A middle-aged man comes after a road traffic accident with bleeding from the scalp. He is unconscious. A card in his pocket reveals that he is a known diabetic on Tab Glimepiride + Metformin 2 tablets twice daily. What should the next step in management?
Send blood for tests, sta IV glucose and send to CT
Sta normal saline and send to CT
Dextrose solution, CT scan
Airway, CT scan. Blood sugar if <70 sta dextrose
Ans: D.Airway, CT scan. Blood sugar if <70 sta dextrose (Ref Harrison 19/e p2435, 18/e p3008; ATLS 9/e 2013; 72(5): p1363-1366)First testing of blood sugar necessary before glucose administration for dehydration.To rule out diabetic ketoacidotic coma rather than hypoglycemia.Non-contrast head CT (NCCT):Advisable in emergency situations.To avoid cerebral edema due to glucose administration.