Question

An unresponsive client is admitted to the emergency room with a history of diabetes mellitus. The client's skin is cold and clammy, and her blood pressure reading is \(82 / 56\). The first step in emergency treatment of the client's symptoms would be: A. Checking the client's blood sugar B. Administering intravenous dextrose C. Intubation and ventilator support D. Administering regular insulin

Short answer

Answer: Administering intravenous dextrose is the most appropriate first step in treating the unresponsive client, as it provides an immediate glucose source to help stabilize their condition.

Step-by-step solution

Evaluate the symptoms and the urgency of the situation

The client is unresponsive, has cold and clammy skin, and a low blood pressure of \(82/56\). These symptoms indicate an urgent situation that needs immediate intervention. Let us examine the given options to determine the most appropriate first step.

Analyze the given options

We have four options for the first step in treating the client's symptoms: A. Checking the client's blood sugar: This is important for a diabetic patient, but it would not help in stabilizing their current condition. B. Administering intravenous dextrose: This can provide an immediate glucose source for the patient, which might help in stabilizing their condition if it is caused by low blood sugar. C. Intubation and ventilator support: This is usually needed in severe cases where patients have difficulty breathing or maintaining oxygen levels but is not directly related to diabetes. D. Administering regular insulin: Insulin might help regulate a diabetic patient's blood sugar levels, but administering insulin in an emergency situation without any information on the patient's current blood sugar can risk causing further harm.

Determine the most appropriate first step

Considering the possible benefits and risks, the most appropriate first step in treating the unresponsive client with diabetes mellitus would be administering intravenous dextrose (Option B). This ensures that the client receives an immediate glucose source to help stabilize their condition, before other interventions like checking blood sugar levels and administering insulin are carried out.

Key concepts

Emergency Treatment

When a patient is admitted to the emergency room, the primary focus is on _stabilizing their condition_ immediately. The patient's symptoms dictate the urgency and type of intervention required. In this specific case, the patient is unresponsive, with cold, clammy skin and low blood pressure, all of which signal an urgent need for a rapid response.

• _Unresponsiveness_ may imply a critical condition like shock or severe hypoglycemia in diabetic patients.
• _Cold and clammy skin_ often suggests poor circulation, potentially caused by low blood sugar or blood pressure.
• A very low _blood pressure_ reading, such as 82/56, indicates the need for immediate action, as it suggests inadequate blood flow to vital organs.

In such situations, medical personnel must prioritize actions that promise the quickest stabilization. This often involves delivering glucose or stabilizing blood pressure if either is dangerously low.

Diabetes Mellitus

Diabetes Mellitus is a chronic condition that affects the way the body processes glucose. Glucose is a vital energy source for the body's cells, and stable blood sugar levels are crucial for normal functioning. In diabetes, insulin production or response is impaired, leading to abnormal blood sugar levels. There are two main types:

• _Type 1 Diabetes_: Where the body does not produce insulin.
• _Type 2 Diabetes_: Where the body does not use insulin effectively.

Managing diabetes typically involves monitoring blood sugar levels, administering insulin (if necessary), and maintaining a healthy diet and lifestyle. In emergency scenarios like the one described, rapidly fluctuating blood sugar levels can have severe effects, which need immediate treatment to prevent complications such as unconsciousness or shock.

Blood Pressure

Blood pressure is a measure of the force of blood against artery walls. It is crucial for maintaining blood flow throughout the body and providing organs with necessary nutrients and oxygen. Normal blood pressure levels are around 120/80 mmHg. However, in emergencies, such as in our scenario, an extremely low reading like 82/56 mmHg can be dangerous.

• _Hypotension_ (low blood pressure) can lead to dizziness, fainting, and inadequate blood flow to organs.
• In diabetics, low blood pressure alongside unresponsiveness and clammy skin may indicate a hypoglycemic crisis.

Stabilizing blood pressure is often a priority in emergency care, and finding the right balance is key to ensuring adequate organ function and preventing further complications.

Intravenous Dextrose

Intravenous dextrose is a medical intervention used to quickly elevate blood glucose levels, especially during hypoglycemic emergencies. It is a form of glucose administered directly into the bloodstream through an IV line, ensuring rapid absorption.

• _Dextrose preparations_ typically come in concentrations like D5W or D50, indicating the percentage of glucose in water.
• _Immediate availability_ of glucose through IV dextrose helps in stabilizing unconscious patients like the one in our scenario.
• It's crucial to monitor the patient's response to ensure the glucose levels are appropriately balanced after administration.

Using IV dextrose is often the preferred first step in treating emergencies like severe hypoglycemia seen in diabetic patients, as it directly addresses the root cause of the symptoms.