulin this morning but has not eaten since. His blood glucose level is 45 mg/dL. What is the MOST appropriate intervention for this patient?
- AAdminister 50% dextrose (D50) intravenously.
- BAssist ventilations with a bag-valve mask.
- CAdminister oral glucose gel.
- DAdminister glucagon intramuscularly.
Show answer & explanationAnswer & explanation
Correct answer: D. Administer glucagon intramuscularly.
The patient is unconscious and hypoglycemic (blood glucose 45 mg/dL). While IV D50 is the preferred treatment for unconscious hypoglycemia, as an EMT, if IV access is not yet established or permitted by protocol, intramuscular glucagon is the appropriate intervention. Oral glucose is contraindicated in unconscious patients due to aspiration risk. Ventilations are not indicated unless there is respiratory compromise.
Why the other options are wrong
- A. D50 IV is the ideal treatment, but may not be within an EMT's scope or immediate capability.
- B. There is no indication of respiratory depression; the primary problem is hypoglycemia.
- C. Oral glucose is for conscious patients; risk of aspiration in an unconscious patient.
Hypoglycemia Management (Unconscious)
For an unconscious diabetic patient with hypoglycemia, rapid administration of glucose is critical. If IV access is not available or within scope, intramuscular glucagon is the next best option.
- Blood glucose < 60 mg/dL is generally considered hypoglycemic.
- Oral glucose is only for conscious patients with intact gag reflex.
- IV D50 is the most rapid and effective treatment.
- IM glucagon mobilizes glucose from the liver and is a good alternative when IV access is delayed or impossible.
Memory trick: No swallow? Glucagon to the muscle, or D50 to the vein!