Ch. 19: Diabetic Emergencies and Altered Mental Status Flashcards

Question

BG: Mid to high 100s are often without acute symptoms

Answer 1

may lead to hypoglycemia

Answer 2

may experience dehydration and other more serious symptoms and should receive medical care

Answer 3

usually above 500 mg/dL

Answer 4

extremely low blood glucose (15 mg/dL)

Answer 5

1. Occasionally a person with only mild hypoglycemia and minor altered mental status can be treated by simply giving him something to eat. In a person who is only slightly confused, it may be more appropriate to ask him to ingest a glass of milk or a piece of toast than a tube of oral glucose. You must understand that this course of treatment will take longer to resolve the hypoglycemia and is certainly not appropriate for a patient who has severe hyperglycemia. Always use good clinical judgment to determine if your patient needs more aggressive care. 2. Determine if all of the following criteria for administration of oral glucose are present: The patient has a history of diabetes, has an altered mental status, and is awake enough to swallow safely. 3. If the patient meets the criteria for administration of oral glucose and if he is able, let the patient squeeze the glucose from the tube directly into his mouth. 4. Reassess the patient. If the patient’s condition does not improve after administration of oral glucose, consult medical direction about whether to administer more. If at any time the patient loses consciousness, do not administer further oral glucose, and take steps to ensure an open airway. ○ Patient not awake enough to swallow: § Secure airway, provide § artificial ventilation if necessary § CPR if needed § Position the patient appropriately. If the patient does not need to be ventilated, place him in the recovery position (on his side) so he is less likely to choke on or to aspirate fluids or vomitus into his lungs. Call for ALS

Answer 6

§ We only administer oral glucose to those patients we feel can swallow it and protect their airway from aspiration. § Some EMS systems allow administration of intranasal glucagon to patients who are unable to safely swallow oral glucose. Glucagon is a naturally occurring hormone that signals the liver to convert stored glycogen into glucose and release it into the bloodstream. □ Not in mass □ To use an intranasal medication, the appropriate dose of glucagon is drawn into a syringe, which is then attached to an atomizer device. The atomizer is then inserted into the patient’s nostril, and the medication is administered rapidly. The mist that is ejected from the atomizer clings to the highly vascular mucous membrane of the nose, and the medication is absorbed into the bloodstream.

Answer 7

○ Three typical differences § Onset □ Hyperglycemia slower; hypoglycemia is faster & seizures may occur § Skin □ Hyperglycemia: warm, red, dry skin □ Hypoglycemia: cold, pale, moist or clammy skin § Breath □ Hyperglycemia: acetone breath (not always present) ○ Hyperglycemia § rapid and deep breathes (like they just ran a race) § Dry mouth, thirst, abdominal pain and vomiting § Treatment: given under close medical supervision in hospital ○ Giving glucose will help the hypoglycemic patient by getting needed sugar into his bloodstream and to the brain. Although the hyperglycemic patient already has too much sugar in his blood, the extra dose of glucose will not have time to cause damage in the short time before he reaches the hospital and can be diagnosed and treated. This is why “sugar (glucose) for everyone” is the rule of thumb for diabetic emergencies

Answer 8

Hypoxia, sepsis, drug and alcohol use, brain injuries, metabolic abnormalities, infectious disease such as meningitis

Answer 9

Simply an infection; refers to a more severe collection of problems associated with the body’s response to an infection

Answer 10

§ vasodilation that once helped move white blood cells now causes a severe drop in pressure within the cardiovascular system --> distributive shock § capillary permeability that helped dilute toxins now results in a massive fluid shift out of the cardiovascular system --> hypovolemic shock § Together leas to massive hypoperfusion of body tissue

Answer 11

respiratory infections and pneumonia, urinary tract infections (UTIs), and skin/wound infections

Answer 12

history of coughing and fever

Answer 13

history of frequent or painful urination, foul-smelling urine, and/or fever commonly associated with patients who have indwelling devices such as urinary catheters or vascular access devices as these devices provide an easy access route into the body for bacteria and other microbes.

