Chapter 22 | Diabetic Emergencies and Altered Mental Status

Question 1

Define:

DM

(abbreviation)

Answer 1

diabetes mellitus

Question 2

Fill in the blank:

The abbreviation for diabetes is [BLANK].

Answer 2

The abbreviation for diabetes is DM.

Question 3

Define:

RAS

(abbreviation)

Answer 3

reticular activating system

Question 4

Define:

reticular activating system (RAS)

Answer 4

series of neurologic circuits in the brain that control the functions of staying awake, paying attention, and sleeping

Question 5

Fill in the blank:

Normal consciousness is regulated by a series of neurologic circuits in the brain that comprise the [BLANK].

Answer 5

Normal consciousness is regulated by a series of neurologic circuits in the brain that comprise the reticular activating system (RAS).

Question 6

True or false:

Although you may rule out immediate life threats, even a slightly altered mental status indicates serious underlying issues.

Answer 6

true

Question 7

True or false:

If you rule out immediate life threats, a patient with a slightly altered mental status may not have any underlying issues.

Answer 7

false

AMS could indicate deeper problems

Question 8

Define:

glucose

Answer 8

most basic form of sugar

body’s main source of energy

Question 9

Fill in the blank:

The insulin–glucose relationship has been described as a “[BLANK]” mechanism.

Answer 9

The insulin–glucose relationship has been described as a “lock and key” mechanism.

Question 10

Explain:

“lock and key” metaphor for insulin and glucose

Answer 10

insulin acts as key

(without insulin “key”) glucose cannot enter the “locked” cells

Question 11

Define:

hypoglycemia

Answer 11

low blood sugar

Question 12

Define:

hyperglycemia

Answer 12

high blood sugar

Question 13

List:

causes of hypoglycemia in patients with diabetes

5 points

Answer 13

• taking too much insulin (processing sugar too fast)
• not eating (decreased sugar intake)
• over-exertion (processing sugars too fast)
• vomiting a meal (lost sugar)
• fever or shivering (increased metabolic rate)

Question 14

List:

necessities to maintain consciousness

3 points (things; not processes)

Answer 14

• oxygen
• glucose
• water

Question 15

Define:

DKA

(abbreviation)

Answer 15

diabetic ketoacidosis

Question 16

Define:

diabetic ketoacidosis (DKA)

Answer 16

condition that occurs as result of severe hyperglycemia because body doesn’t have enough insulin to allow blood sugar into your cells for use as energy

Question 17

Define:

SNOT

(acronym)

Answer 17

• stroke/seizure/sugar
• narcotics
• oxygen
• toxins/trauma/temperature

Question 18

Define:

AEIOUTIPS

(“vowel tips”; acronym)

Answer 18

• alcohol
• epilepsy
• insulin
• overdose
• underdose
• trauma
• infection
• psychosis
• stroke

(causes of AMS)

Question 19

Fill in the blank:

[BLANK] is one of the most common causes of AMS.

Answer 19

Hypoxia is one of the most common causes of AMS.

Question 20

Fill in the blank:

For patients with AMS, you should first attempt to [BLANK] to obtain patient’s baseline mental status.

Answer 20

you should first attempt to interview family members and bystanders to obtain patient’s baseline mental status.

Question 21

Define:

T1D

(abbreviation)

Answer 21

type 1 diabetes

Question 22

Define:

T2D

(abbreviation)

Answer 22

type 2 diabetes

Question 23

Explain:

difference between T1D and T2D

Answer 23

• T1D: underproduction of insulin by pancreas
• T2D: inability of body’s cells to use insulin properly

Question 24

List:

signs of hypoglycemia

5 points (at onset)

Answer 24

• abnormal/agitated behavior (AMS)
• pale/clammy skin
• tachycardia
• seizures
• syncope

(very rapid onset)

Question 25

# List: *results* of **hypoglycemia** | 3 points (if left untreated)

Answer 25

* AMS * unconsciousness * permanent brain damage (starving brain cells)

Question 26

# List: *signs/symptoms* of **hyperglycemia** | 3 points

Answer 26

* chronic thirst or hunger * increased urination * nausea

Question 27

# List: *effects* of **hyperglycemia** | 3 points (physiology if left untreated)

Answer 27

* profound **dehydration** (hence excessive thirst) * **excessive waste** products (hence extra peeing) * **DKA** (extreme hyperglycemia)

Question 28

# Fill in the blank: The onset of hypoglycemia is typically **[RAPID/GRADUAL]**.

Answer 28

The onset of hypoglycemia is typically **very rapid**.

Question 29

# Fill in the blank: The onset of hyperglycemia is typically **[RAPID/GRADUAL]**.

Answer 29

The onset of hyperglycemia is typically **gradual**. | (develops over days/weeks)

Question 30

# List: *signs/symptoms* of **DKA** | 3 points

Answer 30

* profound **AMS** * **rapid breathing** * acetone (sweet) **odor in breath** | like being drunk with a sweet breath

Question 31

# Fill in the blank: The severe dehydration associated with DKA can cause **[BLANK]**.

Answer 31

The severe dehydration associated with DKA can cause **shock**. ## Footnote: the renal threshold for active glucose reabsorption is exceeded as blood glucose levels rise (leading to glucose loss in the urine) renal response to dehydration by retaining fluids (in addition to glucose loss in urine) causes decrease in fluid (blood) volume low blood volume causes hypovolemic shock (drop in blood pressure and amount of oxygen in your body)

Question 32

# Fill in the blank: The blood sugar of a symptomatic diabetic patient with hypoglycemia is less than **[BLANK]** mg/dL.

Answer 32

The blood sugar of a symptomatic diabetic patient with hypoglycemia is less than **60-80** mg/dL.

