1.Chapter DiabeticEmergencies and AlteredMental 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. PatientCARE 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 bodys 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/dlNormal 60-80 mg/dl Moderate hypoglycemia Below 50 mg/dl Severe hypoglycemia Above 140 mg/dl Hyperglycemia Question results that are inconsistent with patients 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 alife-threatening emergency for people with diabetes.But it is one that the EMT-B can treat. K EY TERM 20. PatientASSESSMENT 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. PatientASSESSMENT Diabetic Signs and Symptoms

Intoxicated appearance, staggering,slurred speech, unconsciousness

Cold, clammy skin

(Continued) 22. PatientASSESSMENT Diabetic Signs and Symptoms

Rapid heart rate

Hunger

Seizures (in severe cases)

Insulin or oral antidiabetic medication

(Continued) 23. PatientASSESSMENT Diabetic Signs and Symptoms

Unusual behavior

Anxiety

Refusal to cooperate or

combativeness

24. PatientASSESSMENT Diabetic Signs and Symptoms

Perform initial assessment.

Perform focused history and

physical exam.

Get SAMPLE history.

Take baseline vital signs.

25. PatientASSESSMENT Diabetic Signs and Symptoms

Perform initial assessment.

(Some hypoglycemic patients are unconscious. You must make sure the airway remainspatent in theseindividuals.) 26. PatientASSESSMENT 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. PatientASSESSMENT Diabetic Signs and Symptoms

Perform focused history

and physical exam.

Trauma involved?

Has the patient seized?

Fever?

Interruptions in episode?

(Continued) 28. PatientASSESSMENT 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. PatientASSESSMENT 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. PatientCARE 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. PatientCARE 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. PatientCARE 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 ontotongue depressor and place betweencheek 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

(Complicationsof pregnancy) Causes of Seizures 46. PatientASSESSMENT 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. PatientCARE 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. PatientCARE 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. PatientCARE 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 tissuethat is deprived of oxygen.

Caused by:

• Blockage or

• Hemorrhage of a blood vesselin the brain

Stroke 53.

Prompt transport is critical.

Identify potential strokepatients and notify thehospital.

Stroke 54. Cincinnati Prehospital Stroke Scale Assess for 1) facial droop, 2) arm drift,and 3) slurred speech 55. If the patients 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 subtleand 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 RECEPTORP 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 patients 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 Dizzinessand Syncope (Continued) 68.

Any medications for this condition?

Any nausea/vomiting/bowel changes?

Assessment of Dizzinessand 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 strokescale. R EVIEW QUESTIONS