Medical Emergencies · patient case question
During a different appointment a patient is returned to the upright position and immediately reports feeling dizzy and light-headed. What is the most appropriate next step?
Patient case: Type 1 diabetic who skipped breakfast
Patient: Male, 31 years old
Chief Complaint: Attends a morning appointment for a restoration.
Background: Type 1 diabetes on a basal-bolus insulin regimen. He took his usual morning insulin but forgot to eat breakfast before leaving the house.
Current Findings: Twenty minutes into the appointment he becomes pale, sweaty and shaky, and reports feeling dizzy and confused. He is conscious and able to swallow.
Vital Signs: BP 118/72 mmHg · HR 104 bpm · Respirations 18/min
Show answer and explanation
Correct answer: A. Return the patient to the supine position
- A. CORRECT. This is orthostatic (postural) hypotension from rapid repositioning — blood pools in the lower limbs and cerebral perfusion falls transiently. Returning the patient supine restores cerebral blood flow immediately and prevents a syncopal episode. Bring the chair up slowly afterwards, in stages.
- B. Nitroglycerin is a vasodilator. It would lower blood pressure further and worsen the situation. It is for anginal chest pain.
- C. Emergency services are unnecessary for a self-limiting postural episode that resolves on repositioning.
- D. Oxygen does not correct the problem while the patient remains upright; the issue is perfusion, not oxygenation.
Note: This is why the chair is raised in stages, and why patients on antihypertensives, older patients and pregnant patients are given a moment seated on the edge of the chair before standing.
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