EMTB-11 Ch19 Diabetes & AMT

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Bitter
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66513
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EMTB-11 Ch19 Diabetes & AMT
Updated:
2011-02-15 15:00:05
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Chapter19 Diabetic Emergencies Altered Mental Status
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Chapter19 Diabetic Emergencies and Altered Mental Status
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  1. Glucose
    a from of sugar, the body's basic source of energy. Sugars that a person eats are converted into glucose & absorbed into the bloodstream.
  2. Insulin
    hormone produced by the pancreas or taken as a medication by many diabetics. For glucose to enter cells, insulin must be present.
  3. Diabetes Mellitus/ sugar diabetes/ diabetes
    condition caused by decreased insulin production. Or more commonly in older patients, the inability of cells to use insulin properly, resulting in high blood sugar. Person with this condition is a diabetic.
  4. Hypoglycemia
    Low blood sugar. Most common diabetic emergency.
  5. Hypoglycemia causes
    • -took too much insulin, thereby putting too much sugar in the cells & not leaving enough in the bloodstream.
    • -reduced sugar instak by not eating.
    • -overexercises/ overexerts, thus using sugars faster
    • -vomits a meal, emptying stomach of sugars & food
  6. Hypoglycemia symptoms (insulin shock)
    • -Blood sugar below 70mg/dL
    • -Rapid onset, rapid pulse, cold sweaty skin
    • -Normal breath smell, drooling, hostile behavior
  7. Hyperglycemia
    High blood sugar. Usually caused by a decrease in insuling; leaving too much sugar in bloodstream, not entering cells. Could result from body's inability to produce insulin or because insulin injection wasn't taken.
  8. Hyperglycemia symptoms
    • -slower gradual onset (hours or days)
    • -increased urination, thirst, hunger, nauseated
    • -Kussmal/ exaggerated breathing
    • -sweet acetone breath odor
    • -weak rapid pulse, warm/ dry/ red skin
    • -restlessness, confusion
  9. Hyperglycemia causes
    too much food, too little insulin, illness, or stress.
  10. Diabetic Emergency Assesment
    • 1. Identify altered mental status. History of diabetes.
    • 2. Perform focused history & physical exam
    • 3. Determine if patient is alert enough to swallow.
    • 4. Take baseline vitals.
  11. Normal glucose level
    • 70-110 mg/dl - Normal
    • <60-80 mg/dl - hypoglycemic
    • >120-140 mg/dl - hyperglycemic
  12. Type I Diabetes, juvenile diabetes
    Insulin dependent. Individuals with little or no ability to produce insulin. Often starts in childhood. Injects insulin at least once daily.
  13. Type II Diabetes
    Non-insulin dependent. Occurs in individuals who DON'T produce sufficient amounts of insulin or whose body cells cannot absorb insulin properly. Associated with obesity. Can be controlled without taking insulin, through diet and oral meds.
  14. Hyperglycemia causis
    • -Not taken enough insulin or forgotten to.
    • -Has overeaten.
    • -Has infection that upset his insulin/glucose balance.
    • -Stress.
  15. Seizure
    Sudden change in sensation, behavior, or movement. Usually last 1-3 minutes. The most severe form of seizure produces uncontrolled violent muscle contractions called convulsions.
  16. Epilepsy
    Medical condition that causes seizures. With proper medication, many epileptic patients will no longer have seizures.
  17. Status Epilepticus
    A prolonged seizure or when a person suffers two or more convulsive seizures without regaining full conciousness. Lasting 5- 10 minutes or more.
  18. Altered Mental Status causes
    Possible causes include diabetes, seizure disorders, epilepsy, alcohol use, drug overdose, metabolic abnormalities, head trauma, brain tumor, infectious diseases such as meningitis, hypoxia.
  19. Most common cause of seizures in adults.
    Failure to take prescribed anti-seizure meds.
  20. Febrile seizure
    High fever, most common cause of seizures in infants & children 6 months to 3 yrs of age.
  21. Congenital brain defect
    Defect one is born with. Can cause seizures, most often seen in infants & young children.
  22. Metabolic seizures
    can be caused by irregularities in patient's body chemistry (metabolism).
  23. Idiopathic seizure
    This means occuring spontaneously, with an unknown cause. Often the case with seizures that start in childhood.
  24. Seizure Assessment
    • -What was patient doing before it started?
    • -Exactly what did patient do during seizure. Movement by movement, especially at the beginning.
    • -Was there loss of bladder or bowel movement.
    • -How long did it last?
    • -What did patient do after? Were they asleep and how long? Were they able to answer questions? AVPU
  25. Seizure Patient Care
    • -Place patient on ground or floor.
    • -Loosen restrictive clothing.
    • -Remove surrounding objects that may harm patient.
    • -Do not try to hold patient still.
    • -After convulsions end: protect airway, provide oxygen, be ready to suction. If no likelihood of spine injury, position patient on side for mouth drainage. Treat injuries, immobilize neck & spine.
  26. tonic-clonic / grand-mal seizure
    Person falls to the floor & has severe convulsions. Bowel & bladder control could be lost. Patient may foam/ drool. Face/ lips often become cyanotic.
  27. Stroke / CVA (cerebrovasulcar accident)
    Condition of altered function caused when an artery in the brain is blocked or ruptured. Disrupts the supply of oxygenated blood or causes bleeding into the brain, resulting in dead or injured brain tissue.
  28. Ischemic Stroke
    Caused by a blockage, can occur when a clot or embolism occludes an artery or as a result of artherosclerosis. This mechanism is responsible for most strokes.
  29. Hemmorhagic Stroke
    Caused by bleeding into the brain, frequently the result of longstanding hypertension. Also can occur when a weak area of the artery bulges out (aneurysm) and ruptures.
  30. Hemiparesis
    One-sided weakness. Common sign of stroke.
  31. Aphasia
    General term refers to difficulty in communicating. (Receptive aphasia - patient can speak clearly but does not understand you or the situation.)
  32. Transient Ischemic Attack (TIA), mini-stroke
    Patient appears to be having a stroke because typical signs & symptoms are the same, but they have complete resoultion within 24 hours without treatment. Caused by small clots temporarily blocking circulation & causing hypoxia.
  33. Cincinatti Prehospital Stroke Scale
    • Used to assess conscious patients for stroke.
    • -Ask patient to smileor grimace. Tests facial muscle control. Normal response is for both sides to move equally.
    • -Ask patient to close eyes and extend arms straight out in front for 10 seconds. Normal is both arms moving equally.
    • -Speech. Normal us no slurring, using correct words.
  34. Stroke signs & symptoms
    Facial droop, speech diffiulty, confusion, dizziness, numbness, weakessm hemiparesis, loss of bladder/bowel control, impaired vision, high blood pressure, nausea/vomiting, seizures, unequal pupils, headache, difficult respiration, loss of vision in one eye, unconsciouness (uncommon).
  35. syncope
    Fainting. Brief loss of consciousness with spontaneous recovery. Typically lasts a few seconds to a few minutes. Symptoms preceeding episode may include lightheadedness, dizzines, nausea, weakness, vison change, abnormal skin color, sweating.
  36. Dizziness & Syncope - common causes
    • Hypovolemic (low fluid/ blood volume)
    • Metabolic
    • Environmental/ toxicological
    • Cardiovascular
  37. Dizziness - common variations
    • Weakness, sensation of loss of strength.
    • Vertigo or spinning, surroundings spin around patient.
    • Lightheadedness, sensation that patient is about to pass out (pre-syncope or near-syncope)
  38. Eclampsia
    Severe complication of pregnancy resulting in seizure or coma.

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