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EM 1102 | Emergency Medical Technician > Chapter 22 | Diabetic Emergencies and Altered Mental Status > Flashcards

Chapter 22 | Diabetic Emergencies and Altered Mental Status Flashcards

• General approaches to assessing the patient with an altered mental status • Understanding the causes, assessment, and care of diabetes and various diabetic emergencies • Understanding the causes, assessment, and care of seizure disorders • Understanding the causes, assessment, and care of stroke • Understanding the causes, assessment, and care of dizziness and syncope

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USMLE® Step 1 flashcards Royal College: Emergency Medicine flashcards
1
Q

Define:

DM

(abbreviation)

A

diabetes mellitus

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2
Q

Fill in the blank:

The abbreviation for diabetes is [BLANK].

A

The abbreviation for diabetes is DM.

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3
Q

Define:

RAS

(abbreviation)

A

reticular activating system

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4
Q

Define:

reticular activating system (RAS)

A

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

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5
Q

Fill in the blank:

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

A

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

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6
Q

True or false:

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

A

true

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7
Q

True or false:

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

A

false

AMS could indicate deeper problems

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8
Q

Define:

glucose

A

most basic form of sugar

body’s main source of energy

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9
Q

Fill in the blank:

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

A

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

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10
Q

Explain:

“lock and key” metaphor for insulin and glucose

A

insulin acts as key

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

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11
Q

Define:

hypoglycemia

A

low blood sugar

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12
Q

Define:

hyperglycemia

A

high blood sugar

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13
Q

List:

causes of hypoglycemia in patients with diabetes

5 points

A
  • 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)
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14
Q

List:

necessities to maintain consciousness

3 points (things; not processes)

A
  • oxygen
  • glucose
  • water
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15
Q

Define:

DKA

(abbreviation)

A

diabetic ketoacidosis

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16
Q

Define:

diabetic ketoacidosis (DKA)

A

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

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17
Q

Define:

SNOT

(acronym)

A
  • stroke/seizure/sugar
  • narcotics
  • oxygen
  • toxins/trauma/temperature
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18
Q

Define:

AEIOUTIPS

(“vowel tips”; acronym)

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

(causes of AMS)

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19
Q

Fill in the blank:

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

A

Hypoxia is one of the most common causes of AMS.

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20
Q

Fill in the blank:

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

A

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

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21
Q

Define:

T1D

(abbreviation)

A

type 1 diabetes

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22
Q

Define:

T2D

(abbreviation)

A

type 2 diabetes

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23
Q

Explain:

difference between T1D and T2D

A
  • T1D: underproduction of insulin by pancreas
  • T2D: inability of body’s cells to use insulin properly
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24
Q

List:

signs of hypoglycemia

5 points (at onset)

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

(very rapid onset)

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25
Q

List:

results of hypoglycemia

3 points (if left untreated)

A
  • AMS
  • unconsciousness
  • permanent brain damage (starving brain cells)
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26
Q

List:

signs/symptoms of hyperglycemia

3 points

A
  • chronic thirst or hunger
  • increased urination
  • nausea
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27
Q

List:

effects of hyperglycemia

3 points (physiology if left untreated)

A
  • profound dehydration (hence excessive thirst)
  • excessive waste products (hence extra peeing)
  • DKA (extreme hyperglycemia)
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28
Q

Fill in the blank:

The onset of hypoglycemia is typically [RAPID/GRADUAL].

A

The onset of hypoglycemia is typically very rapid.

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29
Q

Fill in the blank:

The onset of hyperglycemia is typically [RAPID/GRADUAL].

A

The onset of hyperglycemia is typically gradual.

(develops over days/weeks)

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30
Q

List:

signs/symptoms of DKA

3 points

A
  • profound AMS
  • rapid breathing
  • acetone (sweet) odor in breath

like being drunk with a sweet breath

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31
Q

Fill in the blank:

The severe dehydration associated with DKA can cause [BLANK].

A

The severe dehydration associated with DKA can cause shock.

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)

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32
Q

Fill in the blank:

The blood sugar of a symptomatic diabetic patient with hypoglycemia is less than [BLANK] mg/dL.

A

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

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33
Q

Fill in the blank:

You can expect a patient to experience AMS if their blood sugar drops below [BLANK] mg/dL.

A

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

34
Q

Fill in the blank:

The blood sugar of a symptomatic diabetic patient with hyperglycemia is more than [BLANK] mg/dL.

A

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

35
Q

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.

A

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

36
Q

Fill in the blank:

A glucometer reading “HI” indicates [BLANK].

A

A glucometer reading “HI” indicates severe hyperglycemia (> 500 mg/dL).

37
Q

Fill in the blank:

A glucometer reading “LO” indicates [BLANK].

A

A glucometer reading “LO” indicates severe hypoglycemia (< 15 mg/dL).

38
Q

Answer:

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

A

preventing contamination of isopropyl alcohol on skin

39
Q

Define:

stroke

A

death or injury of brain tissue from oxygen deprivation

40
Q

List:

types of stroke

2 points

A
  • hemorragic stroke: bleeding from ruptured blood vessel in brain
  • ischemic stroke: blockage of artery supplying blood to brain
41
Q

Define:

TIA

(abbreviation)

A

transient ischemic attack

42
Q

Define:

transient ischemic attack (TIA)

A

small clots that temporarily block circulation to part of brain

mini stroke

43
Q

Fill in the blank:

TIA causes [BLANK] symptoms.