Answer 14

``` Altered mental status Increased heart rate Increased respiratory rate Low blood pressure High blood glucose levels Decreased capillary refill time ```

Answer 15

- severe sepsis frequently results in profound shock - Consider high-concentration oxygen, particularly if hypoxia is present. Contact Advanced Life Support and intercept with them if possible.

Answer 16

- affect only one part or side of the brain | - Seizure often only affects one part of body

Answer 17

affect entire brain | Result in loss of consciousness

Answer 18

a type of generalized seizure characterized by unconsciousness and major motor activity; without warning patient may cry

Answer 19

tonic, clonic, and postictal phase

Answer 20

body becomes rigid, stiffening for no more than 30 seconds. Breathing may stop, the patient may bite his tongue (rare), and bowel and bladder control could be lost.

Answer 21

body jerks about violently, usually for no more than 1 or 2 minutes (some can last 5 minutes). The patient may foam at the mouth and drool. His face and lips often become cyanotic.

Answer 22

begins when convulsions stop. The patient may regain consciousness immediately and enter a state of drowsiness and confusion, or he may remain unconscious for several hours. Headache is common □ Length may vary □ some patients may become combative and even violent toward rescuers during this phase

Answer 23

§ sensation the patient has when a seizure is about to happen § a smell, a sound, or even just a general feeling right before the seizure begins. It can be important to document this finding when it exists

Answer 24

febrile seizures; high fever

Answer 25

hypoxia, stroke, traumatic brain injury, toxins, hypoglycemia, brain tumor, congenital brain defects, infections, metabolic, idiopathic, epilepsy, measles, mumps (& other childhood diseases), eclampsia, heat stroke

Answer 26

A lack of oxygen frequently causes seizures. These seizures often immediately precede respiratory and/or cardiac arrest

Answer 27

Clots and bleeding in the brain are frequent causes of seizures. We will discuss this topic in greater detail later in this chapter

Answer 28

Brain injuries can cause seizures. So can scars formed at the site of previous brain trauma

Answer 29

Drug or alcohol use, abuse, or withdrawal can cause seizures. Other poisons can also alter brain function to cause a seizure

Answer 30

(low blood sugar) is a frequent cause of seizures.

Answer 31

Seizures due to congenital defects of the brain (defects | one is born with) are most often seen in infants and young children

Answer 32

Swelling or inflammation of the brain caused by an infection can cause seizures

Answer 33

Seizures can be caused by irregularities in the patient’s body chemistry (metabolism)

Answer 34

This means occurring spontaneously with an unknown cause. This is often the case with seizures that start in childhood.

Answer 35

a severe complication of pregnancy

Answer 36

□ an umbrella term used when a person has multiple seizures from an unknown cause □ Born or result of head injury or surgery □ treatment: Medication

Answer 37

§ important to be able to describe the seizure to emergency department personnel § What was the person doing before the seizure started? Was there an aura? § Exactly what did the person do during the seizure—movement by movement—especially at the beginning? Was there loss of bladder and/or bowel control? § How long did the seizure last? § What did the person do after the seizure? Was he asleep (and for how long)? Was he awake? Was he able to answer questions? (If you are present during the seizure, use the AVPU scale to assess mental status.) -Multiple patients seizing at the same time is a major scene safety red flag. If this occurs, consider the possibility of a chemical weapon or similar weapon of mass destruction and take appropriate precautions

Answer 38

• Place the patient on the floor or ground. If there is no possibility of spine injury, position the patient on his side for drainage from the mouth. • Loosen restrictive clothing. • Remove objects that may harm the patient. -Protect the patient from injury, but do not try to hold the patient still during convulsions

Answer 39

○ Protect the airway. A patient who has just had a generalized seizure will sometimes drool and will usually be very drowsy for a little while, so you may need to suction the airway. If there is no possibility of spine injury, position the patient on his side for drainage from the mouth. ○ If the patient is cyanotic (blue), ensure an open airway and provide artificial ventilation with supplemental oxygen. Patients who are breathing adequately may be given oxygen by nasal cannula or nonrebreather based on pulse oximetry readings. Hypoxia is common after long periods of seizure activity. ○ Treat any injuries the patient may have sustained during the convulsions, or rule out trauma. Head injury can cause seizures, or the patient may have injured himself during the seizure. Immobilize the neck and spine if the trauma is suspected. -Transport to a medical facility, monitoring vital signs and respirations closely.

Answer 40

When the patient has two or more convulsive seizures in a row without regaining full consciousness or a single seizure lasting more than 10 minutes (Some systems may consider a patient who is still seizing when EMS arrives) This is a high-priority emergency requiring immediate transport to the hospital and possible ALS intercept (having an Advanced Life Support team meet your ambulance en route). The Paramedics must open and suction the airway and administer a high concentration of oxygen at the scene and while en route

Answer 41

often preceded by an aura. ® abnormal behavior varies widely ® Ie. Confusion, glossy stare, aimless moving about, lip-smacking, chewing, or fidgeting with clothing, may appear to be drunk or on drugs ® not violent but may struggle or fight if restrained ® Very rarely such extreme behavior as screaming, running, disrobing, or showing great fear Treatment: For a simple or complex partial seizure, do not restrain the person; simply remove objects from his path and gently guide him away from danger.

Answer 42

® Less than 10 seconds ® no dramatic motor activity and the person usually does not slump or fall ® temporary loss of concentration or awareness ® may go unnoticed by everyone except the person and knowledgeable members of his family ® child may suffer several hundred absence seizures a day, severely interfering with his ability to pay attention and do well in school ® often stop before adulthood but sometimes worsen and become tonic-clonic seizures Treatment: if you are aware that it has occurred, simply provide the patient with any information he may have missed

Answer 43

can not be left alone and must go drive

Answer 44

death or injury of brain tissue that is deprived of oxygen

Answer 45

occur when a clot or embolism occludes an artery | Responsible for most strokes

Answer 46

caused by bleeding into the brain § Can be a result of long-standing high blood pressure/hypertension Can be a result of weak area of an artery (an aneurysm ) bulges out and eventually ruptures forcing the brain into a smaller than usual space within the skull.

Answer 47

