Your Patient Is a 76-Year-Old Female Who Was Initially Lethargic

Your patient is a 76-year-old female who was initially lethargic but responded to verbal stimuli. According to family members, the patient experienced a sudden decrease in responsiveness. She had a left-sided facial droop, aphasia, a dilated and nonreactive right pupil, and a flaccid left arm. Lung sounds are decreased bilaterally. HR = 58, BP = 172/102, RR = 6 and shallow, SaO₂ = 88%. As you start to treat her, the patient has a generalized seizure lasting about 30 seconds. She is now unresponsive. Which of the following is most appropriate?

A) Intubation, IV of normal saline at a keep open rate, cardiac monitor, blood glucose determination, sublingual nitroglycerin spray, transport without delay
B) Hyperventilate by bag-valve mask, IV of normal saline at a keep open rate, check blood glucose level, administer 25 gm of dextrose if needed, administer naloxone and thiamine, intubate if no improvement, transport without delay
C) Intubation, IV of normal saline at a keep open rate, cardiac monitor, blood glucose determination, transport without delay
D) Hyperventilate by bag-valve mask, IV of normal saline at a keep open rate, diazepam 5 mg IV, intubate if no improvement, transport without delay