Question 33

# Fill in the blank: You can expect a patient to *experience AMS* if their blood sugar drops below **[BLANK]** mg/dL.

Answer 33

You can expect a patient to experience AMS if their blood sugar drops below **50** mg/dL.

Question 34

# Fill in the blank: The blood sugar of a symptomatic diabetic patient with *hyperglycemia* is more than **[BLANK]** mg/dL.

Answer 34

The blood sugar of a symptomatic diabetic patient with hyperglycemia is more than **140** mg/dL.

Question 35

# Fill in the blank: You can expect a patient to experience *dehydration or other serious symptoms* if their blood sugar raises above **[BLANK]** mg/dL.

Answer 35

You can expect a patient to experience *dehydration or other serious symptoms* if their blood sugar raises above **200-300** mg/dL.

Question 36

# Fill in the blank: A glucometer reading *"HI"* indicates **[BLANK]**.

Answer 36

A glucometer reading *"HI"* indicates **severe hyperglycemia (> 500 mg/dL)**.

Question 37

# Fill in the blank: A glucometer reading *"LO"* indicates **[BLANK]**.

Answer 37

A glucometer reading *"LO"* indicates **severe hypoglycemia (< 15 mg/dL)**.

Question 38

# Answer: Why is it important to use the *second* drop of blood to get an accurate glucometer reading?

Answer 38

**preventing contamination** of isopropyl alcohol on skin

Question 39

# Define: stroke

Answer 39

death or injury of brain tissue from oxygen deprivation

Question 40

# List: types of stroke | 2 points

Answer 40

* **hemorragic stroke:** bleeding from ruptured blood vessel in brain * **ischemic stroke:** blockage of artery supplying blood to brain

Question 41

# Define: TIA | (abbreviation)

Answer 41

**t**ransient **i**schemic **a**ttack

Question 42

# Define: transient ischemic attack (TIA)

Answer 42

small clots that temporarily block circulation to part of brain | mini stroke

Question 43

# Fill in the blank: TIA causes **[BLANK]** symptoms.

Answer 43

TIA causes **stroke-like** symptoms. | (TIA stands for **t**ransient **i**schemic **a**ttack)

Question 44

# Fill in the blank: TIA symptoms resolve when **[BLANK]**.

Answer 44

TIA symptoms resolve when **the clots break up**. | (TIA stands for **t**ransient **i**schemic **a**ttack)

Question 45

# Fill in the blank: TIA symptoms should be completely resolved without treatment within **[BLANK]**.

Answer 45

TIA symptoms should be completely resolved without treatment within **24 hours (usually much sooner)**. | (TIA stands for **t**ransient **i**schemic **a**ttack)

Question 46

# Define: CPSS | (abbreviation)

Answer 46

**c**incinnati **p**rehospital **s**troke **s**cale

Question 47

# Define: tonic-clonic seizure

Answer 47

unconsciousness paired with major motor activity

Question 48

# Define: **tonic phase** of seizure

Answer 48

first phase of tonic-clonic seizure wherein **body is rigid for (up to) 30 seconds** | (**t**onic means the **t**ight phase)

Question 49

# Define: **clonic phase** of seizure

Answer 49

second phase of tonic-clonic seizure wherein **body jerks violently for 1-2 minutes** | (**c**lonic means the **c**razy phase)

Question 50

# Define: **postictal phase** of seizure

Answer 50

slow period of **regaining consciousness after convulsions stop** | (slow indeed)

Question 51

# Define: aura | (seizure term)

Answer 51

sensation felt just before seizure or syncope

Question 52

# Define: partial seizure

Answer 52

uncontrolled muscle spasm or convulsion *while patient is fully alert*

Question 53

# Define: hemorragic stroke

Answer 53

bleeding from ruptured blood vessel in brain

Question 54

# Define: ischemic stroke

Answer 54

blockage of artery supplying blood to brain

Question 55

# List: potential *causes* of **seizures** | 9 points

Answer 55

* hypoxia * stroke * TBI * brain tumor * congenital brain defects * toxins * hypoglycemia * infection * epilepsy

Question 56

# Explain: how to care for patient *during seizure* | (biggest priority)

Answer 56

protect patient from injury | (don't try to restrain patient during convulsions)

Question 57

# List ways to protect patient from injury *during seizure* | 3 points

Answer 57

* place patient on floor/ground * loosen restrictive clothing * remove objects that may harm patient

Question 58

# Explain: how to care for patient *after seizure* | (biggest priority)

Answer 58

protect the airway

Question 59

# Fill in the blank: If there is no possibility of spine injury after a patient experiences a seizure, place the patient **[BLANK]**.

