Chapter 19 Diabetic Emergencies and Altered Mental Status Flashcards
Reticular Activating System (RAS)
Series of neurologic circuits in the brain that control the functions of staying awake, paying attention, and sleeping
3 Major components for the brain
- Oxygen - to perfuse
- Glucose - to nourish
- Water - to hydrate
What can cause AMS
- low oxygen
- low glucose/sugar
- dehydration
- other causes like trauma, infection, or chemical toxins
patients who are diabetic either
- don’t produce insulin
- don’t produce enough insulin
- has a body that has become resistant to the insulin that is produced
Specialized cluster of cells in pancreas that secrete insulin
are called the “Islets of Langerhans”
What organ doesn’t need insulin to use glucose
The Brain doesn’t need insulin
Diabetes mellitus
Also called “sugar diabetes” or just “diabetes”, the condition brought about by decreased insulin production or the inability of the body cells to use insulin properly. the person with this condition is a diabetic
- 16 million americans or 1 in 17 people have this condition
Type 1 Diabetes
When Body doesn’t produce any or enough insulin, can often treat by prescribed synthetic insulin
Type 2 Diabetes
When the boys cells fail to use insulin properly, can often treat by diet changes and medication
Hypoglycemia
Low Blood Sugar
happens when diabetic:
- takes to much insulin
- reduces sugar intake by not eating
- overexercises or overexerts themselves
- vomits a meal
- increases the metabolic rate in conditions such as fever/shivering - rapid drop of blood sugar - happens when patient is sick
- Has a rapid onset
- starves body and brain cells causing AMS, Unconsciousness, or Permanent Brain Damage
- body also responds with flight or fight response
- sympathetic nervous system also signals liver to release glycogen
- Diaphoretic - tachycardia - tachypnea - seizures are all signs of sympathetic discharge
treatment
- oral glucose - administered before AMS
- or a meal
Glycogen
A form of stored sugar stored in liver
Hyperglycemia
High Blood Sugar
- usually caused by a decrease in insulin
- develops over days/weeks
- slow onset
- Patient may complain of chronic thirst/hunger
- body will increase urination to try and rid excess sugar in blood
- nausea also frequent complaint
- Dehydration
- will eventually lead to Diabetic Ketoacidosis
Diabetic Ketoacidosis (DKA)
A condition that occurs as the result of high blood sugar (hyperglycemia) characterized by dehydration, AMS, and shock
- patient with DKA will have fruity, acetone odor on breath
- Show signs of severe shock, caused by dehydration
- Tachypnea
Patient Assessment
- BSI scene Safe
- Primary assessment - identify AMS
- Perform OPQRST/SAMPLE
- Determine if patient is alert enough to swallow
- take baseline vitals and administer Oral glucose
Blood Glucose Meters
Meter used to measure blood sugar in the body (All diabetics have these meters)
- Must have permission to use by medical direction
- or direct a family member to use it on patient
Blood Sugar Facts
value less than 60mg/dL
- in a symptomatic diabetic - mild alteration in mental status, is typical of hypoglycemia and is prompt for administration of oral glucose
Value less that 50mg/dL
- significant AMS - will often be to unresponsive in giving oral glucose too
Value more then 140mg/dL - indicates hyperglycemia - without acute symptoms Value more than 300mg/dL - especially for prolonged time may experience Dehydration
- “High” reading is above 500mg/dL
- “Low” reading is below 15mg/dL
Patient Care
- occasionally someone with mild hypoglycemia and minor AMS can be treated by simply given something to eat
- Determine if all following criteria for administering Oral Glucose is met (Is patient alert enough to swallow)
- if met let “patient” squeeze glucose into their mouth
- reassess patient
Glucagon
Naturally occurring hormone that signals liver to convert stored glycogen to glucose and release to bloodstream
Difference with Hyperglycemia and Hypoglycemia
- Onset
- Hyperglycemia usually has slower onset (brain still gets sugar to function, but rest of body starves)
- Hypoglycemia usually has Rapid onset (everything starves and seizures may occur) - Skin
- Hyperglycemia - warm, red, dry skin
- Hypoglycemia - Diaphoretic - Breath
- Hyperglycemia - Fruity, acetone breathe - Also breathe deep and rapidly
- Hypoglycemia - does not
Sepsis
Infection, especially a severe, systemwide response to infection
- One of the most dangerous causes of AMS
- Causes Distributive shock (vessels dilate causing BP drop) and Hypovolemic Shock (Permeability pushes all fluid out of cardiovascular system)
Sepsis Signs and symptoms
- AMS
- Tachycardia
- Tachypnea
- Hypotensive
- High Blood sugar
