You are called to a local physician's office where you find a 52-year-old male patient with a history of chronic renal failure. He is conscious but disoriented. The physician reports that the patient's wife brought him in because he has had a chest cold, missed dialysis yesterday, and is now acting strangely. Physical examination reveals cool, diaphoretic skin; edema to dependent areas, and lung sounds with rhonchi in the right upper lobe. HR = 118, BP = 142/100, RR = 20 and deep, SaO2 = 97, blood glucose = 79 mg/dL. Bloodwork performed by the physician in his office indicates a pH of 7.2. In addition to 15 liters per minute of oxygen by nonrebreathing mask and an IV of normal saline at a keep-open rate, which of the following is most appropriate for this patient in the prehospital setting?
A) IV sodium bicarbonate, 1 mEq/kg
B) IV magnesium sulfate, 10 gm
C) IV dextrose, 25 gm
D) IV furosemide, 120 mg
Question 2
Five minutes after assisting a patient with his epinephrine auto-injector, you determine the patient to be getting progressively worse. The patient has a second auto-injector available; however, written protocols do not address the administration of a second dose. Which one of the following should be your next best action?
A) Request advanced life support (ALS) assistance.
B) Administer the second dose of epinephrine.
C) Continue to monitor the patient.
D) Contact medical direction for further orders.
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