Hypoglycemia MD Flashcards
What are the indications?
suspected hypoglycemia
What considered low blood sugar according to the ALS?
<2 years - <3.0 mmol/L
OVER 2 years! - <4.0mmol/L
What are the conditions for DEXTROSE?
> =2 years old
LOA- ALTERED
Other- hypoglycemia
What are the conditions for GLUCAGON?
LOA- altered
other- hypoglycemia
What are the contraindications for DEXTROSE?
ax or sensitivity
What are the contraindications for GLUCAGON?
Ax or sensitivity
pheochromocytoma (rare benign tumour on the adrenal gland)
What is the TREATMENT for dextrose if it is 10%?
Concentration is 10%
IV - over or equal to 2 years old !!
0.2g/kg (2mL/kg)
MAX - 25g (250ml)
Dosing interval - 10 mins
max doses- 2
What is the TREATMENT for dextrose if it is 50%?
Concentration is 50%!!
IV - over or equal to 2 years old !!
0.5g/kg (1mL/kg)
MAX - 25g (50ml)
Dosing interval - 10 mins
max doses- 2
What are we supposed to titrate the dextrose to? (hint- what pt presentation do we wanna see)
titrate dextrose to a LOA where the pt can safely consume complex carbs!!
If we are not PCP AIV and cannot use dextrose, whats our next option?
GLUCAGON
What is the treatment for glucagon?
<25kg
IM
0.5mg
max single dose- 0.5mg
Interval- every 20 mins
max dose- 2
> =25kg
IM
1mg
max single dose- 1mg
Interval- every 20 mins
max dose- 2
If the pt responds to the dextrose or glucagon, he or she may receive oral glucose tabs or simple carbs? T OR F?
TRUEE
If only MILD symptoms of hypoglycemia is exhibited, the pt may receive ________ or _____ instead of the meds we can give them.
oral glucose tabs or simple carbs!!
If a pt initiates an informed refusal of transport, what do medics need to have before we go?
a final set of vitals including blood glucometry attempted and documented.
What are the treat and discharge requirements in the first paragraph?
the pt is >=18 yrs old - <65 yrs old
the pt has a diagnosis of diabetes
the hypoglycemia can be explained by insulin administration with inadequate oral intake
the hypoglycemia promptly responded to a SINGLE administration of dextrose, glucagon, oral glucose tabs or complex carbs
this was an isolated sympotmatic hypoglycemic episode in the past 24 hrs
the blood glucose is >=4.0
the pt has a return to their normal LOC and is asymptomatic
a complete set of vital are within expected normal ranges
What is in the second paragraph for the treat and discharge?
not an intentional overdose
the hypoglycemia must NOT be related to alcohol or substance abuse or withdrawal
no seizure or reported hx of seizure prior to ems arrival
not on an oral hypoglycemic med (type II diabetics)
hypoglycemia is not considered to be related to ana cute medical illness AND
the pt is not pregnant
What are the last 7 things paramedics need to ensure before treating and discharging a patient?
the pt has access to appropriate carbs
a responsible adult agrees to remain w pt for 4 hours
all the pt or SDM questions were answered and care plan developed
the pt or SDM has been advised to follow up with the primary health care team or provider
clear instructions to call 911 were provided should symptoms redevelop
AND the pt or SDM consents to the discharge
What do we do if we are unsure that the pt meets all treat and discharge criteria???
CALL BHP
Where do we take a blood sugar?
finger tip or heel of foot on peds
What is the max amount of medication we can give in GRAMS for both meds in this directive?
25G
It is recommended that we gradually administer ONE dose of DEXTROSE over how long ???….
3 minutes gradually to avoid over treatment causing rebound HYPERglycemia
What is the 15-15 rule?
the pt ingests 15 grams of simple carbs followed by a repeat glucose check in 15 minutes!!
Why do we suggest the pt only consumes 15 grams of simple carbs?
to prevent rebound hyperglycemia that usually occurs after eating a large amount of food. In most patients, 15g of carbs is enough to raise glucose in the blood by 2.1mmol/L in approx. 20 mins
What are examples of 15g of simple carbs?
15 grams of glucose tabs, paste or other formulation
15ml of honey
15ml of water with 3 packs of sugar
150 juice box or soda
