An Older-Appearing Man of Unknown Age Is Brought to the Emergency

question 386

Multiple Choice

An older-appearing man of unknown age is brought to the emergency department by paramedics on New Year's Eve.  They found him minimally responsive and lying on the side of a street.  In the emergency department, the patient's core body temperature is 29 C (84.2 F) , blood pressure is 70/30 mm Hg, heart rate is 40/min, and respirations are 6/min and shallow.  His oxygen saturation is 90% on 5 L oxygen.  On examination, the patient remains unresponsive to verbal stimuli and his breath smells of alcohol.  His pupils are normal and symmetric but have a sluggish reaction to light.  Lung examination reveals crackles bilaterally.  Cardiovascular examination reveals bradycardia with an irregular pulse.  Neurologic examination is difficult to perform but shows marked hyporeflexia throughout.  An initial ECG shows sinus bradycardia with frequent premature ventricular complexes.  Capillary blood glucose is 315 mg/dL.  Paramedics have started an infusion of warmed normal saline via 16-g peripheral access.  The patient has also received one dose of intravenous thiamine. Item 1 of 2
Which of the following is the most appropriate next step in management of this patient?

• A)Atropine
• B)Endotracheal intubation
• C)Insertion of central line through subclavian vein
• D)Insulin infusion
• E)Intravenous furosemide