Chapter 20: Diabetes and Altered Mental Status PDF

8/22/2024 Slid e1 Chapter 20 Diabetes and Altered Mental Status  8/22/2024 Slid OVERVIEW e2 Causes of Altered Mental Status Diabetic Emergency Sei...

8/22/2024 Slid e1 Chapter 20 Diabetes and Altered Mental Status  8/22/2024 Slid OVERVIEW e2 Causes of Altered Mental Status Diabetic Emergency Seizures Stroke Other Possible Causes Emergency Care of Patients with Altered Mental Status Assessment Airway Management Treatment for Diabetic Emergency  8/22/2024 3 AVPU Alert- oriented (PPTE) Alert and disoriented. V- responding to verbal stimuli. P- responding to painful stimuli. U- unconscious/unresponsive.  8/22/2024 Slid CAUSES OF ALTERED MENTAL STATUS e4 Hypoglycemia Hypothermia Poisoning Hyperthermia Intoxication Head trauma Infection Decreasing oxygen levels (hypoxia)  8/22/2024 Slid DIABETIC EMERGENCIES e5 Insulin A hormone that allows for the breakdown of glucose into usable energy Insipidus- because of less anti diuretic hormone from pituitary Mellitus- because of more blood glucose level  8/22/2024 Slid DIABETIC EMERGENCIES e6 Glucose A basic sugar that is present in some form in most foods  8/22/2024 Slid DIABETIC EMERGENCIES e7 Diabetes mellitus A disease that results from failure of the pancreas to produce either enough insulin or usable insulin  8/22/2024 Slid DIABETIC EMERGENCIES e8 Two forms of diabetes Insulin-dependent The pancreas no longer produces any insulin Non-insulin-dependent Some production of insulin still occurs  8/22/2024 Slid DIABETIC EMERGENCIES e9 Common diabetic medications Insulin Humulin Oral medications Diabinese Orinase Micronase  8/22/2024 Slid DIABETIC EMERGENCIES e 10 Blood sugar levels Hypoglycemia A symptomatic decrease in blood sugar concentration Hyperglycemia A symptomatic increase in blood sugar concentration  8/22/2024 Slid DIABETIC EMERGENCIES e 11 Signs and symptoms of hypoglycemia Rapid onset of altered mental status Intoxicated appearance Elevated heart rate Cold, clammy skin Anxiety Hunger Seizures  8/22/2024 Slid SEIZURES e 12 A convulsive movement of the body, or an impaired mental state, caused by random discharge of the brain’s electrical impulses  8/22/2024 Slid SEIZURES e 13 Common causes Hypoglycemia Fever Head trauma Infection Hypoxia Poisoning Epilepsy Overdose Brain tumor Intoxication Unknown  8/22/2024 Slid STROKE e 14 Strokes occur when arteries in the brain become blocked or break Most strokes occur from clots blocking arteries and are called ischemic (about 85%) The another type is hemorrhagic (15%) that is because of bleeding inside the brain.  8/22/2024 Slid STROKE e 15 Signs and symptoms Sudden weakness or numbness (often on one side of the body) Confusion Trouble speaking or seeing Headache Difficulty walking  8/22/2024 Slid STROKE e 16 Assessment Cincinnati Prehospital Stroke Scale Speech Facial droop Arm drift  8/22/2024 Slid STROKE e 17 Cincinnati Prehospital Stroke Scale To assess speech Have the patient repeat the sentence “The sky is clear in Cincinnati.” If the patient slurs the words, this test result is positive  8/22/2024 Slid STROKE e 18 Cincinnati Prehospital Stroke Scale Next, examine the patient’s face If one side of the face or mouth droops, that is a positive sign Ask the patient to smile If one corner of the mouth does not rise as high as the other, that would be a positive sign as well  8/22/2024 Slid STROKE e 19 Cincinnati Prehospital Stroke Scale Ask the patient to hold their arms in front of their body with the palms turned down and close their eyes If one arm drifts away or to the floor, this is a positive sign  8/22/2024 Slid STROKE e 20 Cincinnati Prehospital