Answer 59

After a patient experiences a seizure, if there is no possibility of spine injury, place the patient **in the recovery position**. | (on the side)

Question 60

# Fill in the blank: If a patient is cyanotic after experiencing a seizure, you should **[BLANK]**.

Answer 60

If a patient is cyanotic after experiencing a seizure, you should **open airway and ventilate with supplemental oxygen**.

Question 61

# Describe: standard *duration* of a **seizure**

Answer 61

1 to 3 minutes

Question 62

# Define: status epilepticus

Answer 62

two or more convulsive seizures lasting 5-10 minutes or more without regaining consciousness

Question 63

# Define: sepsis

Answer 63

severe and system-wide response to an infection | (one of the most dangerous causes of AMS)

Question 64

# List: *signs/symptoms* of **sepsis** | 6 points

Answer 64

* AMS * tachycardia * tachypnea * hypotension * hyperglycemia * fever

Question 65

# Define: vertigo

Answer 65

sensation of spinning surroundings

Question 66

# Define: lightheadedness

Answer 66

sensation of nearly passing-out

Question 67

# List: potential *causes* of **AMS** | 4 points

Answer 67

* **S:** seizures, sugar, stroke * **N:** narcotics * **O:** oxygen * **T:** trauma, toxins, temperature

Question 68

# Define: decorticate posturing

Answer 68

abnormal flexion of the arms with the extension of the legs | remember de**cor**ticate posturing for putting arms toward your **core**

Question 69

# Define: decerebrate posturing

Answer 69

abnormal body posture that involves the **arms and legs being held straight out**, the **toes being pointed downward**, and the **head and neck being arched backward** | remember all those e's in d**e**c**e**r**e**brat**e** are for "**e**xtended"

Question 70

# Choose: Which is *not* one of the steps in managing a patient experiencing dizziness and syncope? ## Footnote **A:** Lay the patient flat. **B:** Administer oxygen. **C:** Loosen any tight clothing around the neck. **D:** Apply cold packs to the patient's head.

Answer 70

**D**

Question 71

# Choose: Which of the following is *not* a sign or symptom of stroke? ## Footnote **A:** Vomiting **B:** Sudden impairment of vision **C:** Chest pain **D:** Seizure

Answer 71

**C**

Question 72

# Choose: Which of the items below is *not* part of the Cincinnati Prehospital Stroke Scale? ## Footnote **A:** Ask the patient to smile. **B:** Test for equal grip strength. **C:** Test the patient for arm droop or lack of movement. **D:** Have the patient repeat a simple sentence.

Answer 72

**B**

Question 73

# Answer: For the RAS to work correctly, what three substances are needed?

Answer 73

* **oxygen** to perfuse brain tissue * **glucose** to nourish brain tissue * **water** to keep brain hydrated | (RAS is **r**eticular **a**ctivating **s**ystem)

Question 74

# Answer: Which of the following is the most common cause of seizures in adults? ## Footnote **A:** Failure to take prescribed medication **B:** Head trauma **C:** Withdrawal from alcohol **D:** Fever

Answer 74

**A**

Question 75

# Fill in the blank: *Hypoglycemia* typically occurs **[GRADUALLY/SUDDENLY]**.

Answer 75

*Hypoglycemia* typically occurs **suddenly**. | blood sugar can drop like a rock

Question 76

# Fill in the blank: *Hyperglycemia* typically occurs **[GRADUALLY/SUDDENLY]**.

Answer 76

*Hyperglycemia* typically occurs **gradually**. | takes time for blood sugar to get that high

Question 77

# List: *testable* signs/symptoms of **stroke** | *duh*

Answer 77

* **f**ace drooping * **a**rm weakness * **s**peech slurred * **t**ime since last seen normal

Question 78

# List: *secondary* signs/symptoms of **stroke** | 4 points (things you'd expect that aren't FAST)

Answer 78

* AMS * severe hypertension * unequal pupils * seizures

Question 79

# List: **[BLANK]** may possibly get misdiagnosed as a stroke due to similar symptoms.

Answer 79

**Hypoglycemia** may possibly get misdiagnosed as a stroke due to similar symptoms.

Question 80

# Answer: Can a patient refuse transport *after the administration of oral glucose*?

Answer 80

yes | if presenting normal again and able to consent

Question 81

# Choose: You are transporting an unconscious diabetic patient with clear and equal lung sounds and adequate breathing to the hospital for treatment. **Which of the following would be most appropriate?** ## Footnote **A.** Semi-fowler position with a high flow oxygen **B.** Recovery position with a nasopharyngeal airway and supplemental oxygen **C.** Supine position with an oral airway and assisted ventilations with a BVM **D.** Trendelenburg position with oxygen at 6 lpm via nasal cannula

Answer 81

**B** ## Footnote *It is best to transport an unconscious patient in the recovery position to prevent aspiration if the patient vomits. Oropharyngeal airways are indicated only in unconscious patients that do not have a gag reflex. You do not know if this patient does or does not as that information is not detailed here. High-flow oxygen is to ensure adequate tissue oxygenation.*