Chapter 20 Acute Diabetic Emergencies Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph.

Chapter 20

Acute Diabetic Emergencies

Copyright ©2010 by Pearson Education, Inc.All rights reserved.

Prehospital Emergency Care, Ninth EditionJoseph J. Mistovich • Keith J. Karren

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).

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).

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 26How to Use a Blood Glucose Meter Video

Slide 29Information about Diabetes Video

Slide 39The Use of Oral Glucose Animation

Topics

Understanding Diabetes Mellitus

Acute Diabetic Emergencies

Assessment-Based Approach: Altered Mental Status in a Diabetic Emergency

CASE STUDYCASE STUDY

Dispatch

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

• 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

How would you proceed to assess and care for this patient?

Back to Topics

Understanding Diabetes Mellitus

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

Return to Directory

Click here to view a video on how to use a blood glucose meter.

How to Use a Blood Glucose Meter

Diabetes Mellitus (DM)

Back to Objectives

• Primary problem• Type I diabetes• Type II diabetes

Return to Directory

Click here to view a video on information about diabetes.

Information about Diabetes

Acute Diabetic Emergencies

Back to Topics

Hypoglycemia

Pathophysiology of Hypoglycemia

Back to Objectives

Pathophysiology

• Cause• Reasons for drop

Hypoglycemia

Assessment Findings in Hypoglycemia and

Hypoglycemia Unawareness

Assessment Findings

• Cause• Signs and symptoms• Hypoglycemia

unawarenessBack to Objectives

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

Return to Directory

Click here to view information about the use of oral glucose.

Information about the Useof Oral Glucose

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 20-09 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 STUDYCASE STUDY

Follow-Up

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

Primary Assessment• Partner places a nonrebreather

mask at 15 lpm

• RR: 15; P: 100 and strong

CASE STUDYCASE 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 STUDYCASE 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

CASE STUDYCASE STUDY

• 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 Scenario

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

Reinforce and Review

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