Skills Training Session February 11, 2014

Agenda Quiz Run report guidelines, feedback Scenario Debrief Diabetic Emergencies

Run Reports Return reports from last week Run report cards Neatness, clarity, completeness Questions?

Scenario 23 y.o. [Location] c/c dizziness.

Diabetic Emergencies Diabetes mellitus – Type 1: insulin-dependent Hereditary Need for daily insulin injections – Type 2: non insulin-dependent Patient produces inadequate amounts of insulin or is resistant Controlled by diet or oral hypoglycemic drugs Normal range for blood glucose is mg/dL

Diabetic Emergencies Hypoglycemia: – Blood glucose level <80 mg/dL – Can lead to insulin shock Pale, moist skin Dizziness, altered LOC Hunger Seizure, coma, death

Diabetic Emergencies Hyperglycemia: Blood glucose mg/dL Diabetic keto-acidosis (DKA) mg/dL Diabetic coma possible above 800 mg/dL – Symptoms: Kussmaul respirations: deep, labored breathing Rapid, weak pulse Fruity breath Altered LOC/unresponsiveness Dry, warm skin

Diabetic Emergencies DKA and insulin shock appear very similarly, how do we tell the difference? SKIN SIGNS! “hot and dry, my sugar is high. Pale and clammy, need some candy” Appears similar to EtOH

Diabetic Emergencies Treatment: – Oral glucose, given to a patient with a decreased level of consciousness with a Hx of diabetes One dose is one tube Squeeze onto tongue depressor or swab and spread inside Pt’s cheek. Never stick your finger’s in a patients’ mouth Pt must have a gag reflex and be conscious – Low LOC, Pt may lose gag reflex – O 2 via NRB, 15 L/min

Diabetic Emergencies Treatment: – If Pt is unconscious, do not try to give glucose. – Maintain airway and transport, Pt needs IV glucose.

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