Download Chapter 20

Chapter 20
Acute Diabetic Emergencies
Prehospital Emergency Care, Ninth Edition
Joseph J. Mistovich • Keith J. Karren
Copyright ©2010 by Pearson Education, Inc.
All rights reserved.
Objectives
1.
2.
Define key terms introduced in this chapter.
Describe the following regarding glucose (slides 1213):
a. The function of glucose in the body
b. Response of brain cells and other body cells to insufficient
glucose levels
c. Relationships of glucose and water
3.
4.
5.
Describe how insulin and glucagon function to control
blood glucose levels (slides 14-17).
Describe how glucose levels are regulated in normal
metabolism (slides 20-21).
Explain the purposes and process of checking blood
glucose levels. (slides 22-26).
Objectives
6.
7.
8.
9.
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).
Discuss the pathophysiology, assessment, and
emergency medical care of a hypoglycemic emergency
(slides 30-36).
Identify indications and contraindications to the
administration of oral glucose (slides 37-39).
Discuss the pathophysiology, assessment, and
emergency medical care of diabetic ketoacidosis (DKA)
(slides 40-47).
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).
Multimedia Directory
Slide 26
Slide 29
Slide 39
How to Use a Blood Glucose Meter Video
Information about Diabetes Video
The Use of Oral Glucose Animation
Topics
Understanding Diabetes Mellitus
Acute Diabetic Emergencies
Assessment-Based Approach: Altered Mental Status in a
Diabetic Emergency
CASE STUDY
Dispatch
EMS Unit 106
Respond to 514 Chicago Avenue for a 66-yearold male who is disoriented and belligerent.
The neighbor placed the call.
Time out 1402
Upon Arrival
• 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
How would you proceed to assess and
care for this patient?
Understanding
Diabetes Mellitus
Back to Topics
Glucose (Sugar)
Back to Objectives
• Sources
• Roles
• Brain cells
Hormones That Control Blood
Glucose Levels
Insulin
Back to Objectives
Insulin
• Main functions
• How it works
Hormones That Control Blood
Glucose Levels
Glucagon
Glucagon
• Role
• Functions
Hormones That Control Blood
Glucose Levels
Other Hormones
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
Normal Metabolism and
Glucose Regulation
Back to Objectives
Normal Glucose
Regulation
Checking the Blood Glucose Level
Back to Objectives
• Glucose meters
• Hypoglycemia
• Hyperglycemia
Checking the Blood Glucose Level
Testing the Blood Glucose
Level with a Glucose Meter
• Blood sample
• Equipment needed
How to Use a Blood Glucose Meter
Click here to view a video on how to use a blood glucose meter.
Return to Directory
Diabetes Mellitus (DM)
Back to Objectives
• Primary problem
• Type I diabetes
• Type II diabetes
Information about Diabetes
Click here to view a video on information about diabetes.
Return to Directory
Acute Diabetic
Emergencies
Back to Topics
Hypoglycemia
Pathophysiology of
Hypoglycemia
Back to Objectives
• Cause
• Reasons for drop
Pathophysiology
Hypoglycemia
Assessment Findings in
Hypoglycemia and
Hypoglycemia Unawareness
Assessment
Findings
Back to Objectives
• Cause
• Signs and symptoms
• Hypoglycemia
unawareness
Hypoglycemia
Emergency Medical
Care for Hypoglycemia
Emergency
Medical Care
• For a responsive patient
• For an unresponsive patient
Oral Glucose
Back to Objectives
• Purpose for administration
• Criteria for administration
Information about the Use
of Oral Glucose
Click here to view information about the use of oral glucose.
Return to Directory
Hyperglycemia
Back to Objectives
• Hyperglycemia
• Diabetic ketoacidosis (DKA)
• Hyperglycemic hyperosmolar nonketotic
syndrome (HHNS)
Hyperglycemic Condition: Diabetic
Ketoacidosis (DKA)
Pathophysiology of DKA
Pathophysiology
• Cause
• Results in the body
• Factors causing
hyperglycemia in
DKA patients
Back to Objectives
Hyperglycemic Condition: Diabetic
Ketoacidosis (DKA)
Assessment Findings
in DKA
Assessment
Findings
• Signs and symptoms
– Polyuria
– Polydipsia
– Polyphagia
• Kussmaul’s respirations
Back to Objectives
Hyperglycemic Condition: Diabetic
Ketoacidosis (DKA)
Emergency Medical
Care for DKA
Emergency Medical
Care
•
•
•
•
•
ABCs
Provide O2
Assist ventilation
Check BGL
Contact medical direction
Hyperglycemic Condition:
Hyperglycemic Hyperosmolar
Nonketotic Syndrome (HHNS)
Pathophysiology of HHNS
Back to Objectives
Pathophysiology
• Blood glucose level
• Precipitating factors
Hyperglycemic Condition:
Hyperglycemic Hyperosmolar
Nonketotic Syndrome (HHNS)
Assessment Findings
in HHNS
Back to Objectives
Assessment
Findings
Signs and symptoms
Emergency
Medical Care
•
•
•
•
•
ABCs
Provide O2
Support respirations
Determine BGL
Medical direction
Assessment-Based
Approach: Altered
Mental Status in a
Diabetic Emergency
Back to Topics
Scene Size-Up and Primary
Assessment
Back to Objectives
Look for scene clues
• Medic alert tags
• Insulin pumps
History and Secondary
Assessment
• SAMPLE
• Common
medications
• Questions to ask
History and Secondary Assessment
Signs and Symptoms
Signs and Symptoms
• Place redrawn picture 2009 here – did not have
yet, WDS
Emergency Medical Care
• ABCs
• Determine if patient can
swallow
• Administer oral glucose
• Transport
Reassessment
•
•
•
•
May take 20 minutes to see improvement
Recheck BGL
Continue O2
Manage airway as needed
CASE STUDY
Follow-Up
CASE STUDY
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 STUDY
Primary Assessment
• Partner places a nonrebreather
mask at 15 lpm
• RR: 15; P: 100 and strong
CASE STUDY
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 STUDY
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
Critical Thinking Scenario
• 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
• 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
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 Questions
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?
Reinforce and Review
Please visit
www.bradybooks.com
and follow the myBradykit links
to access content for the text.