DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

2 - 5% of the Total Population of American Society Has Either Diagnosed or Undiagnosed Diabetes Mellitus.

So, the Next Time You Say; She’s Sweet! She Just Might Be.

DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

• Various Levels of Mental Status
• Treatment of Patients With Altered L.O.C.
• Identify Patients That Should Receive Oral Glucose
• How to Administer Oral Glucose

DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

• Understand Why, When, & How to Administer Oral Glucose

DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

• Pancreas
• Large Gland
• Behind Stomach, Attached to Small Intestine
• Produces Enzymes, Glucagon, & Insulin

DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

• Cells "Burn" Sugar For Energy
• Insulin is Essential to Carry Sugar Into Cells
• Diabetics Produce Insufficient or No Insulin
• Insulin Dependent Patients Require Injections
• Refrigerated
• Non-Insulin Dependent Take Oral Meds
• Diabinese, Ornase, Micronase

DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

• Forgotten or insufficient insulin dose
• Infection
• Stress
• Increased dietary intake

• Slow onset
• Nausea/vomiting
• Acetone odor on breath
• Increased urination/hunger/ thirst

DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

• Hypoglycemia (low blood sugar) is a life-threatening emergency for people with diabetes.
• It is the most common emergency for the diabetic patient.

DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

• Hypoglycemia
• S&S of Diabetic W/ Altered Mental Status
• Rapid Onset of Altered L.O.C.
• After Taking Insulin

• Missing Meal
• Vomiting Meal

• Unusual Exercise or Work
• No Predisposing Factors

DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

• S&S (cont)
• Intoxicated Appearance
• Staggering, Slurred Speech, Unconscious
• Elevated Heart Rate
• Cold Clammy Skin
• Hunger
• Seizures

DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

• S&S of Diabetes (cont)
• Search For Medications
• Insulin in Refrigerator
• Oral Meds
• Uncharacteristic Behavior
• Anxious
• Combative

Assessing Diabetic Emergencies

• Perform initial assessment.
• Administer O2
• Perform focused history and physical exam.
• Get SAMPLE history.
• Note any medical alert tags.
• Take baseline vital signs.
• When & how did it start?
• How long did it last?
• Complaints of other symptoms?
• Any trauma involved?
• Any medical alert tags?
• Has the patient seized?
• Fever?
• Interruptions in episode?
• Get a SAMPLE history.
• If the patient has a history of diabetes:
• When did patient last eat?
• Any medications? Last taken?
• Any other illnesses?
• Can the patient swallow?

Give oral glucose if all of these conditions are met:

• History of diabetes
• Altered mental status
• Patient can swallow
• Reassess patient.
• If patient becomes unconscious, stop glucose administration immediately and secure the airway!
• If no improvement, consult medical direction.

If patient is not awake enough to swallow:

• Secure airway.
• Administer oxygen.
• Position appropriately.
• Request ALS & transport.

Blood Glucose Readings

80-120 mg/dl Normal

60-80 mg/dl Moderate hypoglycemia

Below 50 mg/dl Severe hypoglycemia

Above 140 mg/dl Hyperglycemia

Question results that are inconsistent with patient’s condition.

Causes of Inaccurate Reading

• Meter not calibrated
• Low batteries in meter
• Improperly stored or expired test strip
• Insufficient blood on test strip

DIABETIC EMERGENCIES &
ALTERED MENTAL STATUS

• Altered Mental Status
• Variety of Reasons
• Hypoglycemia
• Poisoning / Drugs / O.D.
• Post Seizure - Post Ictal
• Infection
• Head Injury
• Hypoxia

Emergency Care of Altered Mental Status

• Secure airway.
• Ventilate and suction as needed.
• Transport.
• Evaluate potential causes.

Treat patient as trauma patient if

injury cannot be ruled out.

Sudden change in sensation, behavior, or movement caused by irregular electrical activity of the brain

ALTERED MENTAL STATUS

• Seizures
• Grand Mal
• Tonic Clonic Movement (Shaking)
• Petite Mal
• Focal
• Status Epilepticus
• Not Regaining Consciousness Between Seizures
• Emergency

ALTERED MENTAL STATUS

• Seizures (cont)
• May Be Brief or Prolonged
• Chronic Seizures Are Rarely Life-Threatening
• Causes
• Fever, Infection, Poisoning, Hypoglycemia, Trauma, Hypoxia, Brain Tumor
• Pediatrics – Infection/Fever is the #1 Reason from 6 Months to 3 Years
• Epilepsy
• Stroke
• Eclampsia (complication of pregnancy)
• Hypoxia
• Unknown

Information to Obtain

• What was the patient doing before seizure?
• What movements were exhibited?
• Loss of bladder or bowel control?
• What did the patient do after seizure?
• Length of episode?

Emergency Care for Seizures

• Airway
• Protect Patient From Injury - Do Not Restrain
• If No Spinal Injury, Place On Side
• Have Suction Ready
• If Cyanotic, Assure Airway & Ventilate
• Transport Quietly
• May Have Underlying Problem or Trauma

A life-threatening condition in which the patient has two or more convulsive seizures without regaining consciousness

Emergency Care of Status Epilepticus

• Secure the airway.
• Ventilate with 100% oxygen.
• Request ALS.
• Transport immediately.

Stroke

• Death or injury of brain tissue that is deprived of oxygen.
• Caused by a blockage (ischemic) or bleeding (hemorrhagic) of a blood vessel in the brain.

• Intoxicated appearance, slurred speech, unconsciousness
• Severe headache, vision changes
• One-sided weakness on body
• Confusion
• Loss of bladder/bowel control
• Unequal pupils
• High blood pressure

• "Mini-stroke"
• Signs and symptoms of a stroke
• Often resolved before EMS arrival
• Symptoms resolve without treatment in less than 24 hours
• Significant risk of having a "full" stroke

Treatment of Stroke

• Prompt transport is critical.
• Identify potential stroke patients and notify the hospital.
• Maintain airway; administer oxygen.
• Cincinnati Prehospital Stroke Scale

Dizziness & Syncope

• Syncope is a brief loss of consciousness.
• It can occur at any age; more common in elderly.
• It may be an indicator of serious medical problem.

Causes of Dizziness and Syncope

• Hypovolemia
• Trauma
• Dehydration
• Metabolic
• Hypoglycemia
• Stroke
• Seizure

Environmental/Toxicological

• Alcohol/Drugs
• Carbon Monoxide
• Panic/Anxiety

Cardiovascular

• Fast or slow heart rates
• Electrical system disturbance
• Vagus nerve stimulation

Assessment of Dizziness and Syncope

• Obtain a SAMPLE history.
• Ask about onset time, activities.
• Length of episode?
• Any previous episodes?
• Any medications for this condition?
• Any nausea/vomiting/bowel changes?

Treatment of Dizziness and Syncope

• Administer high-concentration oxygen.
• Loosen restrictive clothing.
• Lay patient flat and elevate legs (if no suspected spinal injury).
• Treat any associated injuries.
• Request ALS and transport.