Question

Gerald Luna is a 45-year-old client with a 15-year history of type 2 diabetes mellitus and a 30-year history of alcoholism. His blood glucose is not well controlled on an oral hypoglycemic agent, and he drinks one six-pack of beer per day. Gerald works at a casino as a slot machine repairman. His wife of 25 years, Andrea, is also employed by the casino in the accounting department. Gerald and Andrea live on a reservation near the casino in a rural setting.

Gerald was involved in a car accident on the way to work. He was not restrained and was thrown from the car into the roadside brush. The crash was witnessed, and bystanders called 911. First responders arrived to find Gerald unconscious with labored breathing and a deformed right lower extremity. A witness stated that Mr. Luna just drove off the road and appeared to be asleep. No other vehicles were involved. The first responders established monitoring equipment, intubated Gerald at the scene, started intravenous fluids with 0.9% normal saline, and splinted his right lower extremity.

Evaluate the information in the case and determine the Top 3 Priority concerns or cues.

Answer 1

Though the case of Mr. Gerald is a diabetic case. At once we can draw a conclusion that if any other things not considerable like there is no other vehicle there after accident, Mr. Gerald gets out of car and lying on roadside brush, then unconscious and stroke due to diabetes is main concern.

Here are some points which can be priority concerns:

1. Mr. Gerald Luna is a diabetic. First concern is that there may be a case of Hypoglycemia. Sugar level of Type 2 Diabetes Mellitus can be decrease to a level that makes Mr. Gerald too shaky and unconscious to handle his driving. Mr. Gerald felt weak and shaky that he stop the car in this weakness. So might not get proper handle on the car. In this case responder should check his sugar level if other hypoglycemia sign and symptoms appears like sweating, tingling lips, nausea etc. And dextrose can be use intravenously immediately if there is low sugar levels.

2. Secondly we can think about hyperglycemia. The sugar level go up because his blood glucose is not well controlled on an oral hypoglycemic agent. He may be feel drowsy and blurred vision makes him that he didn't get proper control on his driving. Because hyperglycemia can make diabetic ketoacidosis,which can leads to unconscious.

3. The physical effects of long term diabetes and alcoholism may lead to nervousness, enxity and confusion. This also leads to concentration difficulties,depression and diabetic stress. Dengorosly high blood sugar or low blood sugar can leads to diabetic coma which make the patient unconscious and may be fatal. Because of diabetic coma Mr. Gerald got breathing problem.

So in that case where no other vehicle involved, patient lay down unconsciously,difficulty in breathing, responder should check glucose levels at once. At that point this can be treated. Because diabetic coma can lead to brain hemorrhage and situation may be worse or fatal.