Chapter 19: Diabetic Emergencies and Altered Mental Status Flashcards
Reticular Activating System
Location: Neurological bundle located within the medulla and pons of the brainstem.
Function: Regulates conciousness
What are the 2 mainstream forms of Diabetes
Type I (Insulin-Dpendent): Inability to produce adequate amounts of insulin.
Type II (Non-Insulin-Dependent): Body fails to adequately respond to insulin.
Common causes of Hypoglycemia in Diabetics
- Too much insulin or other medication used to treat Diabetes.
- Not eating
- Overexertion
- Vommiting
- Ferver and/or excessive shivering can cause drops in blood sugar.
Signs/Symptoms of Hypoglycemia
Signs/Symptoms:
- Rapid onset
- Altered mental status
- Signs of Sympathetic dishcarge
- Pale, Cool, Clammy
- Tachycardic & Tachypnic
- Seizures
- Blood Glucose <60mg/dL
Pathophysiology of Hyperglycemia
Pathophysiology: Typically developes over days or weeks. As cells begin to starve they breakdown fats and proteins. Waste products from this lead to a condition called Diabetic Ketoacidosis (DKA).
Contraindications to Oral Glucose
- Unconciousness
- Known Diabetic who has not taken insulin for days
- Unable to Swallow
Alternate medication to Oral Glucose
- Intranasal Glucagon
- Hormone produced that signals liver to breakdown glycogen to produce glucose for the body.
Pathophysiology of Sepsis
Pathophysiology: Sepsis is often referred to when an infection has led to a systemic response known as Systemic Inflammatory Response. Here normally localized responses to infection such as vasodilation become systemic.
2 Types of seizures
- Partial Seizures
- Generalized Seizures
Phases of Tonic-Clonic seizure
- Tonic Phase: Body becomes rigid. May bite tongue and lose control of bladder and bowl.
- Clonic Phase: Body jerks violently, typically for 1-2minutes, during which time patient may become cyanotic.
- Postictal Phase: Convulsions cease.
*Note: Some seizures are preceded by an Aura. Often a general sensation just before the seizure.
Causes of Seizures
- Hypoxia
- Hypoglycemia
- Stroke
- Brain Trauma
- Toxins/Infections
- Brain Tumor
- Congenital Brain Defects
- Metabolic
- Idiopathic (Spotaneous with no known cause)
Diseases or Dysfunctions often associated with Seizures
- Epilepsy
- Measles and Mumps
- Eclampsia (Hypertensive Complication of Pregnancy)
- Heat Stroke
Status Epilepticus
When a patient has two or more convulsive seizures (or a single seizure lasting more than 10mins) in a row without gaining conciousness.
Types of Partial Seizures
- Simple Partial Seizure (Focal Motor, Focal Sensory, or Jacksonian): Tingling, Stiffening, Jerking in a single part of the body. No loss of conciousness, but it may develop into a tonic-clonic seizure.
- Complex Partial Seizure (Psychomotor or temporal Lobe): Charecterized by widely varing degrees of abnormal behavior.
Absence Seizure
Form of generalized seizure, often referred to as petit mal. They are normally very brief (10secs) and exhibit no dramatic motor activity or loss of conciousness. Instead, there is a temporary loss of awareness.
2 Types of Strokes
- Ischemic Stroke
- Hemorrhagic Stroke
Aphasia
Difficulty in communicating.
- Expressive Aphasia: Difficulty using words
- Receptive Aphasia: Difficulty understanding words
Cincinnati Prehospital Stroke Scale
FAST Acronym:
- F: Facial Droop
- A: Arm Drift
- S: Speech
- T: Time
Local Stroke Protocols?
3 Criteria for thrombolytic drug therapy in stroke patients
- Definite onset of symptoms less than 3 hours prior to drug administration
- Emergency CT ruling out hemorrhagic stroke
- BP that is not excessivly hypertensive at the time of drug administration
Varying Degrees of Dizziness to consider
- Is it loss of strength?
- Vertigo (Spinning surroundings)?
- Light Headedness (pre-syncope)?
4 Most common catagories of Dizziness and Syncope
-
Cardiovascular
- Mechanical or Electrical Failure
- Vasovagal Syncope (Vagus Nerve stimulation)
- Carotid Sinus stimulation
- Hypovolemic
-
Metablic and Structural
- Altered Brain Chemistry or Structure
- Inflammation of the inner/middle ear (treated with Meclizine)
-
Environmental/Toxicological
- Alcohol
- Hyperventilation
SIgns/Symptoms of Hyperglycemia
Signs/Symptoms:
- Blood Glucose >120mg/dL
- Chronic Thirst/Hunger
- Nausea
- Dehydration
- Altered Mental Status (Result of DKA)
- Fruitty acetone odor on patients breath
- Deep Rapid Breaths (To help release ketone buildup)
Signs/Symptoms of Sepsis
Signs/Symptoms:
- Altered Mental Status
- HR
- RR
- Glucose
- BP
