Diabetic Emergencies and Altered Mental Status

Diabetes Mellitus

Decreased insulin production or inability to use insulin properly resulting in high blood sugar

Hypoglycemia• Takes too much insulin or oral medication• Doesn’t eat• Over exercises or over exerts• Vomiting• Children

playing hardnot eating correctly or on time

Signs

• Rapid onset

• AMS or abnormal behavior

• Diaphoretic

Treatment

• Oral Glucose

Must be conscious and able to swallow

Hyperglycemia

• Decrease in insulin leaving sugar in blood stream other than being allowed to enter the cells

• Slower onset

increased urination, thirst and hunger

nauseated

Juicy Fruit

Patient Assessment

Initial Assessment

• AMS

intoxicated appearance

staggering

slurred speech

unconscious

Signs • AMS• Cold, clammy skin• Elevated heart rate• Hunger• Uncharacteristic behavior• Anxiety• Combativeness• seizures

• Blood glucose meters

Patient Care

• If appropriate administer oral glucose

• If not appropriate to administer oral glucose:

A B Cs

Position

Request ALS

Types of Diabetes

• Type I

• Type II

• Hypoglycemia and Hyperglycemia compared

Other causes of AMS

Seizures

• Common causes

Children: Febrile (3 mo to 3 yrs)

Adults: Failure to take medication

Other causes:• Toxic

Drug/alcohol use/withdrawal• Brain tumor• Congenital brain defects• Infection• Metabolic• Trauma• Idiopathic-spontaneous with unknown cause• Epilepsy• Stroke• Measles, mumps or other childhood diseases• Hypoglycemia• Eclampsia• Hypoxia• Heat stroke

Types of seizures:

Partial

• Also called focal motor, or focal sensory

• Simple and complex

Simple:• Tingling• Stiffening or jerking in just one part of the

body• Aura

smellbright lightsburst of color

Complex

• Psychomotor or temporal lobe

• Confusion

• Glassy stare

• Aimless moving about

• Lip smacking

• Chewing or fidgeting with clothing

• May appear to be drunk or on drugs

• Not violent but may struggle or fight restraint

• No loss of consciousness

• Confusion with no memory of episode

• Rarely develops into tonic-clonic …….

Tonic-Clonic• Grand-mal• Three phasesTonic:• body becomes rigid and stiffens for no more than 30

seconds• Breathing may stop• May bite tongue• Bladder and bowel control lost

Clonic

• Violent jerking 1 to 2 minutes

• Foam at the mouth and drooling

• Face and lips become cyanotic

Postictal

• Begins when convulsions stop

• May regain consciousness immediately but be drowsy and confused or

• Remain unconscious

• Headache is common

Absence seizure

• Petit-mal

• Brief lasting only 1 to 10 seconds

• No dramatic motor activity

Patient Assessment

History

• Events leading up to

• Describe the seizure in detail

• Loss of bladder or bowel

• How long did the seizure last

• LOC and GCS after the seizure

• Status Epilepticus

Care

• If seizing when you arrive

*place on ground or floor

*place on side (consider c-spine)

*loosen restrictive clothing

*remove objects that may harm

*protect from injury but do not restrain

• If convulsions have ceased:

*ABCs

*Treat injuries. Remember C-Spine

*Transport

DIZZINESS AND SYNCOPE

Dizziness

• Loss of strength, spinning, lightheadedness, weakness

Syncope

• Brief loss of consciousness with spontaneous recovery

May experience• lightheadedness or dizziness• Nausea • Weakness• Vision changes• Sudden pallor• Sweating• Occasionally• Tachycardia, bradycardia, or a headache

CAUSES OF DIZZINESS AND SYNCOPE

• Hypovalemia

fluid/blood

ectopic pregnancy

AAA

GI bleed

• Metabolic

hypoglycemia

• Enviornmental/toxicological

Alcohol/drugs

CO2 poisoning

Panic attacks

• Cardiovascular

Bradycardia

Tacycardia

Vasovagal syncope

• Typical triggers for vasovagal episodes include:[1]• Prolonged standing or upright sitting, particularly when standing with legs in

a locked position for long periods of time—avoidance of long-term locking of one's legs in the standing position is taught in the military as well as in marching bands and drill teams.

• Standing up very quickly • Stress • Any painful or unpleasant stimuli, such as:

– Giving a blood donation or watching someone give one – Watching someone experience pain – Watching/experiencing medical procedures – Sight of blood – Occasions of slight discomfort, such as dental and eye examinations

• Hyperthermia, a prolonged exposure to heat • Sudden onset of extreme emotions • Hunger

• Nausea or vomiting • Dehydration • Urination ('micturition syncope') or defecation ('defecation syncope') • Abdominal straining or 'bearing down' (as in defecation) • Swallowing ('swallowing syncope') or coughing ('cough syncope') • Random onsets due to nerve malfunctions • Pressing upon certain places on the throat, sinuses, and eyes, also

known as vagal reflex stimulation when performed clinically. • Water colder than 50 Degrees Farenheight, or Ice that comes in

contact with the face, that stimulates the Mammalian diving reflex • High altitude • Use of certain drugs that affect blood pressure, such as

amphetamine • Intense laughter[2]

Patient Assessment• Specify; weakness, spinning, lightheadedness• Warnings• Onset• Duration• Position at time of episode• PMHx.• Meds• Any other complaints at the time• Vomiting, coffee-ground emesis• Black tarry stools• Aura• Seizure activity

Patient Care

• O2

• Loosen tight clothing around neck

• Trendelenberg

• ALS

• Treat injuries

• Transport in POC

Stroke

Death or injury to brain tissue deprived of oxygen

• Ischemic

• Hemorrhagic

• TIA

Warning sign

Signs

• Hemi paresis

opposite side of brain that is affected

• Headache

• Inability to speak

Patient Assessment• Cincinnati Stroke Scale• Facial droop: Have the person smile or show his or her teeth. If one side

doesn't move as well as the other so it seems to droop, that could be sign of a stroke.

– Normal: Both sides of face move equally – Abnormal: One side of face does not move as well as the other (or at all)

• Arm drift: Have the person close his or her eyes and hold his or her arms straight out in front for about 10 seconds. If one arm does not move, or one arm winds up drifting down more than the other, that could be a sign of a stroke.

– Normal: Both arms move equally or not at all – Abnormal: One arm does not move, or one arm drifts down compared with

the other side • Speech: Have the person say, "You can't teach an old dog new tricks," or

some other simple, familiar saying. If the person slurs the words, gets some words wrong, or is unable to speak, that could be sign of stroke.

– Normal: Patient uses correct words with no slurring – Abnormal: Slurred or inappropriate words or mute

• Confusion

• Dizziness

• Numbness, weakness, paralysis

• Incontinence

• Impaired vision; loss of vision in one eye

• High blood pressure

• Respiratory; snoring

• Nausea or vomiting

• Seizures

• Unequal pupils

• Headaches

• Unconsciousness

Care

• Airway

• O2

• Calm and reassure

• Transport in semi-fowler

• Transport on affected side - - unconscious