Transcript CBT 442 Stroke

Overview of CBT 450
Diabetic Emergencies
Complete course available at www.emsonline.net
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Introduction
Diabetic Emergencies
• Diabetes affects 20.8 million people
• At least one-third of people with diabetes are
unaware they have the disease
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Practical Skills
To receive CBT or OTEP credit, you must perform the
following practical skills:
• Patient assessment
• Blood glucometry
• Oral glucose
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Terms
acidosis — Excessive acid in the body fluids.
glucagon — A hormone produced by the pancreas that causes
the liver to convert stored glycogen into glucose and release it
into the bloodstream. The action of glucagon is opposite that
of insulin.
hyperosmolar nonketotic coma — A complication of type 2
diabetes that results in extremely high glucose levels without
the presence of ketones.
ketones — Acids that are the product of fat metabolism.
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Terms, continued
polydipsia — Excessive thirst persisting for long periods of
time despite reasonable fluid intake; often the result of
excessive urination.
polyphagia — Excessive eating; in diabetes, the inability to
use glucose properly can cause a sense of hunger.
polyuria — The passage of an unusually large volume of urine
in a given period.
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Glucose
Glucose, a form of sugar, is body’s main source of
energy
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Insulin
• A hormone produced by pancreas
• Helps glucose enter cells and produce energy
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Types of Diabetes
Type 1 diabetes - body does not produce insulin so
glucose cannot enter cells
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Types of Diabetes, continued
Type 2 diabetes - body does not produce enough
insulin or cells ignore insulin produced
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Hypoglycemia
Too much insulin, too little food or too much
exercise
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Hypoglycemia, continued
Medical history
• Insufficient food intake
• Excessive insulin dosage
• Normal to excessive activity
• Rapid onset
• Absent thirst
• Intense hunger
• Headache
• Seizures
• Recent illness, change in diet
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Hyperglycemia
Too little insulin, not enough exercise or too much
food
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Hyperglycemia, continued
Medical history
• Recent infection
• Three Ps (polyphagia, polydipsisa, polyurea)
• Vomiting, abdominal pain
• Flu-like symptoms, nausea
• Insufficient insulin dosage
• Gradual onset
• Normal activity level
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Hypo Vs. Hyper
• Insufficient food intake
• Insufficient insulin
• Pale, moist skin
• Warm, dry skin
• Rapid onset
• Gradual onset
• Weak, rapid pulse
• Rapid, deep respirations
• Low BP
• Intense thirst
• Low blood glucose
• Increased urination
• High blood glucose
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Insulin Reaction
• Cold, pale, clammy skin
• Abnormal, hostile, bizarre behavior (appears intoxicated)
• Shaking, trembling, weakness
• Full, rapid pulse
• Normal or elevated blood pressure
• Dizziness, headache, blurred vision
• Extreme hunger
• Seizures
• Loss of consciousness
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Diabetic Ketoacidosis
• High blood glucose levels
• The Three P’s
• Altered LOC (advanced DKA)
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Diabetic Coma
Unconsciousness from severe hypoglycemia,
diabetic ketoacidosis or hyperglycemia combined
with profound dehydration
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Patient History
• When did you eat last?
• How much did you eat?
• Have you taken your insulin today?
• Has there been a change in your health, stress or
exercise level?
• When did the symptoms begin?
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Glucometry
1. Don gloves and eye protection.
2. Clean fingertip with an alcohol pad.
3. Grasp finger near area to be pricked and
squeeze.
4. Prick side of finger with a sterile lancet and
squeeze finger gently.
5. Place drop of blood on the test strip.
6. Read meter and record reading and time.
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Care for Diabetic Emergency
• Request medic unit, if indicated
• Maintain airway
• Administer oxygen
• If able to swallow, give oral glucose
• Monitor vital signs and LOC
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Oral Glucose
• Ask patient if able to swallow, if not don’t
administer
• Position upright
• Ask patient to sip or chew sugar-containing
substance
• Monitor patient’s response to glucose
• Repeat blood glucometry
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Swallow Reflex
• Ability to swallow is an effective indicator of the
ability to maintain an airway
If patient can’t swallow
don’t give oral glucose
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Summary
Type 1 diabetes - body does not produce insulin
Type 2 diabetes - body does not produce enough
insulin or cells ignore insulin produced
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Summary, continued
Hypoglycemia - too much insulin, too little food
intake or too much exercise
Hyperglycemia - too little insulin, not enough
exercise or too much food
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Summary, continued
Medical history suggesting hypoglycemia
• Insufficient food intake
• Excessive insulin dosage
• Normal to excessive activity
• Rapid onset
• Absent thirst
• Intense hunger
• Headache, seizures
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Summary, continued
Medical history suggesting hyperglycemia
• Recent infection
• The Three P’s
• Vomiting, abdominal pain
• Flu-like symptoms, nausea
• Insufficient insulin dosage
• Gradual onset
• Normal activity level
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Summary, continued
Treatment for hypoglycemia
• Request medic unit, if indicated
• Maintain airway
• Administer oxygen
• If able to swallow, give oral glucose
• Monitor vital signs and LOC
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Summary, continued
Your primary responsibility for a hyperglycemic
diabetic is to maintain the airway and provide
rapid transport
Guidelines for administering oral glucose
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Ask if able to swallow, if not don’t administer
Position upright
Ask to sip or chew sugar-containing substance
Monitor patient’s response
Repeat blood glucometry
Copyright 2009 Seattle/King County EMS