In this issue: Scenario Questions
“It was a dark and stormy night. The current temp is 60 degrees. You’ve been sleeping all night until the tones go off. You drive approximately 15 minutes and arrive at a well-kept two-story ranch style house with a cat sleeping on the porch. The patient has a history of diabetes and takes insulin. The husband is a military veteran and is concerned that his wife will not wake up. He tells you she is a diabetic and he might have given her too much insulin because he can’t read the fine print. Your patient is an elderly female lying on the couch with snoring respirations. Her skin is cool, pale, and diaphoretic. Once in 1985 she broke her foot but otherwise has not had any medical procedures. Which of the following is the first procedure you should do.”
- Open the airway with a head-tilt chin lift
- Start immediate compressions
- Provide D50 via IV
- Immediate transport to the closest hospital
These questions are long, wandering, and often end up with a really easy answer. Most of the time, they are just following one giant flow chart! Don’t let them intimidate you just because there’s usually a lot of words involved.
Thankfully NREMT is moving away from this style question. If we were to “modernize” this question, it might read like this:
“How should you first treat an unresponsive diabetic patient with snoring respirations?”
E&T Final Thoughts: While you can’t technically measure ST elevation on a simple Lead II strip due to the calibration differences that happen when you run a 12 lead, you should always give your EKG a quick look before giving nitro – if you can see some obvious elevation in Lead II – run the 12 first because you might be dealing with a right-sided infarct!