Remember the basics

We got a patient by ambulance awhile back that arrived with a police escort and in four-point restraints. He had been found laying in the middle of the road, screaming incoherently and became agitated and combative when the police tried to remove him from the road.

The police assumed he was a psych patient and/or on meth.

The EMS providers assumed he was a psych patient and/or on meth.

The ER nurse AND the ER MD assumed he was a psych patient and/or on meth. He was a transient and had never been in our ER.

The routine screening labs were done and some Ativan was given without much effect. About the time more sedation was going to be given the lab called with a critical value - the patient's blood sugar was 23!

1 amp of glucose was given and Viola! the patient was awake, alert, oriented and cooperative. It turns out he was a diabetic and had used his insulin as usual and was trying to beg enough money to get some lunch - the reason he was in the middle of the road.

Things are not always what they seem. Sometime new staff take everything at face value and forget the basics of ER nursing.

ALTERED MENTAL STATUS CAN BE HYPOGLYCEMIA UNTIL PROVEN OTHERWISE! ALWAYS CHECK A BLOOD SUGAR! It only takes a minute or two