KEY VOCABULARY
The following terms will be used during this lesson:
· Conscious - patient is awake and responds to stimuli appropriately
· Coma - patient is not aroused by external stimuli
· Diabetes mellitus - endocrine disorder characterized by inadequate insulin production by beta cells in the islets of Langerhans in the pancreas
· Endocrine Glands - glands that secrete hormones directly into the blood stream
· Glucose – source of energy required by cells for normal functioning
· Hyperglycemia - abnormally high levels of glucose in the blood
· Hypoglycemia - abnormally low levels of glucose in the blood
· Hormones - chemical substances released by a gland that control or affect other glands or body systems
· Insulin – hormone secreted by pancreas which allows cells to use glucose
· Ketoacidosis - complication of diabetes that occurs from too little insulin production or secretion
· Oriented - responds appropriately to questions regarding person, place, time, and events (purpose)
Lets Start ...!!!
DIABETES MELLITUS – OVERVIEW
Pathophysiology
· All cells require glucose for survival · Glucose is primarily acquired from the digestion of carbohydrates · Starches and complex sugars are converted to the simple sugar glucose · If glucose is not available from the ingestion of carbohydrates the body will break down glycogen (a sugar stored in the liver) or protein in the liver · Insulin (a hormone secreted by the beta cells in the pancreas) is necessary to allow glucose to pass from the blood stream into the cells. |
Classifications of diabetes:
Type I: · Insulin dependent (IDDM) · Onset is usually in adolescence or early adulthood · Cause is thought to be a virus that damages the pancreas resulting in an inadequate production of insulin · Usually “brittle” diabetics (hard to control) · Diabetic ketoacidosis is common |
Type II: · Non-insulin dependent (NIDDM) · Use oral hypoglycemic agents Orinase Tolinase Diabinese Diabeta Dymelor · Onset is in older adults · Often associated with obesity · The cells do respond to the insulin that is available |
Complications of diabetes
Acute: · Hypoglycemia · Diabetic ketoacidosis · Hyposmolar, hyperglycemic, nonketotic coma |
Chronic: · Infections · Vascular disease · Coronary artery disease · Stroke · Neuropathies · Blindness |
PATHOPHYSIOLOGY, SIGNS AND SYMPTOMS, AND FIELD MANAGEMENT OF COMMON DIABETIC EMERGENCIES
Hypoglycemia (insulin shock)
Pathophysiology: · Occurs when there is too much insulin in the blood stream. · Usually occurs when the diabetic patient takes their insulin and does not eat. · Can occur if the diabetic patient eats but is vomiting and the nutrients are not absorbed. |
Signs and symptoms: · Dizziness/headache · Pale, cool, clammy · Mental confusion · Abnormal behavior · Altered LOC · Tachycardia is common · Strong or bounding pulse · Normal BP · Shallow respirations |
Field management of hypoglycemia
BLS procedures: · Maintain airway · High flow O2 by mask · Left lateral position if unconscious · Thorough history to determine to determine possible cause · Oral hypoglycemic agent if patient is conscious and has a gag reflex · Transport · Assist with ALS procedures |
ALS procedures: · Advanced airway management prn · Venous access · Monitor · Glucometer · Dextrose 50% if blood glucose < 80 · Glucagon 1 mg. May be ordered if unable to obtain venous access and glucose <80 · Transport |
Hyperglycemia (Diabetic Coma)
Pathophysiology: · Insulin levels are inadequate to meet the body’s needs. · Glucose cannot be utilized by the cells and it accumulates in the bloodstream. · The excess sugar begins to spill over into the urine. · As the sugar is excreted it takes excessive amounts of water with it resulting in serious dehydration. · Ketones and acids are produced as cellular glucose depletion continues. · Ketoacidosis is a serious complication that can result in coma and death. |
Signs and symptoms: · Increased hunger · Increased thirst · Altered LOC · Kussmauls respirations · Hypotension · Weak, rapid pulse · Fruity odor on breath · Frequent urination |
Field management of hyperglycemia
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INITIAL ASSESSMENT AND FOCUSED HISTORY AND DETAILED PHYSICAL EXAMINATION OF DIABETIC PATIENTS
Initial Assessment
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2). Airway: determine responsiveness and patency of airway
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3). Breathing: assess the rate and quality of respirations
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4). Circulation: palpate for pulse noting rate/rhythm/quality
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6). Assess Neurological Status: · Assess level of consciousness using the GCS, and neuro deficits · Hyperglycemia and hypoglycemia both result in altered LOC · Assess thoroughly for “AEIOUTIPS” |
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Focused History and Detailed Physical Examination
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2). Elicit personal history (HAM)
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3). Vital Signs
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4). Special Questions
· Hypoglycemia is often rapid onset · Hyperglycemia is often slow inset
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Head to Toe Examination:
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