lucky_doc
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A 67 yo M is found on the floor in home unresponsive and unarousable. On PE the Pt is breathing spontaneously and he has bouding radial pulses bilaterally. He does not open his eyes, makes no sounds, and withdraws to sternal rub. What is the next step in management of this pt's condition?
A Administer naloxone, thiamine, and dextrose
B Check brain stem reflexes
C Check serum electrolytes
D Intubate
E Undress the patient
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| RX 135
Forum Elite
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a
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| kpmle2
Forum Elite
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A Administer naloxone, thiamine, and dextrose
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| lucky_doc
Forum Junior
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The answer is Intubate !!!!!! remember the ABC's of Trauma 
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| sandra
Forum Guru
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why should intubation be done when he is breathing spontaneously?
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| neurom
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I would check brain stem reflexes
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| arlete
Intern in 2009!!!!!
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I think it's A. If the patient is breathing spontaneously, why intubate?
Where is this question from, and what is the explanation given, lucky_doc?
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| drshvetasm
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D...all unconscious pts to be intubated.
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| farnsworth
Forum Newbie
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D: intubate
rationale: pts w/ a GCS<=8 should be intubated, even if breathing spontaneously (aspiration!).
If the patient was clearly intoxicated with opioids, I used to administer naloxone before considering intubation. But usually 67 y/o patients are rarely intoxicated. The bounding pulses could also indicate an increased intracranial pressure (hypertension with bounding pulses develops as an reflex to maintain an adequate cerebral perfusion pressure), so go with D (intubation).
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| ozdoctor
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"bounding" pulse means that the heart is pumping a large amount of blood with each heartbeat, therefore the pulse will feel very strong. A bounding pulse usually can be caused by exercise, anxiety, or alcohol consumption. If this imply for alcohol intoxication, answer should be A.
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| RX 135
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his gcs score is less than 8..intubate..
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| arlete
Intern in 2009!!!!!
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Good one! 
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| nyimalay
Forum Elite
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Yes. D. Intubate.
Good question. Thanks.
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| SmokyWaters
Forum Elite
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d
its ABCD
A Administer naloxone, thiamine, and dextrose ... its done with circulation
B Check brain stem reflexes ... in secondary survey
C Check serum electrolytes .. after secondary survey
D Intubate .. B of ABC of trauma
E Undress the patient... E exposure of ABCDE of trauma
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