Glucometry ppt

Powerpoint Presentation/ Topics Discussed•Anatomy & Physiology of Pancreas and basic cellular needs (normal individuals)

•glucagon, insulin discussed

•Cellular needs for blood glucose and effects of not efficiently maintaining

•Clinical signs and symptoms of hypo/hyperglycemia

•Diabetes and other compromising metabolic health concerns as a result of blood glucose imbalances, some disorders, common situations discussed in more depth

•Cellular Metabolism briefly reviewed

•Normal and abnormal blood sugar levels as per age range

•Hyperglycemia: signs, symptoms and treatments

•Hypoglycemia: signs, symptom and treatments

•Review of BLS Altered Mental Status/ Diabetic protocols

•Indication for Blood Glucose Check and Glucometer Use

The pancreas has two main jobs in the body:

1)To produce juices that help digest (break

down) food.

2)To produce hormones, such as insulin and

glucagon, that help control blood sugar levels.

Both of these hormones help the body use and

store the energy it gets from food.

Glucagon is an important hormone involved in carbohydrate metabolism. Produced by the pancreas, it is released when the glucose level in the blood is low (hypoglycemia), causing the liverto convert stored glycogen into glucose and release it into the bloodstream. The action of glucagon is thus opposite to that of insulin, which instructs the body's cells to take in glucose from the blood in times of satiation.

*glucagon is naturally occurring in the body, but can also be synthetically made and given to patients

Insulin is a hormone with intensive effects on both

metabolism and several other body systems (eg,

vascular compliance). Insulin causes most of the

body's cells to take up glucose from the blood

(including liver, muscle, and fat tissue cells),

storing it as glycogen in the liver and muscle, and

stops use of fat as an energy source.

*Insulin is naturally occurring in normal functioning

pancreas, but can also be given as a medication to

patients

Hyperglycemia (high blood

sugar) is a slow-onset

condition from decreased

insulin levels in people with

diabetes.

Slow onset

Nausea/vomiting

Acetone odor on breath (DKA)

Increased urination/hunger/ thirst

Some patients present differently

DKA: diabetic keto-acidosis

Forgotten or insufficient insulin dose

Infection

Stress

Increased dietary intake

Hypoglycemia (low blood sugar) is a life-

threatening emergency for people with

diabetes.

It is the most common emergency for the

diabetic patient.

Rapid onset

Intoxicated appearance, staggering, slurred speech, unconsciousness

Cold, clammy skin

Rapid heart rate

Seizures (severe cases)

Unusual or bizarre behavior

Anxiety

Refusal to cooperate or combativeness

CVA/TIA signs and symptoms

After taking too much insulin

Vomiting

After unusual amount of exercise

Reduced sugar intake by not eating

Some disease processes can also cause

The condition brought about by

decreased insulin production, or

the inability of the body cells to

use insulin properly (which

prevents the body’s cells from

taking the simple sugar called

glucose from the bloodstream)

Gestational diabetes (or gestational

diabetes mellitus, GDM) is a condition in

which women without previously diagnosed

diabetes exhibit high blood glucose levels

during pregnancy.

Diabetes insipidus (DI) is a condition

characterized by excretion of large amounts of

severely diluted urine, which cannot be

reduced when fluid intake is reduced. It

denotes inability of the kidney to concentrate

urine

Diabetes mellitus type 1 (Type 1 diabetes,

Type I diabetes, juvenile diabetes) is a form of

diabetes mellitus. Type 1 diabetes is an

autoimmune disease [1] that results in the

permanent destruction of insulin-producing

beta cells of the pancreas. No insulin is

produced naturally.

Diabetes mellitus type 2 or Type 2 Diabetes

(formerly called non - insulin-dependent

diabetes mellitus (NIDDM), or adult-onset

diabetes) is a metabolic disorder that is

primarily characterized by insulin resistance,

relative insulin deficiency, and hyperglycemia.

Get a SAMPLE history.

If the patient has a history of diabetes:

When did patient last eat?

Any medications? Last taken?

Any other illnesses?

Blood

Glucose

Meters

80-120 mg/dl Normal

60-80 mg/dl Moderate hypoglycemia

Below 50 mg/dl Severe

hypoglycemia

Above 140 mg/dl Hyperglycemia

Question results that are inconsistent

with patient’s condition.

Meter not calibrated

Low batteries in meter

Improperly stored or expired test strip

Insufficient blood on test strip

Hypoglycemia

Poisoning (including alcohol & drugs)

Infection

Head trauma

Hypoxia

Commonwealth of Massachusetts 10.01 Official Version DPH/OEMS 3.3

ALTERED MENTAL/NEUROLOGICAL STATUS

An alteration in mental/neurological status is the hallmark of central

nervous system (CNS) injury or illness. Any alteration in

mental/neurological status is abnormal and warrants further examination.

Altered mental/neurological status may be due to many factors. A common

grouping of causes for altered mental/neurological status is the following:

A E I O U – T I P S; Alcoholism, Epilepsy, Insulin, Overdose, Underdose,

Trauma, Infection, Psychiatric and Stroke.

Altered mental/neurological status may present as mild confusion or

complete unconsciousness (coma). Altered mental status may be a result of

a medical condition, traumatic event, or both. EMS agencies should use the

Glasgow Coma Scale (GCS) or AVPU for their ongoing neurological

assessment, as appropriate for the possible causes of the patient's

condition.

Note that GCS has been validated as a predictor of outcome specifically for

trauma.

NOTE: See also Protocols for Diabetic Emergencies; Toxicology/Poisoning;

Seizures; Shock; Syncope; and/or Head Trauma/Injury.

ASSESSMENT / TREATMENT PRIORITIES

1. Ensure scene safety and maintain appropriate body substance

isolation precautions.

2. Maintain open airway and assist ventilations as needed.

Assume spinal injury when appropriate and treat accordingly.

3. Administer oxygen using appropriate oxygen delivery device, as

clinically indicated.

4. Determine patient's hemodynamic stability and symptoms.

Continually assess Level of Consciousness, ABCs and Vital Signs.

5. Obtain appropriate S-A-M-P-L-E history related to event.

6. Monitor and record vital signs and ECG.

7. Initiate transport as soon as possible, with or without ALS. Do

not allow patients to exert themselves and properly secure to cot

in position of comfort, or appropriate to treatment(s) required.

TREATMENT BASIC PROCEDURES

1. BLS STANDING ORDERS

a. If authorized and trained to do so perform Glucometry reading.

b. If patient is a known diabetic who is conscious and can speak

and swallow, administer oral glucose or other sugar source as

tolerated. One dose equals one tube. A second dose may be

necessary. (SEE Diabetic Protocol)

CAUTION: Do NOT administer anything orally if the patient

does not have a reasonable level of Consciousness and

normal gag reflex.

CAUTION: If cerebrovascular accident is suspected, contact

Medical Control

c. If patient is unconscious or seizing, transport on left side

(coma position).

d. If patient’s BLOOD PRESSURE drops below 100mm Hg

systolic: treat for shock.

e. Notify receiving hospital.