Emergency Glucagon Training Protocol PDF

 Training Protocol For Emergency Glucagon Providers Scott Russell Paramedic Cedar Mountain Fire Rescue Transylvania County EMS 2 Training Pre-Requisites  Must reasonably expect to have responsibility for or contact with a...

 Training Protocol For Emergency Glucagon Providers Scott Russell Paramedic Cedar Mountain Fire Rescue Transylvania County EMS 2 Training Pre-Requisites  Must reasonably expect to have responsibility for or contact with a person at known risk for hypoglycemia This is usually a person with diabetes  Person to be trained must be at least 18 years of age Objectives  Initial training or retraining  Covers: An overview of diabetes Recognition of symptoms Factors that lead to hypoglycemia Administration of glucagon Necessary follow-up treatment Protocol  Overview of Diabetes  A chronic/lifelong disease  Affects the way the body uses food Pancreas produces insulin Insulin allows glucose to go into the cells to be used for energy  In diabetes this system does not work  Glucose builds up in the blood stream  Insulin must be replaced with injections Overview of Diabetes -- cont. Type 1 diabetes Type 2 diabetes – Pancreas produces no – Not enough insulin insulin produced or – Treated with insulin (by – Person does not respond shots or pump) to insulin – Usual type for children – May be treated orally and young adults and/or with insulin – No prevention – More common in adults – Lifelong Hyperglycemia (high blood sugar)  increased thirst  frequent urination  increased hunger  weight loss  irritability  flushed, dry skin  nausea and vomiting  weakness and fatigue Complications  High blood sugar levels may cause serious complications over time blindness kidney disease or nerve damage heart disease  It is important to control blood sugar levels  Balance  Management of diabetes consists of an intricate balance of: Insulin Food intake Physical activity Physical/emotional stress, illness  Anything that tips this delicate balance can cause fluctuations in blood sugar  Hypoglycemia (Low Blood Sugar)  Most serious “emergency” problem that can occur with blood sugar control  Comes on very quickly  Requires early detection and immediate attention Common Causes of Hypoglycemia  Too much diabetes medication  Change in meal or snack times  Not enough food  Skipping or not finishing meals or snacks  Getting more physical activity or exercise than usual  Drinking alcohol without eating Mild Symptoms  Hunger  Sweating  Feeling shaky  Feeling nervous Moderate Symptoms  Headache  Behavior changes  Blurred, impaired or double vision  Crabbiness or confusion  Drowsiness  Weakness  Difficulty talking  Severe Symptoms  Unresponsiveness Unwilling or unable to take oral feedings  Loss of consciousness  Seizure activity Symptoms of Hypoglycemia Mild Symptoms Moderate Symptoms Severe Symptoms Hunger Headache Unresponsive Sweating Behavior changes (including being Feeling shaky Blurred, impaired unable or unwilling Feeling nervous or double vision to take oral feeding) Crabbiness or Loss of confusion consciousness Drowsiness Seizure activity Weakness Difficulty talking Intervention For Mild /Moderate Hypoglycemia  Treat right away with a fast acting sugar: 4-8 ounces fruit juice 6 ounces regular (not diet) soda 3 packets or 1 tablespoon sugar in water 3-4 chewable glucose tablets 1 dose of glucose gel (15 g dose) 1 tablespoon of honey 2-4 pieces of hard candy 15 Minute Rule After the initial treatment:  Observe and recheck in 15 minutes  Repeat fast-acting carbohydrate if blood sugar not in acceptable range  If the recheck is within an acceptable range, an extra snack should be given if meal is one hour away or more.  Treatment For Severe Symptoms of Hypoglycemia  Prepare to treat with glucagon if: The person is unwilling or unable to take a treatment The person does not feel better after the second treatment The symptoms worsen to the point the person is unable to swallow Loss of consciousness or seizures occur Glucagon  A hormone, like insulin, made in the pancreas  Acts on the liver by converting glycogen to glucose  Safe and relatively free from adverse reactions  No human overdose has been reported  May cause nausea and vomiting  Glucagon Emergency Kit  Available in a package with supplies needed for administration  Contains: a bottle of glucagon in powder form a syringe or vial filled with special diluting fluid  Patient may have a prescription for the individual with diabetes  Glucagon: Storage and Handling  Store at room temperature {59° - 86°}  Do not mix until needed  Discard any unused portion  Glucagon solution should be clear and of a water-like consistency  Check expiration dates periodically  Injection in fatty tissue or muscle of arm/thigh  Glucagon - Dosages  Manufactured in 1 mg vials  Person’s health care provider will determine individualized dose Intervention/Severe Hypoglycemia— cont.  IF PERSON IS UNCONSCIOUS, BUT BREATHING AND PULSE ARE PRESENT, ASSUME SEVERE HYPOGLYCEMIA. Cut/clamp insulin tubing (if on insulin pump) Obtain glucagon emergency kit Prepare and administer glucagon To Prepare Glucagon  Put on gloves  Remove the flip-off seal from powdered glucagon  Remove needle cover from syringe  Do not remove plastic clip from syringe  Insert the needle into the vial of powdered glucagon  Push the plunger to inject the entire contents of the liquid into the vial of powdered glucagon  Prepare Glucagon -- cont.  Leave the needle on the syringe in the vial  Gently shake bottle until powder dissolves  Withdraw the right amount of medication  Administer Glucagon –cont.  Insert the needle into the loose skin/muscle of the upper arm or thigh  Administer all the medication  Carefully withdraw the needle at the same angle without releasing the person’s limb  Discard needle according to OSHA Bloodborne Pathogen Standards  Administer Glucagon—cont.  It may be difficult to give an injection to a person who is combative or having a seizure Get assistance from another provider Glucagon Administration Video 29  Care Of The Person  Position person on side  Monitor for absent pulse/breath, or seizures  Improvement will usually be seen within 10-15 minutes Although rare, the person may be unresponsive for other reasons  Care Of The Person -- cont.  When responds and able to swallow, feed a fast-acting source of sugar (page 7) Start with clear, sugar-containing liquids  Feed longer-acting source of sugar if possible (carbohydrate and protein)  Seek consultation from medical provider for further direction  Follow-Up  Emergency responder will make decision about need for transport to medical facility  The person or parent/guardian should seek consultation with their healthcare provider to prevent future episodes of hypoglycemia  Replace Glucagon from EMS supply. QUESTIONS?