Ch15 eec3Diabetic Emergencies and Altered Mental Status
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  • 1. Chapter Diabetic Emergencies and Altered Mental Status Fifteen
  • 2. Chapter
    • Recognition and management of diabetic emergencies, including oral glucose
    • Recognition and management of seizures and stroke
    CORE CONCEPTS Fifteen
  • 3. Altered Mental Status K EY TERM Any mental status that is not normal or expected for that patient
  • 4. Causes of Altered Mental Status:
    • 4H Mnemonic
    • Hypoglycemia or hyperglycemia
    • Hypoxia
    • Hypovolemia (shock)
    • Head injury
  • 5. Patient CARE Altered Mental Status Emergency Care Steps
    • Secure airway.
    • Ventilate and suction as needed.
    • Transport.
    Treat patient as trauma patient if injury cannot be ruled out.
  • 6. D IABETIC EMERGENCIES
  • 7. Diabetes K EY TERM Condition brought about by decreased insulin production, which prevents the body’s cells from taking the simple sugar called glucose from the bloodstream
  • 8. Insulin allows sugar to pass from the bloodstream into the cells.
  • 9. Diabetes is treated with injections of insulin or oral medications.
  • 10. Diabetic patients test their blood glucose at home.
  • 11. Blood Glucose Meters
  • 12. Prepare blood glucose meter and test strip.
  • 13. Cleanse skin with alcohol prep.
  • 14. Use lancet to perform finger stick.
  • 15. Apply the blood to test strip.
  • 16. Read blood glucose test results.
  • 17. Blood Glucose Readings 80-120 mg/dl Normal 60-80 mg/dl Moderate hypoglycemia Below 50 mg/dl Severe hypoglycemia Above 140 mg/dl Hyperglycemia Question results that are inconsistent with patient’s condition.
  • 18. Causes of Inaccurate Reading
    • Meter not calibrated
    • Low batteries in meter
    • Improperly stored or expired test strip
    • Insufficient blood on test strip
  • 19. Hypoglycemia Hypoglycemia (low blood sugar) is a life-threatening emergency for people with diabetes. But it is one that the EMT-B can treat. K EY TERM
  • 20. Patient ASSESSMENT Diabetic Signs and Symptoms
    • Rapid onset ( just minutes) of altered
    mental status:
    • After taking insulin and missing a meal
    • After taking insulin and vomiting
    • After unusual amount of exercise
    • For unknown reason
    (Continued)
  • 21. Patient ASSESSMENT Diabetic Signs and Symptoms
    • Intoxicated appearance, staggering, slurred speech, unconsciousness
    • Cold, clammy skin
    (Continued)
  • 22. Patient ASSESSMENT Diabetic Signs and Symptoms
    • Rapid heart rate
    • Hunger
    • Seizures (in severe cases)
    • Insulin or oral antidiabetic medication
    (Continued)
  • 23. Patient ASSESSMENT Diabetic Signs and Symptoms
    • Unusual behavior
    • Anxiety
    • Refusal to cooperate or
    • combativeness
  • 24. Patient ASSESSMENT Diabetic Signs and Symptoms
    • Perform initial assessment.
    • Perform focused history and
    physical exam.
    • Get SAMPLE history.
    • Take baseline vital signs.
  • 25. Patient ASSESSMENT Diabetic Signs and Symptoms
    • Perform initial assessment.
    (Some hypoglycemic patients are unconscious. You must make sure the airway remains patent in these individuals.)
  • 26. Patient ASSESSMENT Diabetic Signs and Symptoms
    • Perform focused history and
    physical exam.
    • How did episode occur?
    • When did it start?
    • How long did it last?
    • Complaints of other symptoms?
    (Continued)
  • 27. Patient ASSESSMENT Diabetic Signs and Symptoms
    • Perform focused history
    and physical exam.
    • Trauma involved?
    • Has the patient seized?
    • Fever?
    • Interruptions in episode?
    (Continued)
  • 28. Patient ASSESSMENT Diabetic Signs and Symptoms
    • Get a SAMPLE history.
    If history of diabetes:
    • When did patient last eat?
    • What medications? When last taken?
    • Any other illnesses?
    • Can the patient swallow?
    (Continued)
  • 29. Patient ASSESSMENT Diabetic Signs and Symptoms
    • Take baseline vital signs.
    (In some areas, protocols direct the EMT-B to treat the patient before getting vital signs.) FOLLOW YOUR LOCAL PROTOCOL!
  • 30. Patient CARE Diabetic Emergencies Emergency Care Steps
    • Give oral glucose if all of these
    • History of diabetes
    • Altered mental status
    • Patient can swallow
    conditions are met:
  • 31. Patient CARE Diabetic Emergencies Emergency Care Steps
    • Reassess patient.
    • If patient becomes unconscious,
    stop glucose administration immediately and secure the airway!
    • If no improvement, consult
    medical direction.
  • 32. Patient CARE Diabetic Emergencies Emergency Care Steps
    • If patient is not awake enough
    • Secure airway.
    • Ventilate, if necessary.
    • Position appropriately.
    • Transport promptly.
    to swallow:
  • 33. A DMINISTRATION OF ORAL GLUCOSE
  • 34. Squeeze glucose onto tongue depressor and place between cheek and gums. If patient is awake enough, let her squeeze oral glucose into mouth.
  • 35. When glucose is gone, remove tongue depressor and reassess patient.
  • 36. If patient loses consciousness, remove tongue depressor, secure airway, and transport promptly.
  • 37. Oral Glucose
    • Altered mental status
    Indications with history of diabetes
    • Unconsciousness
    • Diabetic who has not
    taken insulin for days
    • Inability to swallow
    Contraindications
  • 38. Dosage
    • One tube
    Oral Glucose
  • 39. Administration
    • Assure altered mental status
    with history of diabetes.
