EC Chp 19 Diabetic Emergencies And Altered Metnal Status Flashcards
Reticular Activating System (RAS)
Series of neurological circuits in the brain that control the fun actions of staying awake, paying attentions and sleeping.
Oxygen is needed to perfume the brain tissue, glucose is needed to nourish the brain tissues, and water is needed to keep brain tissue hydrated
A lack of what rom the brain can result in an altered mental status?
Oxygen is needed to perfume the brain tissue
Glucose is needed to nourish the brain tissues
And water is needed to keep brain tissue hydrated
One of the most common causes of altered mental status is?
Hypoxia
And remember to consider the possibilities of an airway and or breathing problem with a patient with AMS (altered mental status)
Altered mental status an have the following indicators
Rapid heart rate
Absent radial pulse
Pale skin
Delayed capillary refill
You will determine a baseline mental status by doing what?
AVPU
Can be accomplished by simply saying hello
What is Insulin?
A hormone produced by the pancreas or taken as a medication by many diabetics and assists the glucose molecules pass through the cells
What are islets of Langerhans?
Specialized clusters of cells in the pancreas that secrete insulin
When does the pancreas secrete insulin?
When the blood glucose rises above about 90mg/dL
3 things that determine diabetic patients
- They don’t produce insulin
- Don’t produce enough insulin
- Have a body that has become resistant to the insulin that is produced.
About how many Americans have diabetes mellitus?
Roughly 16 million or 1 in 17 people
What is Diabetes mellitus defined?
Sugar diabetes or just diabetes
The condition brought about by decreased insulin production or the inability of the body of the body cells to use insulin properly
Type 1 Diabetes means?
Insulin-dependent diabetes
Occurs when pancreatic cells fail to function properly and insulin is not secreted normally.
Typically would be prescribed synthetic insulin to supplement his inadequate naturally occurring insulin.
Type 2 Diabetes means?
Non insulin dependent diabetes
When the body’s cells fail to use the insulin properly. The pancreas may be secreting enough insulin, but the body is unable to use it to move glucose out of the blood and into the cells.
Hypoglycemia
In Diabetes what could be the cause?
Low blood sugar.
Takes too much insulin Reduces sugar intake by not eating Overexercises or overexerts self Vomits a meal Increases metabolic rate in conditions like fever or swelling
The brain and body do not tolerate low levels of sugar, therefore what happens
Hypoglycemia
Body’s response to hypoglycemia?
- Fight or flight response
- liver then releases Glycogen ( form of stored sugar)
Glycogen
A form of stored sugar released by the liver in an attempt to raise blood glucose levels.
Signs of sympathetic discharge inlude pale, sweaty skin, tachycardia, and rapid breathing
Signs and Symptoms of Hypoglycemia
Confusion, stupor, unconsciousness, and seizures are common.
Constricted blood vessels give the patient pale and sweaty skin
Which increase pulse rate and respiratory rate
Hyperglycemia
High Blood sugar
Usually caused by a decrease in insulin
Which leaves sugar in the bloodstream rather then help it enter the cells
Infection, stress or increasing dietary intake are factors in what?
Hyperglycemia
Hyperglycemia typically develops…
over days and even weeks.
In contrast as with rapid onset of hypoglycemia
Hyperglycemic patient may complain of ?
Chronic thirst and hunger
Breathe very deeply and rapidly
Dry mouth, intense thirst, abdominal pain, and vomiting
Increase in urination and possibly nausea
In an attempt t to ride the blood of excess sugar
Diabetic ketoacidosis
The result of high blood sugar characterized by dehydration, altered mental status, and shock.
Extremely high levels of sugar in the blood begin to draw water away from the body’s cells, what happens next?
Profound dehydration
The waste product of diabetic ketoacidosis
Ketones
Ketones can be described by?
Chemicals released from the liver when you don’t have enough insulin in the your body to turn sugar into energy
Emits a fruity acetone Odor on his breath
Sings of and symptoms of Hyperglycemia
Overall dehydration
Signs and symptoms of shock
Tachycardia, rapid respiration’s, dropping blood pressure
Children are more at risk of what regarding to diabetes?
Hypoglycemia as they are more active and exhaust sugar more so
How often should people with diabetes measure their glucose via a blood glucose meter?
At least once a day and sometimes as often as 5-6 times a day
Diabetes related complications
Or
Motivation to keep blood glucose levels within normal range?
Heart disease, blindness, and kidney failure
A value of less than 60 mg/dL in a Diabetes come with have ?
Mild alteration in mental status or is diaphoretic for hypoglycemia
Any value less than 50 mg/dL will have?
Significant alterations in mental status and possible unresponsiveness.
Glucose level higher than 300, patient may experience?
Dehydration Severe shock, Acetone breath Deep and rapid breaths Warm, red, dry skin.
Sepsis
More severe collection of problems associated with the body’s response to an infection. Steps that once occurred locally but now are occurring throughout the whole body.
