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Chapter 20 Acute Diabetic Emergencies Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph.

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Presentation on theme: "Chapter 20 Acute Diabetic Emergencies Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph."— Presentation transcript:

1 Chapter 20 Acute Diabetic Emergencies Copyright ©2010 by Pearson Education, Inc. All rights reserved. Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren

2 Objectives 1.Define key terms introduced in this chapter. 2.Describe the following regarding glucose (slides ): a.The function of glucose in the body b.Response of brain cells and other body cells to insufficient glucose levels c.Relationships of glucose and water 3.Describe how insulin and glucagon function to control blood glucose levels (slides 14-17).slides Describe how glucose levels are regulated in normal metabolism (slides 20-21).slides Explain the purposes and process of checking blood glucose levels. (slides 22-26).slides 22-26

3 Objectives 6.Discuss the pathophysiology of diabetes mellitus (DM) and contrast type 1 insulin-dependent diabetes mellitus (IDDM) with type 2 noninsulin- dependent diabetes mellitus (NIDDM) (slides 27-29).slides Discuss the pathophysiology, assessment, and emergency medical care of a hypoglycemic emergency (slides 30-36).slides Identify indications and contraindications to the administration of oral glucose (slides 37-39).slides Discuss the pathophysiology, assessment, and emergency medical care of diabetic ketoacidosis (DKA) (slides 40-47).slides 40-47

4 Objectives 10.Compare and contrast the speed of onset and the signs and symptoms of hypoglycemia and hyperglycemia (slides 34, 45) Describe the primary differences between DKA and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) (slides 43, 48, 50) Discuss the pathophysiology, assessment, and emergency medical care of HHNS (slides 48-52).slides Discuss the assessment-based approach to a patient with an altered mental status in a diabetic emergency (slides 53-63).slides 53-63

5 Multimedia Directory Slide 26How to Use a Blood Glucose Meter Video Slide 29Information about Diabetes Video Slide 39The Use of Oral Glucose Animation

6 Topics Understanding Diabetes Mellitus Acute Diabetic Emergencies Assessment-Based Approach: Altered Mental Status in a Diabetic Emergency

7 CASE STUDY Dispatch

8 Respond to 514 Chicago Avenue for a 66-year- old male who is disoriented and belligerent. The neighbor placed the call. EMS Unit 106 Time out 1402

9 Neighbor found patient in her garden next door When she approached him, the patient began cursing at her Patient is acting strange and not making sense Upon Arrival

10 How would you proceed to assess and care for this patient?

11 Back to Topics Understanding Diabetes Mellitus

12 Glucose (Sugar) Back to Objectives

13 Sources Roles Brain cells

14 Hormones That Control Blood Glucose Levels Insulin Back to Objectives

15 Insulin Main functions How it works

16 Hormones That Control Blood Glucose Levels Glucagon

17 Role Functions

18 Hormones That Control Blood Glucose Levels Other Hormones

19 Epinephrine Released by the adrenal glands Stops the secretion of insulin Promotes release of stored glucose from the liver Promotes conversion of other substances into glucose

20 Normal Metabolism and Glucose Regulation Back to Objectives

21 Normal Glucose Regulation

22 Checking the Blood Glucose Level Back to Objectives

23 Glucose meters Hypoglycemia Hyperglycemia

24 Checking the Blood Glucose Level Testing the Blood Glucose Level with a Glucose Meter

25 Blood sample Equipment needed

26 Return to Directory Click here to view a video on how to use a blood glucose meter.here How to Use a Blood Glucose Meter

27 Diabetes Mellitus (DM) Back to Objectives

28 Primary problem Type I diabetes Type II diabetes

29 Return to Directory Click here to view a video on information about diabetes.here Information about Diabetes

30 Acute Diabetic Emergencies Back to Topics

31 Hypoglycemia Pathophysiology of Hypoglycemia Back to Objectives

32 Pathophysiology Cause Reasons for drop

33 Hypoglycemia Assessment Findings in Hypoglycemia and Hypoglycemia Unawareness

34 Assessment Findings Cause Signs and symptoms Hypoglycemia unawareness Back to Objectives

35 Hypoglycemia Emergency Medical Care for Hypoglycemia

36 Emergency Medical Care For a responsive patient For an unresponsive patient

37 Oral Glucose Back to Objectives

38 Purpose for administration Criteria for administration

39 Return to Directory Click here to view information about the use of oral glucose.here Information about the Use of Oral Glucose