``` hemiparesis (one-sided weakness), difficulty or inability to speak, headache, aphasia ○ Confusion ○ Dizziness ○ Numbness, weakness, or paralysis (usually on one side of the body) ○ Loss of bowel and/or bladder control ○ Impaired vision ○ High blood pressure ○ Difficult respiration or snoring ○ Nausea or vomiting ○ Seizures ○ Unequal pupils ○ Headache ○ Loss of vision in one eye Unconsciousness (uncommon) ```

Answer 48

difficulty in using words

Answer 49

case the patient can speak clearly but cannot understand what you are saying, so he will clearly say things that do not make much sense or are inappropriate for the situation.

Answer 50

ministroke § a patient looks as though he is having a stroke because he has the typical signs and symptoms of the condition. However, unlike stroke, a patient with a TIA has complete resolution of his symptoms without treatment within 24 hours (usually much sooner). § small clots may be temporarily blocking circulation to part of the brain § the patient’s symptoms resolve because the affected brain tissue had only a short period of hypoxia and did not sustain permanent damage § Patient at significant risk for full stroke ○ Need to be evaluated to avoid subsequent stroke § Always remember that if symptoms are present, it is impossible to distinguish between a stroke and a TIA in the field. Always assume the worst and treat as if it is a stroke

Answer 51

- Ask the patient to grimace or smile. - Ask the patient to close his eyes and extend his arms straight out in front of him with his palms facing upward - Ask the patient to say, “You can’t teach an old dog new tricks.”

Answer 52

§ most important treatment step in caring for a stroke patient is recognition of the stroke § it may be difficult to determine that a stroke has taken place. There are many problems that can mimic strokes, including tumor or infection in the brain, head injury, seizures, hypoglycemia, and bacterial or viral infections that cause weakness or paralysis of facial nerves § you should also not fear being incorrect. It is far better to overtreat a suspected stroke patient than to ignore an actual stroke § Time-sensitive disorder § commonly the most important treatment priority will be rapid transport to an appropriate destination ○ For a conscious patient who can maintain his airway, calm and reassure him, monitor the airway, and administer oxygen if the oxygen saturation is below 94 percent or if signs of hypoxia or respiratory distress are present. ○ For an unconscious patient or a patient who cannot maintain his airway, maintain an open airway, provide high-concentration oxygen, and transport. ○ Transport to a hospital with the capabilities to manage a stroke patient (CT scan at a minimum). Your destination choice may be guided by a local stroke care protocol, so follow local guidelines. § Most wide-spread Advances in treatment ○ Definite onset of stroke symptoms less than 3 hours prior to the administration of the thrombolytic drug ○ An emergency CT scan of the brain confirming that there is no evidence of a hemorrhagic stroke ○ Blood pressure that is not excessively hypertensive at the time the drug is administered ○ potential candidates for thrombolytics is to determine and document the exact time of onset of symptoms ® Note down person who provides time and contact information

Answer 53

§ many cases you will not be able to diagnose the true cause of the syncope § brief loss of consciousness with spontaneous recovery (few seconds to few minutes) § Some warning: light-headedness, dizziness, nausea, weakness, vision changes, sudden pallor (loss of normal skin color), or sweating ○ include fluttering in the chest (palpitations), a sensation of a racing heart (tachycardia), a slow heart rate (bradycardia), or headache ○ Occasionally incontinence of bladder and/or bowels

