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Ch15 eec3Diabetic Emergencies and Altered Mental Status
 

Ch15 eec3Diabetic Emergencies and Altered Mental Status

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    Ch15 eec3Diabetic Emergencies and Altered Mental Status Ch15 eec3Diabetic Emergencies and Altered Mental Status Presentation Transcript

    • Chapter Diabetic Emergencies and Altered Mental Status Fifteen
    • Chapter
      • Recognition and management of diabetic emergencies, including oral glucose
      • Recognition and management of seizures and stroke
      CORE CONCEPTS Fifteen
    • Altered Mental Status K EY TERM Any mental status that is not normal or expected for that patient
    • Causes of Altered Mental Status:
      • 4H Mnemonic
      • Hypoglycemia or hyperglycemia
      • Hypoxia
      • Hypovolemia (shock)
      • Head injury
    • 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.
    • D IABETIC EMERGENCIES
    • 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
    • Insulin allows sugar to pass from the bloodstream into the cells.
    • Diabetes is treated with injections of insulin or oral medications.
    • Diabetic patients test their blood glucose at home.
    • Blood Glucose Meters
    • Prepare blood glucose meter and test strip.
    • Cleanse skin with alcohol prep.
    • Use lancet to perform finger stick.
    • Apply the blood to test strip.
    • Read blood glucose test results.
    • 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.
    • Causes of Inaccurate Reading
      • Meter not calibrated
      • Low batteries in meter
      • Improperly stored or expired test strip
      • Insufficient blood on test strip
    • 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
    • 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)
    • Patient ASSESSMENT Diabetic Signs and Symptoms
      • Intoxicated appearance, staggering, slurred speech, unconsciousness
      • Cold, clammy skin
      (Continued)
    • Patient ASSESSMENT Diabetic Signs and Symptoms
      • Rapid heart rate
      • Hunger
      • Seizures (in severe cases)
      • Insulin or oral antidiabetic medication
      (Continued)
    • Patient ASSESSMENT Diabetic Signs and Symptoms
      • Unusual behavior
      • Anxiety
      • Refusal to cooperate or
      • combativeness
    • Patient ASSESSMENT Diabetic Signs and Symptoms
      • Perform initial assessment.
      • Perform focused history and
      physical exam.
      • Get SAMPLE history.
      • Take baseline vital signs.
    • 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.)
    • 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)
    • Patient ASSESSMENT Diabetic Signs and Symptoms
      • Perform focused history
      and physical exam.
      • Trauma involved?
      • Has the patient seized?
      • Fever?
      • Interruptions in episode?
      (Continued)
    • 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)
    • 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!
    • 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:
    • 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.
    • Patient CARE Diabetic Emergencies Emergency Care Steps
      • If patient is not awake enough
      • Secure airway.
      • Ventilate, if necessary.
      • Position appropriately.
      • Transport promptly.
      to swallow:
    • A DMINISTRATION OF ORAL GLUCOSE
    • Squeeze glucose onto tongue depressor and place between cheek and gums. If patient is awake enough, let her squeeze oral glucose into mouth.
    • When glucose is gone, remove tongue depressor and reassess patient.
    • If patient loses consciousness, remove tongue depressor, secure airway, and transport promptly.
    • Oral Glucose
      • Altered mental status
      Indications with history of diabetes
      • Unconsciousness
      • Diabetic who has not
      taken insulin for days
      • Inability to swallow
      Contraindications
    • Dosage
      • One tube
      Oral Glucose
    • Administration
      • Assure altered mental status
      with history of diabetes.
      • Assure patient is conscious.
      Oral Glucose
    • Administration
      • Administer glucose on
      tongue depressor between cheek and gum or let patient self-administer.
      • Perform ongoing assessment.
      Oral Glucose
      • Increases blood sugar
      Actions
      • None when given properly
      • May be aspirated if given
      to patient without gag reflex Side Effects Oral Glucose
    • Reassessment Strategies
      • If patient seizes or loses
      consciousness, remove tongue depressor; secure airway. Oral Glucose
    • Seizure Sudden change in sensation, behavior, or movement caused by irregular electrical activity of the brain K EY TERM
    • Causes of Seizures
      • Poisoning
      • Brain tumor
      • Congenital brain defects
      • Infection
      • Trauma
      (Continued)
      • Epilepsy
      • Stroke
      • Hypoglycemia
      • Eclampsia
      • Hypoxia
      • Unknown
      (Complications of pregnancy) Causes of Seizures
    • 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?
    • 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)
    • Patient CARE Seizures Emergency Care Steps
      • After seizure subsides:
      • Protect airway with positioning
      and suction.
      • If cyanotic, ventilate with oxygen.
      • Treat injuries.
      • Transport.
    • Status Epilepticus A life-threatening condition in which the patient has two or more convulsive seizures without regaining consciousness K EY TERM
    • Patient CARE Status Epilepticus Emergency Care Steps
      • Transport immediately.
      • Secure the airway.
      • Attempt to ventilate with 100% oxygen.
    • S TROKE
      • Death or injury of brain tissue that is deprived of oxygen.
      • Caused by:
        • Blockage or
        • Hemorrhage of a blood vessel in the brain
      Stroke
      • Prompt transport is critical.
      • Identify potential stroke patients and notify the hospital.
      Stroke
    • Cincinnati Prehospital Stroke Scale Assess for 1) facial droop, 2) arm drift, and 3) slurred speech
    • 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
    • Signs & Symptoms of Stroke
      • Intoxicated appearance, slurred speech, unconsciousness
      • Severe headache, vision changes
      • One-sided weakness on body
      • Confusion
    • Signs & Symptoms of Stroke
      • Loss of bladder/bowel control
      • Unequal pupils
      • High blood pressure
    • 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
    • Treatment of Stroke
      • Prompt transport is critical.
      • Identify potential stroke patients and notify the hospital.
      • Maintain airway; administer oxygen.
    • Cincinnati Prehospital Stroke Scale Have patient attempt to smile.
    • Cincinnati Prehospital Stroke Scale Have patient attempt to hold arms straight in front of them for 10 seconds.
    • Cincinnati Prehospital Stroke Scale Evaluate patient’s speech.
      • 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
      • Hypovolemia
        • Trauma
        • Dehydration
      • Metabolic
        • Hypoglycemia
        • Stroke
        • Seizure
      Causes of Dizziness and Syncope (Continued)
      • Environmental/Toxicological
        • Alcohol/Drugs
        • Carbon Monoxide
        • Panic/Anxiety
      Causes of Dizziness and Syncope (Continued)
      • Cardiovascular
        • Fast or slow heart rates
        • Electrical system disturbance
        • Vagus nerve stimulation
      Causes of Dizziness and Syncope
      • Obtain a SAMPLE history.
      • Ask about onset time, activities.
      • Length of episode?
      • Any previous episodes?
      Assessment of Dizziness and Syncope (Continued)
      • Any medications for this condition?
      • Any nausea/vomiting/bowel changes?
      Assessment of Dizziness and Syncope
      • Administer high-concentration oxygen.
      • Loosen restrictive clothing.
      • Lay patient flat and elevate legs (if no suspected spinal injury).
      Treatment of Dizziness and Syncope (Continued)
      • Treat any associated injuries.
      • Request ALS and transport.
      Treatment of Dizziness and Syncope
    • 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