chapter 20 acute diabetic emergencies copyright ©2010 by pearson education, inc. all rights...
TRANSCRIPT
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Chapter 20
Acute Diabetic Emergencies
Copyright ©2010 by Pearson Education, Inc.All rights reserved.
Prehospital Emergency Care, Ninth EditionJoseph J. Mistovich • Keith J. Karren
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Objectives
1. Define key terms introduced in this chapter.2. Describe the following regarding glucose (slides 12-13
):a. The function of glucose in the bodyb. Response of brain cells and other body cells to insufficient
glucose levelsc. Relationships of glucose and water
3. Describe how insulin and glucagon function to control blood glucose levels (slides 14-17).
4. Describe how glucose levels are regulated in normal metabolism (slides 20-21).
5. Explain the purposes and process of checking blood glucose levels. (slides 22-26).
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Objectives
6. Discuss the pathophysiology of diabetes mellitus (DM) and contrast type 1 insulin-dependent diabetes mellitus (IDDM) with type 2 noninsulin- dependent diabetes mellitus (NIDDM) (slides 27-29).
7. Discuss the pathophysiology, assessment, and emergency medical care of a hypoglycemic emergency (slides 30-36).
8. Identify indications and contraindications to the administration of oral glucose (slides 37-39).
9. Discuss the pathophysiology, assessment, and emergency medical care of diabetic ketoacidosis (DKA) (slides 40-47).
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Objectives
10. Compare and contrast the speed of onset and the signs and symptoms of hypoglycemia and hyperglycemia (slides 34, 45).
11. Describe the primary differences between DKA and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) (slides 43, 48, 50).
12. Discuss the pathophysiology, assessment, and emergency medical care of HHNS (slides 48-52).
13. Discuss the assessment-based approach to a patient with an altered mental status in a diabetic emergency (slides 53-63).
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Multimedia Directory
Slide 26How to Use a Blood Glucose Meter Video
Slide 29Information about Diabetes Video
Slide 39The Use of Oral Glucose Animation
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Topics
Understanding Diabetes Mellitus
Acute Diabetic Emergencies
Assessment-Based Approach: Altered Mental Status in a Diabetic Emergency
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CASE STUDYCASE STUDY
Dispatch
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Respond to 514 Chicago Avenue for a 66-year-old male who is disoriented and belligerent. The
neighbor placed the call.
EMS Unit 106
Time out 1402
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• Neighbor found patient in her garden next door • When she approached him, the patient began
cursing at her• Patient is acting strange and not making sense
Upon Arrival
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How would you proceed to assess and care for this patient?
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Back to Topics
Understanding Diabetes Mellitus
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Glucose (Sugar)
Back to Objectives
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• Sources• Roles• Brain cells
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Hormones That Control Blood Glucose Levels
Insulin
Back to Objectives
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Insulin
• Main functions• How it works
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Hormones That Control Blood Glucose Levels
Glucagon
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Glucagon
• Role• Functions
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Hormones That Control Blood Glucose Levels
Other Hormones
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Epinephrine
• Released by the adrenal glands
• Stops the secretion of insulin
• Promotes release of stored glucose from the liver
• Promotes conversion of other substances into glucose
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Normal Metabolism and Glucose Regulation
Back to Objectives
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Normal Glucose Regulation
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Checking the Blood Glucose Level
Back to Objectives
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• Glucose meters• Hypoglycemia• Hyperglycemia
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Checking the Blood Glucose Level
Testing the Blood Glucose Level with a Glucose Meter
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• Blood sample
• Equipment needed
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Return to Directory
Click here to view a video on how to use a blood glucose meter.
How to Use a Blood Glucose Meter
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Diabetes Mellitus (DM)
Back to Objectives
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• Primary problem• Type I diabetes• Type II diabetes
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Return to Directory
Click here to view a video on information about diabetes.
Information about Diabetes
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Acute Diabetic Emergencies
Back to Topics
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Hypoglycemia
Pathophysiology of Hypoglycemia
Back to Objectives
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Pathophysiology
• Cause• Reasons for drop
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Hypoglycemia
Assessment Findings in Hypoglycemia and
Hypoglycemia Unawareness
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Assessment Findings
• Cause• Signs and symptoms• Hypoglycemia
unawarenessBack to Objectives
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Hypoglycemia
Emergency Medical Care for Hypoglycemia
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Emergency Medical Care
• For a responsive patient• For an unresponsive patient
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Oral Glucose
Back to Objectives
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• Purpose for administration• Criteria for administration
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Return to Directory
Click here to view information about the use of oral glucose.