Answer 54

§ Determine patients meaning ○ A sensation of loss of strength ○ Vertigo (surrounding spinning around you) ○ Light-headedness

Answer 55

§ Generally related to brain § hypoxia, hypoglycemia, and hypovolemia § events may happen rapidly, such as blood flow to the brain being reduced by a cardiac dysrhythmia; or they may happen slowly, such as slow gastrointestinal bleeding that finally reaches the point where the patient is unable to stand without losing consciousness - Cardiovascular Causes -stimulation of the carotid sinus -vasovagal synscope (simply fainting; most common)

Answer 56

○ syncope can be a sign of acute myocardial infarction and can be caused by an alteration in the heart’s ability to pump ○ Frequently these symptoms are caused by electrical changes in the heart that result in abnormal heart rates. A cardiac dysrhythmia in which the heart beats extremely fast (a tachycardia) can lead to either dizziness or syncope ○ A very slow heart rate (a bradycardia) may also lead to dizziness or syncope through reduced cardiac output ○ May not be noticeable when patient in lying flat ® When the patient tries to sit or stand, though, dizziness and syncope can occur when blood goes to the legs and the brain does not get enough blood

Answer 57

® area is located in the carotid artery under the mandible. When stimulated, it sends signals to the heart to slow down. Some people have a very sensitive carotid sinus. All that may be needed to stimulate it in some sensitive individuals is turning the head while wearing a shirt with a tight collar

Answer 58

® thought to be the result of stimulation of the vagus nerve, which in turn signals the heart to slow down. ® Suddenly frightened and under significant emotional stress

Answer 59

low fluid/blood volume

Answer 60

○ Causes: dehydration, internal bleeding, and trauma ® Most serious: bleeding ® Dehydration: common in heat or diarrhea ○ Women of childbearing age: ruptured ectopic pregnancy that results in significant blood loss. ® Usually accompanied by abdominal pain ○ A slowly bleeding (“leaking”) abdominal aortic aneurysm can also lead to life-threatening blood loss. Such an aneurysm often causes the patient to experience abdominal pain radiating to the back ○ Gastrointestinal bleeding with or without abdominal pain ® Fairly common in the elderly

Answer 61

○ metabolic, something is wrong with the brain or the structures near it ® the inner and middle ears must be properly functioning for a person to maintain a sense of balance ® Inflammation in these areas can cause dizziness ○ Hypoglycemia --> both dizziness and syncope ○ Occasionally a stroke or seizure

Answer 62

○ Alcohol is the most commonly used drug, and when a patient drinks too much, it can lead to an altered level of consciousness. ® Fluctuating levels of consciousness ○ Panic and anxiety attack patient hyperventilates by breathing faster and deeper. When a patient breathes this hard, it can change the blood chemistry in a way that constricts the blood vessels supplying the brain with oxygen. Fortunately when the patient loses consciousness, the hyperventilation ceases and things return at least partly to normal

Answer 63

§ Questions to ask: ○ Describe what you mean by “dizziness.” Let the patient use his own words. ○ Did you have any warning? If so, what was it like? ○ When did it start? ○ How long did it last? ○ What position were you in when the episode occurred? ○ Have you had any similar episodes in the past? If so, what cause was found? ○ Are you on medication for this kind of problem? ○ Did you have any other signs or symptoms? Nausea? Vomiting (is there blood or material resembling coffee grounds)? Black, tarry stools (digested blood)? ○ Did you witness any unpleasant sight or experience a strong emotion? ○ Did you hurt yourself? ○ Did anyone witness involuntary movements of the extremities (like seizures)? § Most cases should be evaluated by ALS ○ initiate cardiac monitoring and rule out certain dysrhythmias as a cause underestimate shock and sepsis as a potential underlying problem associated with these findings.

Answer 64

§ After attending to any threats of life 1. Administer oxygen based on oxygen saturation levels (goal is 94 percent) and patient’s level of distress. Some patients will not receive oxygen. 2. Call for ALS if the patient has signs of instability and it is available in your area. 3. Loosen any tight clothing around the neck. 4. Lay the patient flat. 5. Treat any associated injuries the patient may have incurred from the fall. § Decision Point: Is My Patient Stable? Is My Patient Likely to Remain Stable? The urgency of your treatment and transport will depend on these decisions.

Ch. 19: Diabetic Emergencies and Altered Mental Status Flashcards

(89 cards)