Approach to altered mental status (pediatrics) Quiz: Ace Your Exams

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A 17-year-old boy is brought to the emergency department (ED) by a parent for evaluation of altered mental status. The parent reports they found the patient in a bedroom 20 minutes before presentation to the ED, breathing but difficult to arouse. There is a past medical history of asthma controlled with as-needed albuterol. The parent notes the patient has been having a difficult year and is failing several classes. Temperature is 97.2 °F (36.2 °C), blood pressure is 105/60 mmHg, pulse is 65/min, respiratory rate is 12/min, oxygen saturation is 97% on room air. On physical examination, the patient is slumped slightly in bed and incoherent. Miosis is noted bilaterally. Cardiopulmonary examination is normal. Glasgow coma scale is 10. Bedside glucose is obtained and is 64 mg/dL. Which of the following is the best next step in management?

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Intravenous glucose

Ceftriaxone

Urine toxicology

Intubation and mechanical ventilation

Naloxone