9/11/2012

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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)

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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

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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

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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

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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

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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

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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

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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

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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!

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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

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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

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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.

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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

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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

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9/11/2012

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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

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