    • Assure patient is conscious.
    Oral Glucose
  • 40. Administration
    • Administer glucose on
    tongue depressor between cheek and gum or let patient self-administer.
    • Perform ongoing assessment.
    Oral Glucose
  • 41.
    • Increases blood sugar
    Actions
    • None when given properly
    • May be aspirated if given
    to patient without gag reflex Side Effects Oral Glucose
  • 42. Reassessment Strategies
    • If patient seizes or loses
    consciousness, remove tongue depressor; secure airway. Oral Glucose
  • 43. Seizure Sudden change in sensation, behavior, or movement caused by irregular electrical activity of the brain K EY TERM
  • 44. Causes of Seizures
    • Poisoning
    • Brain tumor
    • Congenital brain defects
    • Infection
    • Trauma
    (Continued)
  • 45.
    • Epilepsy
    • Stroke
    • Hypoglycemia
    • Eclampsia
    • Hypoxia
    • Unknown
    (Complications of pregnancy) Causes of Seizures
  • 46. Patient ASSESSMENT Seizures Signs and Symptoms
    • What was patient doing before seizure?
    • What movements exhibited?
    • Loss of bladder or bowel control?
    • What did patient do after seizure?
    • Length of episode?
  • 47. Patient CARE Seizures Emergency Care Steps
    • Place patient on floor.
    • Position patient on side.
    • Loosen restrictive clothing.
    • Remove harmful objects.
    • Protect patient from injury; do not
    hold patient still. (Continued)
  • 48. Patient CARE Seizures Emergency Care Steps
    • After seizure subsides:
    • Protect airway with positioning
    and suction.
    • If cyanotic, ventilate with oxygen.
    • Treat injuries.
    • Transport.
  • 49. Status Epilepticus A life-threatening condition in which the patient has two or more convulsive seizures without regaining consciousness K EY TERM
  • 50. Patient CARE Status Epilepticus Emergency Care Steps
    • Transport immediately.
    • Secure the airway.
    • Attempt to ventilate with 100% oxygen.
  • 51. S TROKE
  • 52.
    • Death or injury of brain tissue that is deprived of oxygen.
    • Caused by:
      • Blockage or
      • Hemorrhage of a blood vessel in the brain
    Stroke
  • 53.
    • Prompt transport is critical.
    • Identify potential stroke patients and notify the hospital.
    Stroke
  • 54. Cincinnati Prehospital Stroke Scale Assess for 1) facial droop, 2) arm drift, and 3) slurred speech
  • 55. If the patient’s family members say he/she is just “acting a little strange” or “not him/herself ” the EMT-Basic should always consider the possibility of a diabetic emergency or stroke. Sometimes early symptoms of these medical problems are subtle and overlap. Becoming experienced at obtaining a history and understanding the medications that patients take can help you uncover clues to the problem the patient may be experiencing today. P RECEPTOR P EARL
  • 56. Signs & Symptoms of Stroke
    • Intoxicated appearance, slurred speech, unconsciousness
    • Severe headache, vision changes
    • One-sided weakness on body
    • Confusion
  • 57. Signs & Symptoms of Stroke
    • Loss of bladder/bowel control
    • Unequal pupils
    • High blood pressure
  • 58. Transient Ischemic Attack (TIA)
    • “ Mini-stroke”
    • Signs and symptoms of a stroke
    • Often resolved before EMS arrival
    • Symptoms resolve without treatment in less than 24 hours
    • Significant risk of having a “full” stroke
  • 59. Treatment of Stroke
    • Prompt transport is critical.
    • Identify potential stroke patients and notify the hospital.
    • Maintain airway; administer oxygen.
  • 60. Cincinnati Prehospital Stroke Scale Have patient attempt to smile.
  • 61. Cincinnati Prehospital Stroke Scale Have patient attempt to hold arms straight in front of them for 10 seconds.
  • 62. Cincinnati Prehospital Stroke Scale Evaluate patient’s speech.
  • 63.
    • Syncope is a brief loss of consciousness.
    • It can occur at any age; more common in elderly.
    • It may be an indicator of serious medical problem.
    Dizziness & Syncope
  • 64.
    • Hypovolemia
      • Trauma
      • Dehydration
    • Metabolic
      • Hypoglycemia
      • Stroke
      • Seizure
    Causes of Dizziness and Syncope (Continued)
  • 65.
    • Environmental/Toxicological
      • Alcohol/Drugs
      • Carbon Monoxide
      • Panic/Anxiety
    Causes of Dizziness and Syncope (Continued)
  • 66.
    • Cardiovascular
      • Fast or slow heart rates
      • Electrical system disturbance
      • Vagus nerve stimulation
    Causes of Dizziness and Syncope
  • 67.
    • Obtain a SAMPLE history.
    • Ask about onset time, activities.
    • Length of episode?
    • Any previous episodes?
    Assessment of Dizziness and Syncope (Continued)
  • 68.
    • Any medications for this condition?
    • Any nausea/vomiting/bowel changes?
    Assessment of Dizziness and Syncope
  • 69.
    • Administer high-concentration oxygen.
    • Loosen restrictive clothing.
    • Lay patient flat and elevate legs (if no suspected spinal injury).
    Treatment of Dizziness and Syncope (Continued)
  • 70.
    • Treat any associated injuries.
    • Request ALS and transport.
    Treatment of Dizziness and Syncope
  • 71. 1. List the signs and symptoms of hypoglycemia. 2. What are five causes of seizures? 3. Explain how to do the Cincinnati stroke scale. R EVIEW QUESTIONS