Stroke Scale A patient with two or three positive signs on the Cincinnati Prehospital Stroke Scale is very likely to be suffering a stroke Any patient you suspect of having a stroke should be given oxygen and transported immediately to the hospital There are many excellent treatments for strokes, but they must be given quickly after symptoms begin Strokes are true medical emergencies and these patients should be transported without delay  8/22/2024 Slid CAUSES OF ALTERED MENTAL STATUS e 21 Other causes Poisoning Intoxication Infection Head trauma Decreased oxygen levels Hypothermia or hyperthermia  8/22/2024 Slid e 22 EMERGENCY CARE OF PATIENTS WITH ALTERED MENTAL STATUS  8/22/2024 Slid EMERGENCY CARE OF PATIENTS WITH ALTERED e 23 MENTAL STATUS Diabetic emergencies Assessment Airway management Administration of oral glucose  8/22/2024 Slid EMERGENCY CARE OF PATIENTS WITH ALTERED e 24 MENTAL STATUS Diabetic emergencies Assessment Scene size-up Initial assessment Focused history and physical exam SAMPLE OPQRST Examine the environment for clues.  8/22/2024 Slid EMERGENCY CARE OF PATIENTS WITH ALTERED e 25 MENTAL STATUS Diabetic emergencies Airway management Positioning Suction Maintaining and reassessing the airway of a patient with altered mental status is your top priority!  8/22/2024 Slid EMERGENCY CARE OF PATIENTS WITH ALTERED e 26 MENTAL STATUS General treatment Airway maintenance High-flow oxygen Assist ventilations as needed Administration of oral glucose Transport EMERGENCY CARE OF PATIENTS WITH ALTERED MENTAL STATUS Administration of oral glucose EMERGENCY CARE OF PATIENTS WITH ALTERED MENTAL STATUS Administration of oral glucose EMERGENCY CARE OF PATIENTS WITH ALTERED MENTAL STATUS Administration of oral glucose EMERGENCY CARE OF PATIENTS WITH ALTERED MENTAL STATUS Administration of oral glucose EMERGENCY CARE OF PATIENTS WITH ALTERED MENTAL STATUS Administration of oral glucose  8/22/2024 Slid ORAL GLUCOSE e 32 Generic name Oral glucose Trade name Glutose, Insta-Glucose  8/22/2024 Slid ORAL GLUCOSE e 33 Indications Patients with altered mental status with a known history of diabetes controlled by medication  8/22/2024 Slid ORAL GLUCOSE e 34 Contraindications Unresponsive Unable to swallow Never give oral glucose to a patient who is unresponsive or who cannot swallow.  8/22/2024 Slid ORAL GLUCOSE e 35 Administration technique Obtain order from medical direction (either online or offline) Ensure signs and symptoms of altered mental status with a known history of diabetes Ensure patient is conscious and can swallow and protect his or her airway Administer glucose Between cheek and gum Place on tongue depressor between cheek and gum Perform ongoing assessment  8/22/2024 Slid ORAL GLUCOSE e 36 Mechanism of action Increases blood sugar  8/22/2024 Slid ORAL GLUCOSE e 37 Side effects None when given properly May be aspirated by the patient without a gag reflex  8/22/2024 Slid ORAL GLUCOSE e 38 Reassessment strategies If patient loses consciousness or has a seizure, remove tongue depressor from mouth  8/22/2024 Slid EMERGENCY CARE OF PATIENTS WITH ALTERED e 39 MENTAL STATUS Seizures Protect the patient from the environment Maintain an open airway Administer high-flow oxygen Transport  8/22/2024 Slid EMERGENCY CARE OF PATIENTS WITH ALTERED e 40 MENTAL STATUS Stroke Maintain a position of comfort Maintain and protect the airway Administer high-flow oxygen Transport  8/22/2024 Slid SUMMARY e 41 Causes of Altered Mental Status Diabetic Emergency Seizures Stroke Other Possible Causes Emergency Care of Patients with Altered Mental Status Assessment Airway Management Treatment for Diabetic Emergency