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You have been assigned 4 patients on an Intermediate Medical Care Unit. Two of the patients are post myocardial infarctions at various stages of their infarctions with multiple types of arrhythmias, the third patient is having drastic blood sugar fluctuations 218 down to 50 within minutes and its rebounds back up with changes in mentation and the fourth is reported to be having frequent TIA's. One of the MI patients is having some dizziness and your TIA patient is presenting signs of impending stroke.

How to prioritize these patients? 

Okay so  I need some help figuring this out.

So, I have 4 patients 1. Post myocardial infarction w/ dizziness 2. Post myocardial infarction 3. Blood sugar 218 down to 50 in minutes goes up with meds/ change in mentation 4. Frequent TIA’s with impending stroke signs.  Patient one could be at risk for a heart attack with the sign of dizziness right? and patient 4 is possibly on the verge of a stroke and patient 2 I'm unsure about. Patient 3 I would put last most likely because his blood sugar will be up after meds but changes in mentation worry me. 

Initial though of priority was: 4, 1, 2, 3.  what are your thoughts?

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    I would say 4,3,1,2. In my opinion the low blood sugar takes precedence over dizziness in a post-infact patient. The dizziness is the only symptom mentioned, so IMO there is no need for immediate action. A blood sugar of 50 is really low, and needs to be addressed ASAP since they are at risk for a seizure or diabetic coma. 

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    Just as a general rule of thumb, change in mentation is always a very big RED FLAG. It means something is very wrong and needs it be fixed very fast. A blood sugar of 50 is hypoglycemic and needs to be fixed STAT with juice or glucose tablets if conscious or IV dextrose if unconscious. A hypoglycemic blood sugar should never ever be left to wait.

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    On 2/1/2021 at 1:58 PM, Kait L said:

    third patient is having drastic blood sugar fluctuations 218 down to 50 within minutes and its rebounds back up with changes in mentation and the fourth is reported to be ha

    Without any intervention?

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    • Expert
    On 2/14/2021 at 4:54 PM, londonflo said:

    Without any intervention? 

    Excellent point. I would get somebody else to get a different glucometer and check these, because NOBODY does this unless something else is going on. OTOH, this is a homework assignment and the person who wrote it is likely focusing only on whether the student knows about symptoms without asking whether the student knows about actual care situations.

    Normally I don't do somebody's homework, preferring to hear what they thought first, and then to lead them through a decision tree. This student has done that, so kudos is due. (Kudos is a singular word, BTW. No extra charge ? )

    If it were me with that patient load, I'd ask for help as a first priority (hah, like I'd get it, I hear you say. Point taken). Impending stroke is an emergency and requires the most attention, as in, at the bedside. You don't want to discover that the side of the face went slack, level of consciousness faded, and the arm and leg went limp fifteen or 60 minutes after the event.

    Yes, crashing/unstable BG is bad and can have bad consequences, but can be reversed or at least controlled at bedside in a way that a stroke cannot. Besides, it's easy to fix a BG of 50 c some D50W, and 210 isn't that bad in the infinite scheme of things; a little high is less dangerous to brain function than too low.

    If the MIs' arrhythmias (unspecified, BTW) are stable, you have decent telemetry and a reliable tech, and VS are stable, eyeball but not much to do right away.

    That's my take. Of course all of them need more data, but this is what you have at the moment.

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