A

TIA causes stroke-like symptoms.

(TIA stands for transient ischemic attack)

44
Q

Fill in the blank:

TIA symptoms resolve when [BLANK].

A

TIA symptoms resolve when the clots break up.

(TIA stands for transient ischemic attack)

45
Q

Fill in the blank:

TIA symptoms should be completely resolved without treatment within [BLANK].

A

TIA symptoms should be completely resolved without treatment within 24 hours (usually much sooner).

(TIA stands for transient ischemic attack)

46
Q

Define:

CPSS

(abbreviation)

A

cincinnati prehospital stroke scale

47
Q

Define:

tonic-clonic seizure

A

unconsciousness paired with major motor activity

48
Q

Define:

tonic phase of seizure

A

first phase of tonic-clonic seizure wherein body is rigid for (up to) 30 seconds

(tonic means the tight phase)

49
Q

Define:

clonic phase of seizure

A

second phase of tonic-clonic seizure wherein body jerks violently for 1-2 minutes

(clonic means the crazy phase)

50
Q

Define:

postictal phase of seizure

A

slow period of regaining consciousness after convulsions stop

(slow indeed)

51
Q

Define:

aura

(seizure term)

A

sensation felt just before seizure or syncope

52
Q

Define:

partial seizure

A

uncontrolled muscle spasm or convulsion while patient is fully alert

53
Q

Define:

hemorragic stroke

A

bleeding from ruptured blood vessel in brain

54
Q

Define:

ischemic stroke

A

blockage of artery supplying blood to brain

55
Q

List:

potential causes of seizures

9 points

A
  • hypoxia
  • stroke
  • TBI
  • brain tumor
  • congenital brain defects
  • toxins
  • hypoglycemia
  • infection
  • epilepsy
56
Q

Explain:

how to care for patient during seizure

(biggest priority)

A

protect patient from injury

(don’t try to restrain patient during convulsions)

57
Q

List

ways to protect patient from injury during seizure

3 points

A
  • place patient on floor/ground
  • loosen restrictive clothing
  • remove objects that may harm patient
58
Q

Explain:

how to care for patient after seizure

(biggest priority)

A

protect the airway

59
Q

Fill in the blank:

If there is no possibility of spine injury after a patient experiences a seizure, place the patient [BLANK].

A

After a patient experiences a seizure, if there is no possibility of spine injury, place the patient in the recovery position.

(on the side)

60
Q

Fill in the blank:

If a patient is cyanotic after experiencing a seizure, you should [BLANK].

A

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

61
Q

Describe:

standard duration of a seizure

A

1 to 3 minutes

62
Q

Define:

status epilepticus

A

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

63
Q

Define:

sepsis

A

severe and system-wide response to an infection

(one of the most dangerous causes of AMS)

64
Q

List:

signs/symptoms of sepsis

6 points

A
  • AMS
  • tachycardia
  • tachypnea
  • hypotension
  • hyperglycemia
  • fever
65
Q

Define:

vertigo

A

sensation of spinning surroundings

66
Q

Define:

lightheadedness

A

sensation of nearly passing-out

67
Q

List:

potential causes of AMS

4 points

A
  • S: seizures, sugar, stroke
  • N: narcotics
  • O: oxygen
  • T: trauma, toxins, temperature
68
Q

Define:

decorticate posturing

A

abnormal flexion of the arms with the extension of the legs

remember decorticate posturing for putting arms toward your core

69
Q

Define:

decerebrate posturing

A

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 decerebrate are for “extended”

70
Q

Choose:

Which is not one of the steps in managing a patient experiencing dizziness and syncope?

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.

A

D

71
Q

Choose:

Which of the following is not a sign or symptom of stroke?

A: Vomiting

B: Sudden impairment of vision

C: Chest pain

D: Seizure

A

C

72
Q

Choose:

Which of the items below is not part of the Cincinnati Prehospital Stroke Scale?

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.

A

B

73
Q

Answer:

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

A
  • oxygen to perfuse brain tissue
  • glucose to nourish brain tissue
  • water to keep brain hydrated

(RAS is reticular activating system)

74
Q

Answer:

Which of the following is the most common cause of seizures in adults?

A: Failure to take prescribed medication

B: Head trauma

C: Withdrawal from alcohol

D: Fever

A

A

75
Q

Fill in the blank:

Hypoglycemia typically occurs [GRADUALLY/SUDDENLY].

A

Hypoglycemia typically occurs suddenly.

blood sugar can drop like a rock

76
Q

Fill in the blank:

Hyperglycemia typically occurs [GRADUALLY/SUDDENLY].

A

Hyperglycemia typically occurs gradually.

takes time for blood sugar to get that high

77
Q

List:

testable signs/symptoms of stroke

duh

A
  • face drooping
  • arm weakness
  • speech slurred
  • time since last seen normal
78
Q

List:

secondary signs/symptoms of stroke

4 points (things you’d expect that aren’t FAST)

A
  • AMS
  • severe hypertension
  • unequal pupils
  • seizures
79
Q

List:

[BLANK] may possibly get misdiagnosed as a stroke due to similar symptoms.

A

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

80
Q

Answer:

Can a patient refuse transport after the administration of oral glucose?

A

yes

if presenting normal again and able to consent

81
Q

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?

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

A

B

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.

EM 1102 | Emergency Medical Technician (40 decks)

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