Chapter 19 Flashcards
reticular activating system (RAS)
series of neurologic circuits in the brain that control the functions of staying awake, paying attention, and sleeping
oxygen is needed to ______ brain tissue?
perfuse
oxygen is needed to perfuse brain tissue (oxygenate)
glucose is needed to _______ brain tissue?
nourish
glucose is needed to nourish brain tissue
water is needed to _____ brain tissue
hydrate
water is needed to hydrate brain tissue
lack of water, O2, glucose leads to_____?
altered mental status
substance abuse can also harm _____?
brain tissue
safety when treating a patient under an altered mental status
keeping your self, and team safe prior to approaching.
use law enforcement if necessary
one of the most common causes of altered mental status
hypoxia
Signs of hypo perfusion
tachycardia
pulsless
pale diaphoretic skin
delayed capillary refill time
glucose and insulin
glucose by itself is too large to pass on to a cell, it requires insulin to do so.
insulin binds to receptors and allows the large glucose molecule to pass into the cells
pancreas
secretes insulin when the blood sugar levels rise above 90 mg/dl
islets of Langerhans
specialized clusters of cells secrete insulin
- brain cells do not need insulin to move glucose from the bloodstream
- most other body cells need insulin to process the glucose
glucose/insulin described as (lock and key)
diabetes mellitus
also known as diabetes
type 1 diabetes
occurs when the pancreatic cell fails to function properly and insulin is not secreted normally
(generally prescribed synthetic insulin)
(formerly known as insulin dependent diabetes)
type 2 diabetes
(formerly known as non insulin dependent diabetes)
occurs when the body fails to use insulin properly.
-pancreas creates insulin but the body can not transfer glucose through the insulin produced
-can be controlled by diet and oral antidiabetic medications
hypoglycemia
low blood sugar
this is the most common emergency for diabetes
caused by the following
- too much insulin
- reduced sugar intake by not eating
- uses glucose too quickly (over exertion)
- vomits a meal
- increase of metabolic rate
hyperglycemia
high blood sugar
normally caused by a decrease in insulin, which leaves sugar in the bloodstream rather than helping it into the cells
- signs
- patient might complain of chronic thirst or hunger
- increased urine (body trying to get rid of the excess sugar)
- dry mouth
- intense thirst
- abdominal pain
- vomiting
side effects of hyperglycemia
blood sugar in high 100’s
-high blood sugar causes water to be drawn from the bodies cells, potentially resulting in profound dehydration
diabetic ketoacidosis
condition caused by high blood sugar
effects of high blood sugar
- dehydration
- altered mental status
- shock
diabetic children
- more at risk than diabetic adults.
- exhaust blood sugar levels quicker than adults, especially if their insulin was taken.
- less disciplined to eat proper, and on time.
(more risk of hypoglycemia)
blood glucose meter
portable blood glucose meters
used up to 6 times a day
blood sugar of less than 60 mg/dl
typical of hypoglycemia and should be quickly administered glucose
blood sugar of less than 50 mg/dl
patients with this low of blood sugar can cause unresponsive and altered mental status
potentials of wrong blood sugar reading
if a reading comes in at 25mg/dl and the patient is alert and aware, there would be cause for concern to believe that the reading is wrong.
- glucose meter needs calibration
- not enough blood on the test strip
- expired test strips
meter reading “High”
if the meter reads high, and doesn’t give a numeric result the patient is in excess of roughly 500 mg/dl (extreme)
meter reading “low”
if reading low, patient is roughly less than 15mg/dl (extreme)
intranasal glucagon
when patients are unable to safely swallow oral glucose, when EMS systems allow intranasal glucose can be administered.
-glucose is put into an atomizer device and administered into nostril
sepsis
infection, a severe system wide infection
3 types of infections
- respiratory infection (pneumonia)
- urinary tract infections (UTI)
- skin/wound infections
evidence of severe sepsis
- altered mental status
- increased heart rate
- increased respiratory rate
- low blood pressure
- high blood glucose level
- decreased capillary refill time
patients unaltered mental status with history of an infection
always consider severe sepsis
hyperglycemic patients frequently breath______?
-very deeply and rapidly, as though they have just run a race
common symptoms of hyperglycemia
- dry mouth
- intense thirst
- abdominal pain
- vomiting
