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Chapter 18
Diabetic
Emergencies
Slide Presentation prepared by
Randall Benner, M.Ed., NREMT-P
© 2012 Pearson Education, Inc.
Learning Objectives
• Understand the basic disease process associated
with diabetes mellitus.
• Differentiate between hyperglycemia and
hypoglycemia.
• List the signs and symptoms of hyperglycemia.
• List the signs and symptoms of hypoglycemia.
• Describe and demonstrate the first aid care of a
severe hyperglycemic victim.
• Describe and demonstrate the first aid care of a
hypoglycemic victim.
© 2012 Pearson Education, Inc.
Introduction
• More than 14 million diabetics in the U.S.
• First indication of the disease often occurs when
a patient experiences their first diabetic
emergency
• First Aiders can provide better care when they
understand the underlying disease process and
management goals.
© 2012 Pearson Education, Inc.
Diabetes Overview
• Role of insulin in glucose transport into cell
– Glucose levels rise in the blood stream, causing
additional complications.
– Cells resort to using fat and proteins for glucose
creation.
– Without insulin, the glucose still cannot enter the cell.
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Use of Sugar in Diabetes
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Types of Diabetes
• Type I (IDDM)
– Little or no insulin production
– Usually starts in childhood
• Type II (NIDDM)
– Insufficient secretion of insulin, or low sensitivity
of cells to insulin presence
– Formerly known as adult onset diabetes
• Gestational diabetes
– Occurs as a result of pregnancy
– Managed with diet, and occasionally, medications
© 2012 Pearson Education, Inc.
Hyperglycemia Characteristics
• Hyperglycemia (high levels of glucose)
– Glucose spills into urine, patient becomes dehydrated
and acidic
– Altered mental status, dehydration, poor vitals
– Fever, hyperventilation, abdominal pain
– Fruity odor on breath, air hunger
– Frequent urination, intense thirst
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Hyperglycemia Signs & Symptoms
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Hypoglycemia Characteristics
• Hypoglycemia (low levels of glucose)
– Low glucose levels result in brain dysfunction and
changes in mental status
– Possibly combative, dizzy
– Rapid pulse and breathing, blood pressure usually
normal
– Seizures or tremors
– No thirst, no excessive urination
– Moist, pale skin, no fever
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Hypoglycemia Signs & Symptoms
© 2012 Pearson Education, Inc.
Other Assessment Considerations
• Always assess for history of diabetes in
unresponsive patients.
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Medical Alert Tag
Insulin injection marks on thigh or abdomen
Insulin pump on the body
Evidence of diabetic medicine near/on patient
• If in doubt, the careful administration of sugar to
the patient will not be harmful.
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Hyperglycemia vs. Hypoglycemia
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First Aid: Hyperglycemic Victim
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•
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Take standard precautions, activate EMS.
Consider manual stabilization of cervical spine.
Open and maintain the airway.
Provide artificial ventilations if breathing is
inadequate.
• Be alert for vomiting, position patient on their side
if no trauma is suspected.
• Treat for shock, keep the patient warm.
• Reassess and reassure the victim until EMS
arrives.
© 2012 Pearson Education, Inc.
First Aid: Responsive Hypoglycemic Victim
• Take standard precautions, activate EMS.
• If patient can follow commands
– Administer orange juice with added sugar.
– Administer concentrated oral glucose if available.
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Do NOT give hard candy.
Watch for vomiting, position patient on side.
Treat for shock, keep the patient warm.
Reassure and monitor the victim until EMS
arrives.
© 2012 Pearson Education, Inc.
First Aid: Unresponsive Hypoglycemic
Victim
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•
•
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Take standard precautions, activate EMS.
Consider manual stabilization of cervical spine.
Open and maintain the airway.
Provide artificial ventilations, if necessary.
Watch for vomiting.
Position patient on their side if no trauma is
suspected.
• Treat for shock, keep the patient warm.
• Monitor continuously until EMS arrives.
© 2012 Pearson Education, Inc.
Summary
• Diabetes is a common disease in the U.S.
population.
• The disease occurs when the body produces too
little insulin or cannot effectively use the insulin it
produces.
• Hyper- and Hypo- glycemia are the two
conditions that arise from diabetic complications.
• Untreated diabetes, hyperglycemia, and
hypoglycemia are serious conditions requiring
medical intervention.
© 2012 Pearson Education, Inc.