An 8-year-old girl with type 1 diabetes mellitus is brought

Discussion in 'USMLE Step 2 CK' started by Jones., Sep 20, 2008.

  1. Jones.

    Jones. Guest

    An 8-year-old girl with type 1 diabetes mellitus is brought to the emergency department 10 minutes after being involved in a motor vehicle collision. She was in the back seat of a small automobile that was rear-ended. Initially, she was alert during transport and reported bilateral thigh pain, but then she stopped talking, closed her eyes, and became unresponsive to voice; on arrival, she responds to noxious stimuli with brief grimaces and no withdrawal. Her blood pressure is 40/palpable mm Hg, pulse is 148/min, and respirations are 28/min. Air entry is symmetric. The pupils are equal and react to light. No cardiac murmur is heard. The abdomen is soft. There is swelling of the upper portions of both thighs. Her hematocrit is 37%. Which of the following is the most appropriate next step in management?

    A ) Measurement of arterial blood gases

    B ) X-ray film of the chest

    C ) CT scan of the head

    D ) Administration of 50% dextrose in water

    E ) Infusion of 0.9% saline
  2. Senior.

    Senior. Guest

    e of course
    50% D5 is hypertonic.
    you cannot give a hypertonic fluid in a hypovolemic hypotensive pt!
    50 % D5 is indicated only in hypoglycemic pts.
  3. Guest

    Guest Guest

    E. ABC's - Ariway stable, Now take care of Hypotension next

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