Clinical scenario week 5: · Learn Emergency Medicine

Clinical scenario week 5:

Early in the morning, an ambulance is requested to a private residence after a colleague has been unable to reach the patient prior to work. When the door is opened by a family member, the patient is found lying in bed and appears significantly unwell.

The patient is a 42-year-old male with a known history of type 1 diabetes mellitus. He is drowsy and difficult to engage but responds weakly to verbal stimuli. He appears pale and diaphoretic, with rapid, shallow breathing. A faint sweet odor is noted on his breath.

His airway is patent, and he is breathing spontaneously. Respiratory rate is 24 breaths per minute. Heart rate is 110 beats per minute and regular, blood pressure is 115/70 mmHg, and oxygen saturation is 97% on room air. Capillary blood glucose is measured at 28 mmol/L.

Further examination reveals no signs of trauma. The patient has dry skin and dry mucous membranes. According to family members, he has experienced nausea, abdominal pain, and reduced oral intake over the past 24 hours. He uses insulin daily, but it is unclear whether he has administered his usual doses during the past day.

Questions

Which findings in this case suggest diabetic ketoacidosis, and why?
Which prehospital interventions should be prioritized to stabilize the patient prior to hospital arrival?

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