40 Hyperglycemia Back to Objectives

41 Hyperglycemia Diabetic ketoacidosis (DKA) Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

42 Hyperglycemic Condition: Diabetic Ketoacidosis (DKA) Pathophysiology of DKA

43 Pathophysiology Cause Results in the body Factors causing hyperglycemia in DKA patients Back to Objectives

44 Hyperglycemic Condition: Diabetic Ketoacidosis (DKA) Assessment Findings in DKA

45 Assessment Findings Signs and symptoms –Polyuria –Polydipsia –Polyphagia Kussmaul’s respirations Back to Objectives

46 Hyperglycemic Condition: Diabetic Ketoacidosis (DKA) Emergency Medical Care for DKA

47 Emergency Medical Care ABCs Provide O 2 Assist ventilation Check BGL Contact medical direction

48 Hyperglycemic Condition: Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) Pathophysiology of HHNS Back to Objectives

49 Pathophysiology Blood glucose level Precipitating factors

50 Hyperglycemic Condition: Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) Assessment Findings in HHNS Back to Objectives

51 Assessment Findings Signs and symptoms

52 Emergency Medical Care ABCs Provide O 2 Support respirations Determine BGL Medical direction

53 Assessment-Based Approach: Altered Mental Status in a Diabetic Emergency Back to Topics

54 Scene Size-Up and Primary Assessment Back to Objectives

55 Look for scene clues Medic alert tags Insulin pumps

56 History and Secondary Assessment

57 SAMPLE Common medications Questions to ask

58 History and Secondary Assessment Signs and Symptoms

59 Place redrawn picture here – did not have yet, WDS

60 Emergency Medical Care

61 ABCs Determine if patient can swallow Administer oral glucose Transport

62 Reassessment

63 May take 20 minutes to see improvement Recheck BGL Continue O 2 Manage airway as needed

64 CASE STUDY Follow-Up

65 Primary Assessment Patient sitting on couch Find Digoxin in kitchen and insulin in refrigerator Patient is pale and sweating profusely Patient speaking in mumbled words CASE STUDY

66 Primary Assessment Partner places a nonrebreather mask at 15 lpm RR: 15; P: 100 and strong CASE STUDY

67 Secondary Assessment Do rapid assessment BP: 102/60 mmHg; P: 108; RR:16; skin pale, cool, and moist; SpO 2 : 97 percent BGL: 48mg/dL Administer one tube of glucose Place patient in left lateral position CASE STUDY

68 Treatment and Reassessment Becomes oriented to name and place Pulse rate, skin, and SpO 2 improve Change over to nasal cannula Alert and oriented upon arrival Transfer care without incident CASE STUDY

69 34-year-old female with an altered mental status Responds to painful stimuli only with moans A neighbor called 911 after finding her on the couch and not responding Critical Thinking Scenario

70 S – Supine on the couch, not alert A – Unknown M – Her neighbor brings you the patient’s medications: Zoloft and Novolin P – Her neighbor doesn’t know the patient’s medical history L – Unknown E – Patient called the neighbor 20 minutes ago and said she wasn’t feeling well Critical Thinking Scenario

71 Vital signs: BP: 108/62 mmHg HR: 122 bpm RR: 12 per minute with snoring respirations but adequate chest rise Skin is pale, cool, and very diaphoretic Critical Thinking Scenario

72 1.What emergency care would you provide during the primary assessment? 2.Based on the signs, what condition do you suspect the patient is experiencing? 3.What other assessment procedures would be helpful to you for this patient? 4.What would you expect the blood glucose reading to be in the patient? 5.Why is the onset of the altered mental status significant in this patient? Critical Thinking Questions

73 Reinforce and Review Please visit and follow the myBradykit links to access content for the text.


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