Bonner County EMS System Patient Care Treatment Guidelines-Medical Emergencies & OB/GYNMedical Emergencies: Hypoglycemia - 7035

HYPOGLYCEMIAHISTORY

Known diabetic, medic alert tag Past medical history Medications Change in

responsiveness/condition Disorientation

SIGNS AND SYMPTOMS Decreased mental status or lethargy Change in baseline mental status Bizarre behavior Hypoglycemia (cool, diaphoretic

skin) Hyperglycemia (warm, dry skin;

fruity breath; Kussmaul respiration; signs of dehydration)

Irritability Lowered gross motor or deep tendon

reflexes Glasgow Coma Scale <14

ASSESSMENT CNS (stroke, tumor, seizure,

infection, trauma) Hypothermia Infection (CNS and other) Thyroid (hyper / hypo) Shock: septic, metabolic,

trauma Diabetes (hyper/

hypoglycemia) Toxicologic or ingestion Acidosis / Alkalosis Pulmonary (Hypoxia) Electrolyte abnormality Psychiatric disorder

TREATMENT GUIDELINESR-EMR E-EMT A-AEMT P-PARAMEDIC **M-Medical Control

*****Higher level providers are responsible for lower level treatments***

Initial Patient Contact (2000). Oxygen Administration (9000) 10-15 L via non-rebreather (NRB). Glascow Coma Scale (A2). R Consider ALS assist with cardiac monitor and 12-lead EKG (9030) if indicated. Transport to receiving facility, with ALS intercept. E Blood Glucose Analysis (9040); for glucose <60 and awake with patent airway,

administer 1 tube Oral Glucose PO/SL (buccal).2

Reevaluate blood glucose; may repeat Oral Glucose if ALOC and or glucose <60 remain.2

Establish IV with NS, draw labs; do not delay transport for IV access.2

If Paramedic is not on scene or expected within 10 minutes and lungs are clear, consider IV D5W, 5 cc/kg, and check for breath sounds after giving bolus.2

For glucose <60 and patent IV, administer 12.5-25 gm of 50% Dextrose IV. For glucose <60 and no IV, administer 1unit (1 mg) Glucagon IM (can also be

given IV).2

Reevaluate blood glucose and repeat as indicated for glucose <60 and ALOC.

A

ALS required for continued ALOC, long transport, oral diabetic medication.

Consider other causes of ALOC if patient not responding to above measures. P ** Call Medical Control for Stroke, or deterioration despite appropriate care**. M2EMT providers may perform these procedures if credentialed with the appropriate OM.Pearls:Be especially cautious if the patient is on oral diabetic medication. It is safer to assume Hypoglycemia than Hyperglycemia if doubt exists. Recheck blood glucose after Dextrose or Glucagon.

____________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 4/1/14 final 5/10/2023 page 1 of 2

Bonner County EMS System Patient Care Treatment Guidelines-Medical Emergencies & OB/GYNMedical Emergencies: Hypoglycemia - 7035

Do not let alcohol confuse the clinical picture. Alcoholics frequently develop Hypoglycemia and may have unrecognized injuries. Sublingual or buccal administration may provide the fastest route to systemic effect. Low glucose (< 60), normal glucose (60 - 120), high glucose (120), very high glucose (> 250).Consider Restraints if necessary for patient's and/or personnel's protection per the restraint procedure.QA 100% review of Hypoglycemia treated with D5W (observing efficacy of this strategy).

____________________________________________________________________________________________________________BCEMS Medical DirectorEffective: 4/1/14 final 5/10/2023 page 2 of 2