Clinical scenario: Unresponsive male found by housekeeper

You are asked to respond to the fitness room at a local hotel

"Engine 3, Medic 1 response Code 3 to 164 Eastlawn Dr, in the workout room of the hotel behind the lobby for a report of an unresponsive male."

The engine comes to a stop and you walk into the lobby where you are met by a man who identifies himself as the on-duty manager, Steven. He guides you back to a small workout room off of the main lobby where a member of the housekeeping staff is with a man lying supine on a weight bench who appears to be unresponsive.

The staff member states that she came into the room approximately 20 minutes ago to collect towels and that she saw your patient working out. When she returned 15 minutes later with fresh towels, he was not responsive, lying on the bench where you find him.

As you perform a primary surve, you find that his eyes are closed and that he does not respond to verbal or painful stimulus. Your patient has irregular, snoring respirations. His upper extremities are held against his chest and when you check his pupils with a penlight you find that both are dilated and respond sluggishly to light.

There are no evident signs of trauma or obvious mechanisms for traumatic injury as you survey the room so you open the patient’s airway with a head-tilt chin-lift. With an open airway, the patient stops snoring but still presents with irregular respirations. The second firefighter from your engine assembles the BVM and begins ventilating the patient.

The patient’s vital signs are:

  • BP: 168/94
  • HR: 54
  • RR: 8 to 24, irregular
  • SpO2: 99% on supplemental O2

With the patient’s airway and breathing managed, you perform a secondary assessment. There are no findings consistent with trauma and no clues about his medical history. The patient is not carrying identification. Your ALS transport unit is five minutes away.

Think about these questions as you consider what to do next:

  • What other assessments would you perform?
  • What is your working diagnosis?
  • What additional treatment options are you considering?
  • Should you administer Narcan intranasal?

Post your answers below in the comments and view the clinical solution for this patient.

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