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9/11/2012
1
Slide 1
Chapter 20
Diabetes andAltered Mental Status
Slide 2
Overview 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
Slide 3
Causes of Altered Mental Status
Hypoglycemia
Poisoning
Intoxication
Infection
Hypothermia
Hyperthermia
Head trauma
Decreasing oxygen levels (hypoxia)
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
2
Slide 4
Diabetic Emergencies
Insulin A hormone that allows for the breakdown of
glucose into usable energy
Slide 5
Diabetic Emergencies
Glucose A basic sugar that is present in some form in most
foods
Slide 6
Diabetic Emergencies
Diabetes mellitus A disease that results from failure of the pancreas
to produce either enough insulin or usable insulin
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
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Slide 7
Diabetic Emergencies
Two forms of diabetes Insulin-dependent
• The pancreas no longer produces any insulin
Non-insulin-dependent• Some production of insulin still occurs
Slide 8
Diabetic Emergencies
Common diabetic medications Insulin
• Humulin
Oral medications• Diabinese
• Orinase
• Micronase
Slide 9
Diabetic Emergencies
Blood sugar levels Hypoglycemia
• A symptomatic decrease in blood sugar concentration
Hyperglycemia• A symptomatic increase in blood sugar concentration
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
4
Slide 10
Diabetic Emergencies
Signs and symptoms of hypoglycemia Rapid onset of altered mental status Intoxicated appearance Elevated heart rate Cold, clammy skin Anxiety Hunger Seizures
Slide 11
Seizures
A convulsive movement of the body, or an impaired mental state, caused by random discharge of the brain’s electrical impulses
Slide 12
Seizures
Common causes Fever
Infection
Poisoning
Overdose
Intoxication
Hypoglycemia
Head trauma
Hypoxia
Epilepsy
Brain tumor
Unknown
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
5
Slide 13
Stroke
Strokes occur when arteries in the brain become blocked or break
Most strokes occur from clots blocking arteries and are called ischemic
Slide 14
Stroke
Signs and symptoms Sudden weakness or numbness (often on one
side of the body)
Confusion
Trouble speaking or seeing
Headache
Difficulty walking
Slide 15
Stroke
Assessment Cincinnati Prehospital Stroke Scale
• Speech
• Facial droop
• Arm drift
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
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Slide 16
Stroke
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
Slide 17
Stroke 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
Slide 18
Stroke
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
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
7
Slide 19
Stroke
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
Slide 20
Causes of Altered Mental Status
Other causes Poisoning
Intoxication
Infection
Head trauma
Decreased oxygen levels
Hypothermia or hyperthermia
Slide 21
Emergency Care of Patients with Altered Mental Status
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
8
Slide 22
Emergency Care of Patients with Altered Mental Status
Diabetic emergencies Assessment
Airway management
Administration of oral glucose
Slide 23
Emergency Care of Patients with Altered Mental Status
Diabetic emergencies Assessment
• Scene size-up
• Initial assessment
• Focused history and physical exam SAMPLE
OPQRST
Examine the environment for clues.
Slide 24
Emergency Care of Patients with Altered Mental Status
Diabetic emergencies Airway management
• Positioning
• Suction
Maintaining and reassessing the airway of a patient with altered mental status is your
top priority!
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
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Slide 25
Emergency Care of Patients with Altered Mental Status
General treatment Airway maintenance
High-flow oxygen
Assist ventilations as needed
Administration of oral glucose
Transport
Slide 26
Emergency Care of Patients with Altered Mental Status
Administration of oral glucose
Slide 27
Emergency Care of Patients with Altered Mental Status
Administration of oral glucose
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
10
Slide 28
Emergency Care of Patients with Altered Mental Status
Administration of oral glucose
Slide 29
Emergency Care of Patients with Altered Mental Status
Administration of oral glucose
Slide 30
Emergency Care of Patients with Altered Mental Status
Administration of oral glucose
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
11
Slide 31
Oral Glucose
Generic name Oral glucose
Trade name Glutose, Insta-Glucose
Slide 32
Oral Glucose
Indications Patients with altered mental status with a known
history of diabetes controlled by medication
Slide 33
Oral Glucose
Contraindications Unresponsive
Unable to swallow
Never give oral glucose to a patient who is unresponsive or who cannot swallow.
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
12
Slide 34
Oral Glucose 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
Slide 35
Video Clip: Administration of Oral Glucose
Slide 36
Oral Glucose
Mechanism of action Increases blood sugar
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
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Slide 37
Oral Glucose
Side effects None when given properly
May be aspirated by the patient without a gag reflex
Slide 38
Oral Glucose
Reassessment strategies If patient loses consciousness or has a seizure,
remove tongue depressor from mouth
Slide 39
Emergency Care of Patients with Altered Mental Status
Seizures Protect the patient from the environment
Maintain an open airway
Administer high-flow oxygen
Transport
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company
9/11/2012
14
Slide 40
Emergency Care of Patients with Altered Mental Status
Stroke Maintain a position of comfort
Maintain and protect the airway
Administer high-flow oxygen
Transport
Slide 41
Summary
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
Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company