We responded to a report of a 25 year old male unconscious. No other information. Well, this could be anything. It turned out to be a combination of things. When we arrived on scene, we found our patient passed out in the driveway just outside the front door of the house. There were a couple of steps up to the door and at the top of the steps sat an empty wheelchair. According to the other people on scene, they were bringing him into the house in the wheelchair and he fell out face first on to the cement. They had rolled him over to his back which is how we found him. He didn't have any obvious trauma or bleeding of any kind although he was incontinent to urine (maybe more). I don't know how hard he hit the ground but he was out, out, out. I directed the firefighter to take manual c-spine and asked about the patients medical history and if he was perhaps diabetic. He was. I checked his sugar and it came back at 57. Now, this is low and low enough to be treated with IV glucose, but not so low that he should be this unconscious. So what was the real cause here? Did he fall out because he was hypoglycemic or did the fall knock him out and he also happens to be a little low on blood sugar? Chicken/egg, egg/chicken.
Well, the low blood sugar I can fix so we started there. Unbeknownst to me, while I was getting the blood sugar, my captain (also a medic but usually working the clipboard and not the patient) had begun setting up for the IV. I gave the firefighter the IV bag to spike and flood. He had to hold c-spine with his knees while he flooded the bag but the patient was so deeply unconscious he wasn't moving anyway. I started looking for IV access on the other arm just in case the captain didn't get it but since he had a headstart he got the IV (his first in about a year I think) before me. I got the glucose ready while the captain secured the IV and, warning the firefighter to be ready on the c-spine for when this guy woke up, pushed the sugar in. The ambulance crew arrived at this time and began setting up for full spinal precautions (rigid neck collar, long backboard, pads and tape for his head, and straps to hold him to the board).
The patient started to come around with the sugar on board and could now talk to us. I'm still not convinced this was purely a sugar problem alone since 57 really isn't that low, but it got our patient back to alert and oriented before he went off to the hospital.
There wasn't really any major chaos or anxiety, but I appreciated how all the jobs got done, and done well, with a minimum of verbal communication. Everybody knew what needed to be done and did what the other person wasn't doing. We had a bit of a confusing mystery, more or less solved and a patient who was deeply unconscious in the driveway talking and answering questions by the time the ambulance arrived. The firefighter was multi-tasking, the captain was using his rusty medic skills, and all the right care was being given. When scenes run smooth and the outcome is good it just make you appreciate professionals.
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