Do not give an opioid, tramadol, benzodiazepine, or sedating muscle relaxant to someone who has consumed alcohol because of additive respiratory and CNS depression.

With RBS 300 mg/dL, the person needs urgent clinical assessment today, especially if they have vomiting, abdominal pain, deep/rapid breathing, drowsiness, confusion, dehydration, fever, or cannot keep fluids down. Check ketones, electrolytes, renal function, and look for infection or diabetic ketoacidosis/hyperosmolar state. A tendon injury also needs examination and often splinting to exclude rupture.

For pain while awaiting assessment:

Avoid giving oral ibuprofen, naproxen, diclofenac, ketorolac, or aspirin until a clinician checks hydration and kidney function, because glucose of 300 can accompany dehydration or renal impairment. Alcohol also raises GI bleeding risk with NSAIDs.

Avoid paracetamol/acetaminophen if the person is heavily intoxicated, drinks heavily or chronically, has liver disease, is malnourished, or may have taken another acetaminophen-containing product. Do not combine it with alcohol without clinician advice.

If there is deformity, inability to actively move the involved joint/digit, a cut over the tendon, numbness, a pale/cold limb, or severe escalating pain, go to the emergency department immediately.

Ketonov is usually ketorolac, an NSAID. Because this person has recent alcohol intake and RBS 300 mg/dL, I would not repeat the IM injection without in-person medical review. Hyperglycemia can mean dehydration or kidney impairment, which makes ketorolac more likely to cause acute kidney injury; alcohol also increases stomach bleeding risk.

If a clinician has assessed them, confirmed they are hydrated with acceptable renal function, and the ampoule was 30 mg ketorolac, standard adult repeat dosing is:

Ketorolac must be used for no more than 5 days total and must not be combined with ibuprofen, diclofenac, naproxen, aspirin, or other NSAIDs. The manufacturer advises against increasing the dose or frequency for breakthrough pain. FDA ketorolac label

Important: do not repeat it if there is vomiting, poor urine output, dehydration, abdominal pain, black stools/blood in vomit, kidney disease, ulcer/previous GI bleed, blood thinner use, NSAID allergy/asthma reaction, or pregnancy.

With glucose around 300 mg/dL, seek urgent assessment now, particularly if there is nausea/vomiting, abdominal pain, marked thirst/urination, drowsiness, confusion, rapid/deep breathing, or ketones.