Skills Training SessionFebruary 11, 2014

Agenda

• Quiz• Run report guidelines, feedback• Scenario• Debrief• Diabetic Emergencies

Run Reports

• Return reports from last week• Run report cards• Neatness, clarity, completeness• Questions?

Scenario

• 23 y.o. M/F @ [Location] c/c dizziness.

Diabetic Emergencies

• Diabetes mellitus– Type 1: insulin-dependent• Hereditary• Need for daily insulin injections

– Type 2: non insulin-dependent• Patient produces inadequate amounts of insulin or is

resistant• Controlled by diet or oral hypoglycemic drugs

• Normal range for blood glucose is 80-120 mg/dL

Diabetic Emergencies

• Hypoglycemia:– Blood glucose level <80 mg/dL– Can lead to insulin shock• Pale, moist skin• Dizziness, altered LOC• Hunger• Seizure, coma, death

Diabetic Emergencies

• Hyperglycemia: Blood glucose 120-400 mg/dL• Diabetic keto-acidosis (DKA) 400-800 mg/dL• Diabetic coma possible above 800 mg/dL

– Symptoms: • Kussmaul respirations: deep, labored breathing• Rapid, weak pulse• Fruity breath• Altered LOC/unresponsiveness• Dry, warm skin

Diabetic Emergencies

• DKA and insulin shock appear very similarly, how do we tell the difference?• SKIN SIGNS! “hot and dry, my sugar is high. Pale and

clammy, need some candy”

• Appears similar to EtOH

Diabetic Emergencies

• Treatment:– Oral glucose, given to a patient with a decreased

level of consciousness with a Hx of diabetes• One dose is one tube• Squeeze onto tongue depressor or swab and spread

inside Pt’s cheek. • Never stick your finger’s in a patients’ mouth• Pt must have a gag reflex and be conscious

– Low LOC, Pt may lose gag reflex

– O2 via NRB, 15 L/min

Diabetic Emergencies

• Treatment:– If Pt is unconscious, do not try to give glucose. – Maintain airway and transport, Pt needs IV

glucose.

THANK YOU