An unresponsive 28-year-old female presents with hot, clammy skin and foul-smelling vaginal discharge. Her blood pressure is 86/58 and SpO2 is 92% on room air. What should you do?

• A. assist her ventilation.
• B. obtain a sample of the discharge for the hospital.
• C. remove her clothing and place a moistened sheet over her.
• D. administer oxygen.

Answer: (D)

In shock states, the immediate priority is to maximize oxygen delivery to tissues. This patient is unresponsive with hypotension and signs that suggest poor perfusion, and her SpO2 on room air is 92%—not ideal in a scenario where circulation is compromised. Providing supplemental high-concentration oxygen quickly raises the amount of oxygen carried in the blood and helps ensure vital organs receive the oxygen they need while you assess and address the underlying cause and prepare for transport.

The other actions don’t directly stabilize the patient’s oxygenation or perfusion. Obtaining a discharge sample won’t improve survival in the moment, removing clothing and placing a moistened sheet doesn’t address the life-threatening issue at hand, and assisted ventilation is indicated only if the patient’s breathing is inadequate or absent. Start with oxygen now, then assess airway, breathing, and circulation and escalate as needed.