A 68-year-old male is found unresponsive with a strong odor of alcohol on his breath. His wife states he is a diabetic and takes insulin, but she is unsure if he ate recently. His skin is cool and clammy, and his pulse is rapid and thready. What is the MOST appropriate initial intervention?
- AAdminister supplemental oxygen via non-rebreather mask.
- BRequest advanced life support (ALS) for IV dextrose administration.
- CTransport immediately to the nearest hospital.
- DAdminister oral glucose.
Show answer & explanationAnswer & explanation
Correct answer: B. Request advanced life support (ALS) for IV dextrose administration.
The patient's unresponsive state, history of diabetes and insulin use, cool/clammy skin, and rapid/thready pulse strongly suggest severe hypoglycemia. While EMTs cannot administer IV dextrose, requesting ALS for this intervention is critical as it is the definitive treatment for severe hypoglycemia in an unresponsive patient and is more urgent than oxygen alone or immediate transport without intervention.
Why the other options are wrong
- A. While oxygen may be beneficial, the primary life threat is profound hypoglycemia, which requires glucose. Oxygen alone will not correct the underlying problem.
- C. Transport is necessary, but requesting ALS for immediate intervention (IV dextrose) en route or at the scene is more critical than simply transporting without addressing the life-threatening hypoglycemia.
- D. Oral glucose is contraindicated in an unresponsive patient due to the risk of aspiration.
Unresponsive Hypoglycemia Management
For an unresponsive diabetic patient suspected of severe hypoglycemia, the critical intervention is the rapid administration of glucose, typically intravenously (dextrose) by ALS, or glucagon intramuscularly if IV access is not immediately available.
- Suspect hypoglycemia in unresponsive diabetics, especially with cool/clammy skin.
- Oral glucose is contraindicated due to aspiration risk.
- EMTs should request ALS for IV dextrose or administer IM glucagon (if protocol allows).
- Rapid reversal of symptoms is expected with glucose administration.
Memory trick: Low Sugar? Call ALS for IV Sugar!