- Decreased Cap refill
Care
- Recognition of sepsis for Emergency Dept
- Administering O2
seizure
a sudden change in sensation, behavior, or movement. The most severe form of seizure produces violent muscle contractions called convulsions
Partial Seizure
A seizure that affects only one part or one side of the brain
Generalized Seizure
a seizure that affects both sides of the brain
Tonic Clonic Seizure
a generalized seizure in which the patient loses consciousness and has jerking movements of paired muscle groups
Postictal Phase
The period of time immediately following a Tonic Clonic Seizure in which the patient foes from full loss of consciousness to full mental status
Aura
A sensation experienced by a seizure patient right before the seizure which might be a smell, sound, or status
Tonic Phase
Body Becomes Rigid, Stiffening for no more then 30 seconds - breathing may stop - bowel/bladder control could be lost
Clonic Phase
Body Jerks violently usually no more than 1-2 minutes - may foam at mouth - may become cyanotic
Causes of Seizures
- Hypoxia
- Low Blood Sugar - Hypoglycemia
- Stroke - clots and bleeding in the brain
- Trauma to brain
- Toxins- Drug or alcohol use, abuse, and withdrawal
- Brain tumor
- Infection - causing inflammation in brain
- metabolic - can be caused by irregularities in body chemistry
- Idiopathic - means spontaneously with unknown cause
Epilepsy
A medical condition that causes seizures
Patient care for seizures
- During
- position patient on side if no C-Spine Precaution
- loosen restrictive clothes
- remove objects that can harm
After Convulsion
- Protect Airway
- If patient Cyanotic administer O2 by mask or BVM after airway secured
- treat any injuries sustained
- transport
Status Epilepticus
A prolonged seizure or situation when a person suffers two or more convulsive seizures without regaining full consciousness
Complex partial seizure
Also called psychomotor or temporal lobe
- preceded by an aura
- May involve confusion, a glassy Stare, Aimless moving about, lipsmacking or chewing, or fidgeting with clothes
Absence seizure
Is brief, usually less than 10 seconds
Stroke
Also known as cerebral vascular accident (CVA) refers to the death or injury of the brain tissue that is deprived of oxygen
- Caused by blockage of an artery that supplies blood to part of the brain
- or bleeding from a ruptured blood vessel in the brain
Hemorrhagic stroke
Or stroke caused by bleeding into the brain
- Result of long-standing high blood pressure
- can also occur when a weak area of an artery bulges out and eventually ruptures, aneurysm
Ischemic stroke
Can occur when a clot or embolism occlusion artery, responsible for most strokes
Hemipharesis
One sided weakness of body due to a stroke
Subarachnoid hemorrhage
Bleeding from an artery under the arc annoyed layer of the meninges
Expressive aphasia
Difficulty in using words after a stroke
Aphasia
General term that refers to, difficulty in communication
Receptive aphasia
Another form of aphasia, when patient can speak clearly but cannot understand what you are saying, so they will clearly say things That do not make much sense
Transient Ischemic Attack
A.k.a. a mini stroke
- patient with a TIA has complete resolution of their symptoms without treatment within 24 hours
- with TIA, small clots may be temporarily blocking circulation to part of the brain
- Patients with this condition or at significant risk of having a full-blown stroke
Cincinnati stroke scale
- Smile - show teeth
- Arm sway
- Speech
Signs and symptoms of Stroke
Confusion, dizziness, numbness, weakness, paralysis, Loss of bowel and or bladder control, impaired vision, high blood pressure, difficult respiration or snoring, nausea or vomiting, seizures, unequal pupils, headache, loss of vision in one eye, unconsciousness
Thrombolytic drug
Medication used to dissolve clot
- patient has a window of 3 hrs to receive treatment
Syncope or fainting
A brief loss of consciousness with spontaneous recovery
Vertigo or presyncope
The sensation of your surroundings spinning around you
- Happens when eyes and fluid balance system in ears aren’t matching
“Time is tissue”
Saying when treating a person with stroke - act rapid and safe to save persons life
Carotid sinus
This area is located in the carotid artery under the mandible, when stimulated, it sends signals to the heart to slow down
Vasovagal syncope
This is thought to be the result of stimulation of the Vegas nerve – simple fainting
Patient care – dizziness & syncope
- Administer oxygen based on oxygen saturation levels – Goal is 94%
- Call for ALS
- Loosen any tight clothing around neck
- lay patient flat
- Treat any associated injuries the patient may have incurred from fall
