254.A 48-year-old man presents to the ED with ethanol intoxication. His
BP is 150/70 mm Hg, HR is 95 beats per minute, temperature is 97.9°F, R R
is 14 breaths per minute, and oxygen saturation is 93% on room air. The
patient is somnolent and snoring loudly with occasional gasps for air. On
examination, the patient’s gag reflex is intact, his lungs are clear to auscul-
tation, heart is without murmurs, and abdomen is soft and nontender. He
is rousable to stimulation. A head CT is negative for intracranial injury. His
ethanol level is 270 mg/dL. Which of the following actions is most appro-
priate to assist the patient with respirations?
a. Nasal airway
b. Oral airway
c. Bag-valve-mask ventilation
d. Laryngeal mask airway
e. Tracheoesophageal airway
255.A 52-year-old woman is brought to the ED by her husband for
altered mental status for 1 day. The patient has hypertension and diabetes
but has not been taking her medications for the last 5 days since she lost
her insurance and could not afford her prescriptions. Her BP is 168/91 mm Hg,
HR is 125 beats per minute, temperature is 99.8°F, and RR is 18 breaths per
minute. Her fingerstick glucose is 900 mg/dL. There is glucose in her urine,
but no ketones. Which of the following is the most appropriate next step in
management?
a. Administer IV fluids and insulin
b. Obtain head CT scan
c. Obtain ECG
d. Obtain chest radiograph and urine culture
e. Administer broad coverage antibiotics
270 Emergency Medicine