You are dispatched to a residence for an "ill person." Upon arrival, you enter the residence and find the patient, a 72-year-old woman, lying on the couch; she is responsive to pain only. Her son, who arrived shortly before you, tells you that her air conditioner went out, and that he came over to her house to pick her up and found her in her present condition. He further tells you that his mother has diabetes, hypertension, and congestive heart failure. Assessment of the patient reveals that her skin is flushed, hot, and dry; her pulse is rapid and weak; and her blood pressure is low. After moving the patient to the ambulance and applying high-flow oxygen, you should next:
A) remove any bulky clothing, assess her temperature, begin active cooling if her temperature is greater than 105°F, and start a large-bore IV with normal saline.
B) intubate her to protect her airway, apply chemical ice packs to her trunk area only, start an IV and give a normal saline bolus, and assess her axillary temperature.
C) cover her with sheets that are soaked with water, start a large-bore IV and give a 20-mL/kg fluid bolus, and administer 50% dextrose for presumed hypoglycemia.
D) strip her to her underclothing, begin rapid cooling measures, assess her rectal temperature if possible, establish vascular access, and assess her blood glucose level.
Answer: D) strip her to her underclothing, begin rapid cooling measures, assess her rectal temperature if possible, establish vascular access, and assess her blood glucose level.
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