A 60 - year - old male diabetic and hypeensive patient was found unconscious in the morning. On examination pulse - 120/min, bp-160/100 mm Hg and bilateral extensor plantars are elicited. . What is next step to be done for management?
"In any unconscious diabetic patient first evaluate the CNS event Capillary Blood sugar and urinary ketones of patient" Option a - CT scan to evaluate damage, Hypeensive encephalopathy, stroke,cerebrovascular accident. Option b - If question asked Next step, patient is Diabetic, unconscious so it could be a simple hypoglycemia then he could have seizure, resulted in extensor planter in patient he could be in post ictal deficit. Option c - Ruled out because there is no evidence of raised ICP Raised ICP - | HR with | BP Mannitol is given for Cushing reflex, papilledema, Ventricular dilation. Option d- No immediate reduction of BP with other antihypeension. Conceptual permissive Hypeension Keep the BP on the higher side in patient with CNS events because that maintain the perfusion of brain. Cerebral perfusion pressure= Mean Aerial pressure-ICP If we | MAP the perfusion of brain will also reduce. CPP=MAP-ICP
Order CT scan
Check blood glucose
Give Intravenous mannitol
Immediately reduces by with antihypeensives
Diabetes Mellitus