Information about the Useof Oral Glucose
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Hyperglycemia
Back to Objectives
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• Hyperglycemia
• Diabetic ketoacidosis (DKA)
• Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)
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Hyperglycemic Condition: Diabetic Ketoacidosis (DKA)
Pathophysiology of DKA
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Pathophysiology
• Cause
• Results in the body
• Factors causing hyperglycemia in DKA patients Back to Objectives
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Hyperglycemic Condition: Diabetic Ketoacidosis (DKA)
Assessment Findings in DKA
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Assessment Findings
• Signs and symptoms– Polyuria– Polydipsia– Polyphagia
• Kussmaul’s respirations
Back to Objectives
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Hyperglycemic Condition: Diabetic Ketoacidosis (DKA)
Emergency Medical Care for DKA
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Emergency Medical Care
• ABCs• Provide O2
• Assist ventilation• Check BGL• Contact medical direction
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Hyperglycemic Condition: Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
Pathophysiology of HHNS
Back to Objectives
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Pathophysiology
• Blood glucose level• Precipitating factors
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Hyperglycemic Condition: Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
Assessment Findings in HHNS
Back to Objectives
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Assessment Findings
Signs and symptoms
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Emergency Medical Care
• ABCs• Provide O2
• Support respirations• Determine BGL• Medical direction
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Assessment-Based Approach: Altered Mental Status in a
Diabetic Emergency
Back to Topics
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Scene Size-Up and Primary Assessment
Back to Objectives
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Look for scene clues• Medic alert tags• Insulin pumps
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History and Secondary Assessment
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• SAMPLE• Common
medications• Questions to ask
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History and Secondary Assessment
Signs and Symptoms
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Signs and Symptoms
• Place redrawn picture 20-09 here – did not have yet, WDS
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Emergency Medical Care
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• ABCs• Determine if patient can
swallow• Administer oral glucose• Transport
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Reassessment
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• May take 20 minutes to see improvement• Recheck BGL• Continue O2
• Manage airway as needed
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CASE STUDYCASE STUDY
Follow-Up
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Primary Assessment• Patient sitting on couch
• Find Digoxin in kitchen and insulin in refrigerator
• Patient is pale and sweating profusely
• Patient speaking in mumbled words
CASE STUDYCASE STUDY
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Primary Assessment• Partner places a nonrebreather
mask at 15 lpm
• RR: 15; P: 100 and strong
CASE STUDYCASE STUDY
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Secondary Assessment• Do rapid assessment • BP: 102/60 mmHg; P: 108; RR:16;
skin pale, cool, and moist; SpO2: 97 percent
• BGL: 48mg/dL• Administer one tube of glucose • Place patient in left lateral position
CASE STUDYCASE STUDY
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Treatment and Reassessment
• Becomes oriented to name and place
• Pulse rate, skin, and SpO2 improve
• Change over to nasal cannula
• Alert and oriented upon arrival
• Transfer care without incident
CASE STUDYCASE STUDY
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• 34-year-old female with an altered mental status
• Responds to painful stimuli only with moans
• A neighbor called 911 after finding her on the couch and not responding
Critical Thinking Scenario
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• S – Supine on the couch, not alert • A – Unknown• M – Her neighbor brings you the patient’s
medications: Zoloft and Novolin• P – Her neighbor doesn’t know the patient’s
medical history• L – Unknown• E – Patient called the neighbor 20 minutes
ago and said she wasn’t feeling well
Critical Thinking Scenario
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Vital signs:
• BP: 108/62 mmHg
• HR: 122 bpm
• RR: 12 per minute with snoring respirations but adequate chest rise
• Skin is pale, cool, and very diaphoretic
Critical Thinking Scenario
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1. What emergency care would you provide during the primary assessment?
2. Based on the signs, what condition do you suspect the patient is experiencing?
3. What other assessment procedures would be helpful to you for this patient?
4. What would you expect the blood glucose reading to be in the patient?
5. Why is the onset of the altered mental status significant in this patient?
Critical Thinking Questions
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