Answer: It would be reasonable to treat for suspected hypoglycemia given the patient’s blood glucose level and symptoms described. As you have astutely pointed out, the patient’s symptoms may be from their hypoglycemia as well as the trauma. One of the changes to the ALS-PCS v4.9 was the removal of the set prescriptive list of symptoms of hypoglycemia. No longer must a patient have “Agitation; OR Altered LOA; OR Seizure; OR Symptoms of a stroke”. This allows for paramedic clinical judgement in utilizing the Hypoglycemia Medical Directive.
In complex situations such as these, ensure you treat the life and limb threats (here utilizing spinal precautions, as you did) and consider all potential causes for the patient’s symptoms. As always, ensure to document your rationale for treatment and thought process.