1. Skills Training Session February 11, 2014

2. Agenda Quiz Run report guidelines, feedback Scenario Debrief Diabetic Emergencies

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

4. Scenario 23 y.o. M/F @ [Location] c/c dizziness.

5. 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 80-120 mg/dL

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

7. Diabetic Emergencies Hyperglycemia: Blood glucose 120-400 mg/dL Diabetic keto-acidosis (DKA) 400-800 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

8. 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

9. 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

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

11. THANK YOU