One of the most dangers causes of altered mental status
Sepsis can cause hypovolemic shock and symptoms include:
Altered mental status Increased heart rate and respiratory rate Low blood pressure High blood glucose levels Decreased capillary refill
Seizure ( fit, spell, attack)
A sudden change in sensation, behavior, or movement.
The most severe ones produce violent muscle contractions called convulsions.
It is not a disease in itself but rather a sign of some underlying defect, injury or disease.
What are the two types of seizures
Partial and generalized
Partial Seizures ( focal motor, focal sensory, Jacksonian) are?
Only one part or one side of the brain and often only one area of the body and patient may not lose consciousness
Tingling, stiffening, or jerking in just one part of body. May be an Aura, which is a sensation such as a smell, bright lights, a burst of colors or rising sensation
Complex partial seizures are(psychomotor or temporal lobe)?
Characterized by abnormal behavior that varies from person to person.
Confusion, glassy stare, aimless moving about , lip smacking or chewing or fidgeting with clothing
Generalized Seizure is defined by?
And absent seizure (petit mal)?
Affect of the entire brain and affect the consciousness
Is brief usually less than 10 seconds. Temporary loss of concentrations or awareness. May go unnoticed and often stop before adulthood or worsen.
A generalized seizure called a Tonic-Clonic seizure is?
The most likely to be called for EMS as the patient loses consciousness and has jerking movement of paired muscle groups.
Come without wearing and laser only a few minutes has 3 phases
3 phases of a Tonic Clonic Seizure?
Tonic Phase:
Clonic Phase
Postictal Phase;
Tonic Phase
The Body becomes rigid, stiffening no more than 30 sec. Breathing may stop , the patient may bite his tongue and bowl and bladder control could be lost
Clonic Phase
The body jerks violently usually no more than 1-2 minutes, foaming or drool from the mouth, lips and face become cyanotic
Postictal Phase begins when?
The convulsions stop, may regain consciousness and enter a state of drowsiness and confusion.
May remain unconscious for several hours and headache is common.
Aura
A sensation experience by a seizure patient right before the seizure which might be smell, sound or general feeing
Most common causes of Seizures in adults and infants?
failure to take prescribed antiseizure medication
6months - 3 years is high fever (febrile seizures)
Other causes of Seizures
Hypoxia, stroke, traumatic brain injury,
Toxins, Hypoglycemia, brain tumor
Congenital brain defects, infection
Metabolic, idiopathic (unknown)
Also Epilepsy, measles, mumps, eclampsia (pregnancy) and heat stroke
Epilepsy
A condition that causes seizures
Patients experiencing a seizure, Care?
- Place patient on the floor or ground
- loosen restrictive clothing
- remove objects that my harm the patient
- protect the patient from injury
Status Epilepticus
A prolonged seizure or situation when a person suffers two or more convulsive seizures without regaining full consciousness
Absence seizures are?
Ones that may go unnoticed by everyone except the person and knowledgeable members of his family. They often stop before adulthood but can worsen
Stroke (cerebral vascular accident) CVA is…
A condition of altered function caused when an artery in the brain is blocked or ruptured, disrupting the supply of oxygenated blood or causing bleeding in the brain
Death or injury of brain tissue that is deprived of oxygen
An ischemic stroke is
Can occur when a clot of embolism occludes an artery
A stroke caused by bleeding into the brain is…
Frequently a result of long-standing blood pressure (hypertension)
A hemorrhagic stroke
A common sign of a stroke is one sided weakness, also referred to as?
Hemiparesis
Aphasia means?
Difficulty communicating
Receptive aphasia
In this case the patient can speak clearly but cannot understand what you are saying.
Transient Ischemic Attack (TIA)
Or Ministroke is when…
A patient is weak on one side and having difficulty speaking, but is alert, oriented and perfectly normal without any evident weakness of speech.
However the patient has a complete resolution of his symptoms without treatment within 24 hours
With TIA, small clots may be temporarily blocking circulation to part of the brain. When the symptoms resolve its because?
The affected brain tissue only had a short period of hypoxia and did not sustain permanent damage. However they are at significant risk to having a full blown stroke
When evaluating a patient for a stroke what do you ask the patient to do?
Cincinnati Stroke Scale
- Ask the patient to smile or show their teeth
- ask the patient to close their eyes and hold their arms out straight (drifting)
- ask them to say a phrase to check their speech
The use of clot busting (thrombolytic) drugs in cases of ischemic stroke are
The most advance stroke care, but time is of the essence
Syncope
Fainting or a brief loss of consciousness with spontaneous recovery
Presyncope or near syncope?
About to pass out
Vertigo
A sensitizing of your surroundings spinning around you
Causes of syncope include…
Hypoxia, hypoglycemia, and hypovolemia
Vasovagal syncope
Simple fainting. The result of stimulation of the vagus nerve
Metabolic and structural causes of syncope
Something is wrong with eh brain or the structures near it.
In cases of syncope what ado you do for the patient in no immediate danger?
Loosen clothing around the neck
Place the patient flat with raised legs if possible
Treat any injuries and transport
