Unresponsive 17 y/o male

[CBEMT]

Ok, fine, turns out he didn't fall off the ladder, but how do we KNOW he didn't fall off the ladder?

[AZCEP]

When you don't know, and the cause is unclear, I doubt there would be a problem with having someone immobilized. The additional imaging that will be needed would be a concern, but you have to consider the possibility of trauma.

[firedoc5]

Ok, fine, turns out he didn't fall off the ladder, but how do we KNOW he didn't fall off the ladder?

That's basically what happened with my brother in law last late Oct. He was found at the bottom of a tree/deer stand. They weren't sure if he fell from the ladder or from the stand itself. Turned out he had an AMI, age 40. Still not clear if he did fall or just collapse prior to starting to climb.

[chbare]

I still have concerns about this case. A DKA patient with a respiratory rate of 4-6 should raise red flags. Even more, this patient was unresponsive to the point of tolerating a combitube without pharmacology related assistance. Living people with a functional nervous system do not usually tolerate combitubes. He may have been down for a while, and hypoxia is to blame: however, I would still be considering additional problems. He most likely was in DKA, but I would still want to look for other problems.

Take care,

chbare.

[CBEMT]

When you don't know, and the cause is unclear, I doubt there would be a problem with having someone immobilized. The additional imaging that will be needed would be a concern, but you have to consider the possibility of trauma.

Er, that was exactly my point. :wink:

[ncmedic309]

I still have concerns about this case. A DKA patient with a respiratory rate of 4-6 should raise red flags. Even more, this patient was unresponsive to the point of tolerating a combitube without pharmacology related assistance. Living people with a functional nervous system do not usually tolerate combitubes. He may have been down for a while, and hypoxia is to blame: however, I would still be considering additional problems. He most likely was in DKA, but I would still want to look for other problems.

I see it the same way - something just doesn't add up. He's working outside and all the sudden his DKA progresses to the point that he loses consciousness and becomes near apneic? His BGL is concerning, but not to the point that it's going to be causing these symptoms. I would still be concerned about trauma (fall and / or electrocution, opiate OD, even though we never got pupillary size or response, etc.) I think there is more to the story than just new onset of DM.

[firedoc5]

I see it the same way - something just doesn't add up. He's working outside and all the sudden his DKA progresses to the point that he loses consciousness and becomes near apneic? His BGL is concerning, but not to the point that it's going to be causing these symptoms. I would still be concerned about trauma (fall and / or electrocution, opiate OD, even though we never got pupillary size or response, etc.) I think there is more to the story than just new onset of DM.

I agree. In a case like this, immobilizing falls into the category of when in doubt, do it. Is there a Hx. of syncope? I just now thought of it, but what is the temp? How long has he been outside?

[fireflymedic]

BG of 560 is high, but no so high that the majority of people wouldn't still be functioning at some level (at least from my experience, granted we have alot of diabetics here). yeah the guy is in DKA with the fruity breath, but we should be seeing kussmaul's respirations with that, not a RR of 4. he has no gag reflex and a GCS automatic of less than 8. His airway is patent for now, but won't be for long. I'd aggressively manage this airway 'cause obviously he can't protect his own without a gag reflex. Intubation would definitely be my choice to go. Can't go wrong with spinal precautions, especially with tubin him. Less movement and there is no indications that he didn't fall off the ladder or any trauma. I think more going on here than simple DKA. Also, did you do the BG from a finger stick or a IV cath - difference in capillary and venous blood don't get accurate results with an IV cath for most machines. Aggressive airway management and fluids is good place to start with this gentleman.

[Adam Swartz]

Functioning as a basic pricked the finger.

[Don1977]

Functioning as a basic pricked the finger.

Wish I could "legally" prick a finger......"the RN did it"