copyright 2009 seattle/king county ems overview of cbt 450 diabetic emergencies complete course...
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Copyright 2009 Seattle/King County EMS
Overview of CBT 450 Diabetic Emergencies
Complete course available at www.emsonline.net
Copyright 2009 Seattle/King County EMS
IntroductionDiabetic Emergencies • Diabetes affects 20.8 million people
• At least one-third of people with diabetes are unaware they have the disease
Copyright 2009 Seattle/King County EMS
Practical Skills
• Patient assessment
• Blood glucometry
• Oral glucose
To receive CBT or OTEP credit, you must perform the following practical skills:
Copyright 2009 Seattle/King County EMS
Termsacidosis — 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.
Copyright 2009 Seattle/King County EMS
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
Copyright 2009 Seattle/King County EMS
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
• Pale, moist skin
• Rapid onset
• Weak, rapid pulse
• Low BP
• Low blood glucose
• Insufficient insulin
• Warm, dry skin
• Gradual onset
• Rapid, deep respirations
• Intense thirst
• 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
Copyright 2009 Seattle/King County EMS
Swallow Reflex
• Ability to swallow is an effective indicator of the ability to maintain an airway
If patient can’t swallow If patient can’t swallow don’t give oral glucosedon’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
Copyright 2009 Seattle/King County EMS
Summary, continued
Your primary responsibility for a hyperglycemic diabetic is to maintain the airway and provide rapid transport
Guidelines for administering oral glucose
• 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
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