Altered Mental Status 269251.A 19-year-old college student presents to the ED complaining of
headache, sore throat, myalgias, and rash that developed over the previous
12 hours. Her BP is 95/60 mm Hg, HR is 132 beats per minute, temperature
is 103.9°F, RR is 19 breaths per minute, and oxygen saturation is 98% on
room air. She is confused and oriented only to person. Physical examina-
tion is remarkable for pain with neck flexion, a petechial and purpuric rash
on her extremities, and delayed capillary refill. Which of the following best
describes the emergency physicians’ priority in managing this patient?
a. Collect two sets of blood cultures prior to antibiotic administration.
b. Call the patient’s parents and have them come immediately to the hospital.
c. Call her roommate to gather more information.
d. Begin fluid resuscitation, administer intravenous (IV) antibiotics, and perform
a lumbar puncture (LP).
e. Administer acetaminophen to see if her headache and fever resolve.
252.A 21-year-old college student is brought to the ED by her roommate
who states that the patient has been very sleepy today. She has a history of
diabetes and has not refilled her medication in over a week. Her BP is
95/61 mm Hg, HR is 132 beats per minute, temperature is 99.7°F, and RR
is 20 breaths per minute. Her fingerstick glucose is 530 mg/dL. Which of
the following choices most closely matches what you would expect to find
on her arterial blood gas with electrolytes and urinalysis?
a. pH 7.38, anion gap 5, normal urinalysis
b. pH 7.57, anion gap 21, presence of glucose and leukocytes in urine
c. pH 7.47, anion gap 12, presence of glucose and ketones in urine
d. pH 7.26, anion gap 12, presence of glucose and ketones in urine
e. pH 7.26, anion gap 21, presence of glucose and ketones in urine
253.A 65-year-old actively seizing woman is brought to the ED by EMS. She
was found slumped over at the bus stop bench. EMS personnel state that
when they found the woman she was diaphoretic and her speech was garbled.
En route to the hospital, she started to seize. As you wheel her to a room, the
nurse gives you some of her vital signs which are a BP of 150/90 mm Hg,
HR of 115 beats per minute, and oxygen saturation of 96%. Which of the
following is the next best step in managing this patient?
a. Request a rectal temperature to rule out meningitis.
b. Call the CT technologist and tell them you are bringing over a seizing patient.
c. Ask for a stat ECG and administer an aspirin.
d. Check the patient’s fingerstick blood glucose level.
e. Intubate the patient.