Diabetic Emergencies and Altered Mental Status
Diabetes Mellitus
Decreased insulin production or inability to use insulin properly resulting in high blood sugar
Hypoglycemia• Takes too much insulin or oral medication• Doesn’t eat• Over exercises or over exerts• Vomiting• Children
playing hardnot eating correctly or on time
Signs
• Rapid onset
• AMS or abnormal behavior
• Diaphoretic
Treatment
• Oral Glucose
Must be conscious and able to swallow
Hyperglycemia
• Decrease in insulin leaving sugar in blood stream other than being allowed to enter the cells
• Slower onset
increased urination, thirst and hunger
nauseated
Juicy Fruit
Patient Assessment
Initial Assessment
• AMS
intoxicated appearance
staggering
slurred speech
unconscious
Signs • AMS• Cold, clammy skin• Elevated heart rate• Hunger• Uncharacteristic behavior• Anxiety• Combativeness• seizures
• Blood glucose meters
Patient Care
• If appropriate administer oral glucose
• If not appropriate to administer oral glucose:
A B Cs
Position
Request ALS
Types of Diabetes
• Type I
• Type II
• Hypoglycemia and Hyperglycemia compared
Other causes of AMS
Seizures
• Common causes
Children: Febrile (3 mo to 3 yrs)
Adults: Failure to take medication
Other causes:• Toxic
Drug/alcohol use/withdrawal• Brain tumor• Congenital brain defects• Infection• Metabolic• Trauma• Idiopathic-spontaneous with unknown cause• Epilepsy• Stroke• Measles, mumps or other childhood diseases• Hypoglycemia• Eclampsia• Hypoxia• Heat stroke
Types of seizures:
Partial
• Also called focal motor, or focal sensory
• Simple and complex
Simple:• Tingling• Stiffening or jerking in just one part of the
body• Aura
smellbright lightsburst of color
Complex
• Psychomotor or temporal lobe
• Confusion
• Glassy stare
• Aimless moving about
• Lip smacking
• Chewing or fidgeting with clothing
• May appear to be drunk or on drugs
• Not violent but may struggle or fight restraint
• No loss of consciousness
• Confusion with no memory of episode
• Rarely develops into tonic-clonic …….
Tonic-Clonic• Grand-mal• Three phasesTonic:• body becomes rigid and stiffens for no more than 30
seconds• Breathing may stop• May bite tongue• Bladder and bowel control lost
Clonic
• Violent jerking 1 to 2 minutes
• Foam at the mouth and drooling
• Face and lips become cyanotic
Postictal
• Begins when convulsions stop
• May regain consciousness immediately but be drowsy and confused or
• Remain unconscious
• Headache is common
Absence seizure
• Petit-mal
• Brief lasting only 1 to 10 seconds
• No dramatic motor activity
Patient Assessment
History
• Events leading up to
• Describe the seizure in detail
• Loss of bladder or bowel
• How long did the seizure last
• LOC and GCS after the seizure
• Status Epilepticus
Care
• If seizing when you arrive
*place on ground or floor
*place on side (consider c-spine)
*loosen restrictive clothing
*remove objects that may harm
*protect from injury but do not restrain
• If convulsions have ceased:
*ABCs
*Treat injuries. Remember C-Spine
*Transport
DIZZINESS AND SYNCOPE
Dizziness
• Loss of strength, spinning, lightheadedness, weakness
Syncope
• Brief loss of consciousness with spontaneous recovery
May experience• lightheadedness or dizziness• Nausea • Weakness• Vision changes• Sudden pallor• Sweating• Occasionally• Tachycardia, bradycardia, or a headache
CAUSES OF DIZZINESS AND SYNCOPE
• Hypovalemia
fluid/blood
ectopic pregnancy
AAA
GI bleed
• Metabolic
hypoglycemia
• Enviornmental/toxicological
Alcohol/drugs
CO2 poisoning
Panic attacks
• Cardiovascular
Bradycardia
Tacycardia
Vasovagal syncope
• Typical triggers for vasovagal episodes include:[1]• Prolonged standing or upright sitting, particularly when standing with legs in
a locked position for long periods of time—avoidance of long-term locking of one's legs in the standing position is taught in the military as well as in marching bands and drill teams.
• Standing up very quickly • Stress • Any painful or unpleasant stimuli, such as:
– Giving a blood donation or watching someone give one – Watching someone experience pain – Watching/experiencing medical procedures – Sight of blood – Occasions of slight discomfort, such as dental and eye examinations
• Hyperthermia, a prolonged exposure to heat • Sudden onset of extreme emotions • Hunger
• Nausea or vomiting • Dehydration • Urination ('micturition syncope') or defecation ('defecation syncope') • Abdominal straining or 'bearing down' (as in defecation) • Swallowing ('swallowing syncope') or coughing ('cough syncope') • Random onsets due to nerve malfunctions • Pressing upon certain places on the throat, sinuses, and eyes, also
known as vagal reflex stimulation when performed clinically. • Water colder than 50 Degrees Farenheight, or Ice that comes in
contact with the face, that stimulates the Mammalian diving reflex • High altitude • Use of certain drugs that affect blood pressure, such as
amphetamine • Intense laughter[2]
Patient Assessment• Specify; weakness, spinning, lightheadedness• Warnings• Onset• Duration• Position at time of episode• PMHx.• Meds• Any other complaints at the time• Vomiting, coffee-ground emesis• Black tarry stools• Aura• Seizure activity
Patient Care
• O2
• Loosen tight clothing around neck
• Trendelenberg
• ALS
• Treat injuries
• Transport in POC
Stroke
Death or injury to brain tissue deprived of oxygen
• Ischemic
• Hemorrhagic
• TIA
Warning sign
Signs
• Hemi paresis
opposite side of brain that is affected
• Headache
• Inability to speak
Patient Assessment• Cincinnati Stroke Scale• Facial droop: Have the person smile or show his or her teeth. If one side
doesn't move as well as the other so it seems to droop, that could be sign of a stroke.
– Normal: Both sides of face move equally – Abnormal: One side of face does not move as well as the other (or at all)
• Arm drift: Have the person close his or her eyes and hold his or her arms straight out in front for about 10 seconds. If one arm does not move, or one arm winds up drifting down more than the other, that could be a sign of a stroke.
– Normal: Both arms move equally or not at all – Abnormal: One arm does not move, or one arm drifts down compared with
the other side • Speech: Have the person say, "You can't teach an old dog new tricks," or
some other simple, familiar saying. If the person slurs the words, gets some words wrong, or is unable to speak, that could be sign of stroke.
– Normal: Patient uses correct words with no slurring – Abnormal: Slurred or inappropriate words or mute
• Confusion
• Dizziness
• Numbness, weakness, paralysis
• Incontinence
• Impaired vision; loss of vision in one eye
• High blood pressure
• Respiratory; snoring
• Nausea or vomiting
• Seizures
• Unequal pupils
• Headaches
• Unconsciousness
Care
• Airway
• O2
• Calm and reassure
• Transport in semi-fowler
• Transport on affected side - - unconscious