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INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please manage this emergency.

Scenario

You are driving to work along the local high street. You see a cyclist swerve across the road and fall off her bicycle. You stop your car and grab your emergency equipment and drugs.

INSTRUCTIONS FOR THE PATIENT, CARRIE PATTERSON

You are 28 years old and have had insulin-dependent diabetes for 15 years. You have just moved to this area for work as a barmaid. You enjoy the work but the late hours make it difficult to control your blood sugar.

You wear a medical alert bracelet on your wrist that says you are an insulin-dependent diabetic.

This morning you set off on your bike to do some shopping. You began to feel hypoglycaemic but did not have any snacks with you. One minute you were riding along, the next thing you know is that you’re lying on the pavement next to your bicycle. This case begins with you lying beside your bicycle on the side of the road. A local GP comes up to you. You are able to say your name but mumble it slowly. If you are asked if you are diabetic, you can mumble ‘Yes’.

You will recover quickly when the doctor gives you either:

  • an injection of intravenous glucose

  • an injection of glucagon IM, IV or SC, or

  • oral/rectal glucose.

The following information is on your medical record at your own GP’s surgery:

  • Past medical history

  • Insulin-dependent diabetes since age 13

  • Medication

  • Long-acting insulin glargine (Lantus 25 u at night)

  • Long-acting insulin mixed with short-acting insulin (Mixtard 30/70 42 u mane, 18 nocte)

  • Short-acting insulin (Novorapid 6–12 u before meals tds)

  • Allergies

  • Nil

  • Immunisations

  • Up-to-date

  • Social history

  • Employed as a barmaid.

SUGGESTED APPROACH TO THE CASE

Primary survey

DRABCDE

Danger—check for any danger at the scene, park car safely, use passers-by to divert traffic if repositioning the patient, make comment on spine precautions

Response—check for any response, person able to mumble their name

Airway—maintain cervical spine precautions

  • — Airway clear, as person able to mumble name

  • — Apply neck collar or manual in-line head and neck stabilisation

Breathing and ventilation—breathing regular and symmetrical with no added sounds

Circulation with haemorrhage control—ability to mumble name suggests brain perfusion

  • — No evidence of external haemorrhage

Disability—Glasgow Coma Scale 14

  • — Eye opening response—opens eyes spontaneously (4)

  • — Verbal response—says name, but not sure where they are and what happened (4)

  • — Motor response—does everything you ask (6)

E...

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