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What does the pancreas do and where is it located?
- secretes insulin, glucose and glucagon
- located mostly in the upper L quadrant
What is glucose?
- a simple carbohydrate (sugar)
- used by the body to produce energy
- major nutrient source
- every carb must be broken down to glucose in order for the body to use it
What is hypoglycemia?
when the blood sugar is low enough to cause CNS symptoms (affecting the brain)
What does the liver secrete?
What is glycogen?
stored sugar, or extra sugar left over from a previous meal
What does insulin do?
allows glucose to enter the cell and decreased the bG
Define hyperglycemia and the symptoms associated with it.
- increased glucose in the blood caused from lack of insulin allowing the glucose to enter the cell
- in short: too much food, too little insulin
- rapid weak pulse
- deep rapid breathing
- decreased LOC
- normal or lowered BP
Define Type I Diabetes
- insulin dependent = pancreas cannot create enough insulin, so these pts must take supplemental insulin
- most common form in young ppl
- 10-15% of diabetes cases
Define Type II Diabetes.
- Non-insulin dependent
- most common type of diabetes in ppl over 30 y/o
- frequently associated with obesity b/c the body mass grows but the pancreas does not = it has insufficient insulin secretion
- these pts take oral medications to stimulate the pancreas to create more insulin (they may also take insulin as well)
In diabetes, the cell responds to starvation by...
metabolizing fat instead of glucose
What are the negative effects of the cell metabolizing fat instead of glucose?
- byproducts of fatty acids and ketones, making the patient severely acidotic (changing the pH in the body)
- can cause severe brain damage or death
- kidneys attempt to eliminate glucose through urine and cause dehydration
How does the patient try to correct acidosis caused from fat metabolization?
- deep rapid breathing pattern called Kussmaul's respirations
- pt breathes off CO2 and the blood becomes more alkaline
What are the signs and symptoms of Diabetic Ketoacidosis?
- hunger (cells are starving)
- thirst (excessive urine output)
- tachycardia and hypotension from excessive urine output
- pale, dry skin
- altered LOC
What are the complications resulting in a patient with diabetic ketoacidosis?
- electrolytes are imbalances from an excessive urine output and potassium levels drop
- acidosis and decreased potassium may cause cardiac dysrhythmia or death
How do we treat diabetic ketoacidosis?
- recognize it
- ALS upgrade
- support ABCs
- correct hypovolemia
- rapid transport where the pt will be placed in insulin and the volume loss will be replaced
The ____ is the only organ that doesn't require insulin to use glucose
List the s/s of hypoglycemia.
- full, rapid pulse
- normal breathing
- dizziness, headache
- fainting, seizures, disorientation, coma
- normal BP
- grossly diaphoretic
- if allowed to progress, pt will become tachycardic (brain wants more blood - more sugar) and brain cells will begin to die from starvation
What are the complications associated with hypoglycemia?
- pt appears intoxicated
- any CNS disturbance possible: coma, confusion, euphoria, combativness
- if not recognized and corrected quickly, permanent brain damage may result (brain cells are dying from starvation)
What can are the things that atheroschlerosis can cause?
- Coronary Artery Disease
- claudation (limping)
- skin breakdown
- amputation of extremities
What are the indications for the use of glucose?
altered/decreased mental status AND known history of diabetes
What are the contraindications for the use of glucose?
- known diabetic who has not taken medications for days
- patient is unable to swallow
What are the precautions/adverse reactions when administering glucose?
use caution to prevent aspiration of glucose paste
What class of drug is glucose?
What are the two methods of glucose administration?
- squeeze small portions of gel into mouth between cheek and gum
- squeeze small portions of gel into tongue depressor, then place gel between cheek and gum
What should an EMT be concerned with just after administering glucose?
Blood Glucose Rebound - in the presence of insulin, glucose introduced into the bloodstream will be flushed rapidly into cells and cause the bG to drop rapidly again. to prevent another hypoglycemic episode, the pt must eat a carb and protein (pb&j)
What are the questions to ask a diabetic pt (or family member)?
- are you on oral medication or insulin?
- have you taken your meds today?
- have you eaten your normal food intake today?
- have you tested your bG today? when?
- what was the result of the bG test?
- any other symptoms?
What should an EMT keep in mind when checking glucometry?
- a tool that should be used to supplement an ALS assessment
- should not be a decision point in determining upgrade or method of transport
- BLS units should not carry glucometers not base any decisions to upgrade or downgrade a ptbased on bG reading
- skill should be performed under ALS supervision
What are the pertinent objective findings in a diabetic patient?
- rapid onset of altered LOC
- intoxicated appearance
- elevated heart rate
- cold clammy skin
- insulin in fridge or other meds found on scene
- uncharacteristic behavior
In the primary exam of a diabetic pt, what should be included in the focused history and physical exam?
- onset - rapid or slow (OPQRST)
- associated symptoms
- evidence of trauma
What does medical direction say about the dosage and administration of glucose?
- administration of one tube of glucose is covered by standing orders
- additional glucose administration requires Medic Unit contact
physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain
What is a febrile seizure?
a seizure caused from a rapid onset of fever, usually occurring in children 6 month to 6 years old
What is the postictal phase?
- the unconcious period after a seizure
- pt is lethargic, disoriented, possibly incontinent
What is the clonic phase?
the rhythmic jerking phase in that occurs during a seizure
What is the tonic/hypertonic phase?
the phase in seizures when all muscles contract simultaneously
What is status epilepticus?
- prolonged seizure or repeated seizures without regaining consciousness in between
- life threatening emergency
- most common in children younger than 2 years
What are the conditions that could cause seizures?
What is the ALS upgrade for seizures?
- actively seizing upon arrival
- first time seizure or unknown history
- seizure with pregnancy, street drug use, recent head injury, or abrupt onset of severe headache
What is the plan/treatment of a pt with seizures?
- protect pt from trauma if still seizing (move furniture out way, etc)
- general pt care procedures
- for febrile seizures, remove clothing down to diaper
What is syncope?
What are the ALS upgrades for syncope?
- altered or decreased LOC
- severe abdominal or back (indicating AAA)
- severe headache (indicating head bleed)
ischemia of the brain
blockage of an artery in the brain, often by a clot traveling from somewhere else in the body
Define hemorrhagic stroke.
ruptured blood vessel causing bleeding in the brain
What is the FAST test?
- F-facial droop
- A-arm drift
- S-slurred speech
symptoms to look for in a stroke patient
What are the ALS upgrades for a stroke patient?
- altered LOC
- uncontrolled nausea/vomiting
- systolic BP greater than 250 or diastolic greater than 110 with new onset of stroke symptoms
- dysarthria (impaired speech) with absent gag reflex
What is dysarthria?
What is dysphasia?
inability to communicate
What is dysphagia?
inability to swallow
What is in the plan/treatment for stroke patients?
- general pt care procedures
- if pt has dysarthria, check for gag reflex with tongue depressor
- if pt is diabetic, have family check bG lvl, if possible
- obtain an accurate "time when last seen normal"
If stroke occurred within the last ______, rapidly transport to nearest stroke center (PSPH).
Define transient ischemic attack.
- small stroke that has no lasting effects or permanent neurological damage
- these pts have a much higher risk of having actual stroke
What is Todd's paralysis.
temporary paralysis in an post seizure patient
What are the ALS upgrades for headaches?
- altered or decreased LOC
- severe or multiple episodes of vomiting
- systolic greater than 250 or diastolic less than 110
- when asked "how does this compare to other headaches you've had?" pt states "worst headache of my life"
- lateralizing signs