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Diabetic Emergencies and Altered Mental Status. Diabetes Mellitus Decreased insulin production or inability to use insulin properly resulting in high.

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Presentation on theme: "Diabetic Emergencies and Altered Mental Status. Diabetes Mellitus Decreased insulin production or inability to use insulin properly resulting in high."— Presentation transcript:

1 Diabetic Emergencies and Altered Mental Status

2 Diabetes Mellitus Decreased insulin production or inability to use insulin properly resulting in high blood sugar

3 Hypoglycemia Takes too much insulin or oral medication Doesnt eat Over exercises or over exerts Vomiting Children playing hard not eating correctly or on time

4 Signs Rapid onset AMS or abnormal behavior Diaphoretic

5 Treatment Oral Glucose Must be conscious and able to swallow

6 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

7 Patient Assessment Initial Assessment AMS intoxicated appearance staggering slurred speech unconscious

8 Signs AMS Cold, clammy skin Elevated heart rate Hunger Uncharacteristic behavior Anxiety Combativeness seizures

9 Blood glucose meters

10 Patient Care If appropriate administer oral glucose If not appropriate to administer oral glucose: A B Cs Position Request ALS

11 Types of Diabetes Type I Type II

12 Hypoglycemia and Hyperglycemia compared

13 Other causes of AMS Seizures Common causes Children: Febrile (3 mo to 3 yrs) Adults: Failure to take medication

14 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

15 Types of seizures: Partial Also called focal motor, or focal sensory Simple and complex

16 Simple: Tingling Stiffening or jerking in just one part of the body Aura smell bright lights burst of color

17 Complex Psychomotor or temporal lobe Confusion Glassy stare Aimless moving about Lip smacking Chewing or fidgeting with clothing

18 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 …….

19 Tonic-Clonic Grand-mal Three phases Tonic: body becomes rigid and stiffens for no more than 30 seconds Breathing may stop May bite tongue Bladder and bowel control lost

20 Clonic Violent jerking 1 to 2 minutes Foam at the mouth and drooling Face and lips become cyanotic

21 Postictal Begins when convulsions stop May regain consciousness immediately but be drowsy and confused or Remain unconscious Headache is common

22 Absence seizure Petit-mal Brief lasting only 1 to 10 seconds No dramatic motor activity

23 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

24 Status Epilepticus

25 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

26 If convulsions have ceased: *ABCs *Treat injuries. Remember C-Spine *Transport


28 Dizziness Loss of strength, spinning, lightheadedness, weakness Syncope Brief loss of consciousness with spontaneous recovery

29 May experience lightheadedness or dizziness Nausea Weakness Vision changes Sudden pallor Sweating Occasionally Tachycardia, bradycardia, or a headache

30 CAUSES OF DIZZINESS AND SYNCOPE Hypovalemia fluid/blood ectopic pregnancy AAA GI bleed

31 Metabolic hypoglycemia Enviornmental/toxicological Alcohol/drugs CO2 poisoning Panic attacks

32 Cardiovascular Bradycardia Tacycardia Vasovagal syncope

33 Typical triggers for vasovagal episodes include:[1][1] Prolonged standing or upright sitting, particularly when standing with legs in a locked position for long periods of timeavoidance 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 oneblood donation –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 heatHyperthermia Sudden onset of extreme emotions Hunger

34 Nausea or vomiting Dehydration Urination ('micturition syncope') or defecation ('defecation syncope')Urinationmicturition syncopedefecation 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 reflexMammalian diving reflex High altitude Use of certain drugs that affect blood pressure, such as amphetamine amphetamine Intense laughter[2][2]

35 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

36 Patient Care O2 Loosen tight clothing around neck Trendelenberg ALS Treat injuries Transport in POC

37 Stroke Death or injury to brain tissue deprived of oxygen Ischemic Hemorrhagic TIA Warning sign

38 Signs Hemi paresis opposite side of brain that is affected Headache Inability to speak

39 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

40 Confusion Dizziness Numbness, weakness, paralysis Incontinence Impaired vision; loss of vision in one eye High blood pressure

41 Respiratory; snoring Nausea or vomiting Seizures Unequal pupils Headaches Unconsciousness

42 Care Airway O2 Calm and reassure Transport in semi-fowler Transport on affected side - - unconscious

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