A man finds his 59-year-old wife unconscious on the couch. She takes medications for type 2 diabetes and has been ill recently and has not eaten for the past 24 hours. What is the most appropriate first action?

• A. open and maintain her airway and assess breathing
• B. assess for the presence of a medical identification tag
• C. administer 100% oxygen via a nonrebreathing mask
• D. administer oral glucose between her cheek and gum

Answer: (A)

In an unconscious patient, the immediate priority is the airway and breathing. If the airway isn’t open or the person isn’t breathing adequately, brain and vital organs can be damaged within minutes, regardless of the underlying cause. Even though a diabetic patient who hasn’t eaten suggests hypoglycemia as a possibility, you cannot give oral glucose when someone is unconscious because they may choke or aspirate. Securing and checking the airway and ensuring effective breathing takes precedence before any other interventions.

That’s why opening and maintaining the airway and assessing breathing is the best first action. After you confirm airway patency and breathing, you can decide on rescue breaths or CPR if needed, and then look for signs of hypoglycemia only when the person’s airway and ventilation are stabilized.