Chapter Diabetic  Emergencies and Altered  Mental Status Fifteen
Chapter <ul><li>Recognition and management of   diabetic emergencies, including   oral glucose </li></ul><ul><li>Recogniti...
Altered Mental Status K EY TERM Any mental status that is not normal or expected for that patient
Causes of Altered Mental Status: <ul><li>4H Mnemonic </li></ul><ul><li>Hypoglycemia or hyperglycemia </li></ul><ul><li>Hyp...
Patient  CARE Altered Mental Status Emergency Care Steps <ul><li>Secure airway. </li></ul><ul><li>Ventilate and suction as...
D IABETIC EMERGENCIES
Diabetes K EY TERM Condition brought about by decreased insulin production, which prevents the body’s cells from taking th...
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...
Causes of Inaccurate Reading <ul><li>Meter not calibrated </li></ul><ul><li>Low batteries in meter </li></ul><ul><li>Impro...
Hypoglycemia Hypoglycemia (low blood sugar) is a  life-threatening emergency for people with diabetes.  But it is one that...
Patient  ASSESSMENT Diabetic Signs and Symptoms <ul><li>Rapid onset (   just minutes) of altered </li></ul>mental status: ...
Patient  ASSESSMENT Diabetic Signs and Symptoms <ul><li>Intoxicated appearance, staggering,    slurred speech, unconscious...
Patient  ASSESSMENT Diabetic Signs and Symptoms <ul><li>Rapid heart rate </li></ul><ul><li>Hunger </li></ul><ul><li>Seizur...
Patient  ASSESSMENT Diabetic Signs and Symptoms <ul><li>Unusual behavior </li></ul><ul><li>Anxiety </li></ul><ul><li>Refus...
Patient  ASSESSMENT Diabetic Signs and Symptoms <ul><li>Perform initial assessment. </li></ul><ul><li>Perform focused hist...
Patient  ASSESSMENT Diabetic Signs and Symptoms <ul><li>Perform initial assessment. </li></ul>(Some hypoglycemic patients ...
Patient  ASSESSMENT Diabetic Signs and Symptoms <ul><li>Perform focused history and </li></ul>physical exam. <ul><li>How d...
Patient  ASSESSMENT Diabetic Signs and Symptoms <ul><li>Perform focused history  </li></ul>and physical exam. <ul><li>Trau...
Patient  ASSESSMENT Diabetic Signs and Symptoms <ul><li>Get a SAMPLE history. </li></ul>If history of diabetes: <ul><li>Wh...
Patient  ASSESSMENT Diabetic Signs and Symptoms <ul><li>Take baseline vital signs. </li></ul>(In some areas, protocols dir...
Patient  CARE Diabetic Emergencies Emergency Care Steps <ul><li>Give oral glucose if all of these  </li></ul><ul><li>Histo...
Patient  CARE Diabetic Emergencies Emergency Care Steps <ul><li>Reassess patient. </li></ul><ul><li>If patient becomes unc...
Patient  CARE Diabetic Emergencies Emergency Care Steps <ul><li>If patient is not awake enough </li></ul><ul><li>Secure ai...
A DMINISTRATION OF ORAL GLUCOSE
Squeeze glucose onto  tongue depressor and place between  cheek and gums. If patient is awake enough,  let her squeeze ora...
When glucose is gone, remove tongue depressor and reassess patient.
If patient loses consciousness, remove tongue depressor, secure airway, and transport promptly.
Oral Glucose <ul><li>Altered mental status </li></ul>Indications with history of diabetes <ul><li>Unconsciousness  </li></...
Dosage <ul><li>One tube </li></ul>Oral Glucose
Administration <ul><li>Assure altered mental status  </li></ul>with history of diabetes. <ul><li>Assure patient is conscio...
Administration <ul><li>Administer glucose on  </li></ul>tongue depressor between cheek and gum or let patient self-adminis...
<ul><li>Increases blood sugar </li></ul>Actions <ul><li>None when given properly </li></ul><ul><li>May be aspirated if giv...
Reassessment Strategies <ul><li>If patient seizes or loses </li></ul>consciousness, remove tongue depressor; secure airway...
Seizure Sudden change in sensation, behavior, or movement caused by irregular electrical activity of the brain K EY TERM
Causes of Seizures <ul><li>Poisoning </li></ul><ul><li>Brain tumor </li></ul><ul><li>Congenital brain defects </li></ul><u...
<ul><li>Epilepsy </li></ul><ul><li>Stroke </li></ul><ul><li>Hypoglycemia </li></ul><ul><li>Eclampsia </li></ul><ul><li>Hyp...
Patient  ASSESSMENT Seizures Signs and Symptoms <ul><li>What was patient doing before seizure? </li></ul><ul><li>What move...
Patient  CARE Seizures Emergency Care Steps <ul><li>Place patient on floor. </li></ul><ul><li>Position patient on side. </...
Patient  CARE Seizures Emergency Care Steps <ul><li>After seizure subsides: </li></ul><ul><li>Protect airway with position...
Status Epilepticus A life-threatening condition in which the patient has two or more convulsive seizures without regaining...
Patient  CARE Status Epilepticus Emergency Care Steps <ul><li>Transport immediately. </li></ul><ul><li>Secure the airway. ...
S TROKE
<ul><li>Death or injury of brain tissue  that is deprived of oxygen. </li></ul><ul><li>Caused by: </li></ul><ul><ul><li>Bl...
<ul><li>Prompt transport is critical. </li></ul><ul><li>Identify potential stroke  patients and notify the  hospital. </li...
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 ...
Signs & Symptoms of Stroke <ul><li>Intoxicated appearance, slurred speech, unconsciousness </li></ul><ul><li>Severe headac...
Signs & Symptoms of Stroke <ul><li>Loss of bladder/bowel control </li></ul><ul><li>Unequal pupils </li></ul><ul><li>High b...
Transient Ischemic Attack (TIA) <ul><li>“ Mini-stroke” </li></ul><ul><li>Signs and symptoms of a stroke </li></ul><ul><li>...
Treatment of Stroke <ul><li>Prompt transport is critical. </li></ul><ul><li>Identify potential stroke patients and notify ...
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.
<ul><li>Syncope is a brief loss of consciousness. </li></ul><ul><li>It can occur at any age; more common in elderly. </li>...
<ul><li>Hypovolemia </li></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Dehydration </li></ul></ul><ul><li>Metabolic <...
<ul><li>Environmental/Toxicological </li></ul><ul><ul><li>Alcohol/Drugs </li></ul></ul><ul><ul><li>Carbon Monoxide </li></...
<ul><li>Cardiovascular </li></ul><ul><ul><li>Fast or slow heart rates </li></ul></ul><ul><ul><li>Electrical system disturb...
<ul><li>Obtain a SAMPLE history. </li></ul><ul><li>Ask about onset time, activities. </li></ul><ul><li>Length of episode? ...
<ul><li>Any medications for this condition? </li></ul><ul><li>Any nausea/vomiting/bowel changes? </li></ul>Assessment of D...
<ul><li>Administer high-concentration oxygen. </li></ul><ul><li>Loosen restrictive clothing. </li></ul><ul><li>Lay patient...
<ul><li>Treat any associated injuries. </li></ul><ul><li>Request ALS and transport. </li></ul>Treatment of Dizziness and S...
1. List the signs and symptoms of hypoglycemia. 2. What are five causes of seizures? 3. Explain how to do the Cincinnati s...
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Ch15 eec3Diabetic Emergencies and Altered Mental Status

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Ch15 eec3Diabetic Emergencies and Altered Mental Status

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