Lecture #12

• secretes insulin, glucose and glucagon
• located mostly in the upper L quadrant

• a simple carbohydrate (sugar)
• used by the body to produce energy
• major nutrient source
• every carb must be broken down to glucose in order for the body to use it

when the blood sugar is low enough to cause CNS symptoms (affecting the brain)

glycogen

stored sugar, or extra sugar left over from a previous meal

allows glucose to enter the cell and decreased the bG

• increased glucose in the blood caused from lack of insulin allowing the glucose to enter the cell
• in short: too much food, too little insulin
• rapid weak pulse
• deep rapid breathing
• decreased LOC
• normal or lowered BP

• insulin dependent = pancreas cannot create enough insulin, so these pts must take supplemental insulin
• most common form in young ppl
• 10-15% of diabetes cases

• Non-insulin dependent
• most common type of diabetes in ppl over 30 y/o
• frequently associated with obesity b/c the body mass grows but the pancreas does not = it has insufficient insulin secretion
• these pts take oral medications to stimulate the pancreas to create more insulin (they may also take insulin as well)

metabolizing fat instead of glucose

• byproducts of fatty acids and ketones, making the patient severely acidotic (changing the pH in the body)
• can cause severe brain damage or death
• kidneys attempt to eliminate glucose through urine and cause dehydration

• deep rapid breathing pattern called Kussmaul's respirations
• pt breathes off CO2 and the blood becomes more alkaline

• hunger (cells are starving)
• thirst (excessive urine output)
• tachycardia and hypotension from excessive urine output
• pale, dry skin
• altered LOC
• dehydration

• electrolytes are imbalances from an excessive urine output and potassium levels drop
• acidosis and decreased potassium may cause cardiac dysrhythmia or death

• recognize it
• ALS upgrade
• support ABCs
• correct hypovolemia
• rapid transport where the pt will be placed in insulin and the volume loss will be replaced

brain

• full, rapid pulse
• normal breathing
• dizziness, headache
• fainting, seizures, disorientation, coma
• normal BP
• pale
• grossly diaphoretic
• if allowed to progress, pt will become tachycardic (brain wants more blood - more sugar) and brain cells will begin to die from starvation

• pt appears intoxicated
• any CNS disturbance possible: coma, confusion, euphoria, combativness
• if not recognized and corrected quickly, permanent brain damage may result (brain cells are dying from starvation)

• Coronary Artery Disease
• claudation (limping)
• skin breakdown
• infection
• amputation of extremities

altered/decreased mental status AND known history of diabetes

• unconcsious
• known diabetic who has not taken medications for days
• patient is unable to swallow

use caution to prevent aspiration of glucose paste

caloric

• squeeze small portions of gel into mouth between cheek and gum
• squeeze small portions of gel into tongue depressor, then place gel between cheek and gum

Blood Glucose Rebound - in the presence of insulin, glucose introduced into the bloodstream will be flushed rapidly into cells and cause the bG to drop rapidly again. to prevent another hypoglycemic episode, the pt must eat a carb and protein (pb&j)

• are you on oral medication or insulin?
• have you taken your meds today?
• have you eaten your normal food intake today?
• have you tested your bG today? when?
• what was the result of the bG test?
• any other symptoms?

• a tool that should be used to supplement an ALS assessment
• should not be a decision point in determining upgrade or method of transport
• BLS units should not carry glucometers not base any decisions to upgrade or downgrade a ptbased on bG reading
• skill should be performed under ALS supervision

• rapid onset of altered LOC
• intoxicated appearance
• elevated heart rate
• cold clammy skin
• seizures
• insulin in fridge or other meds found on scene
• uncharacteristic behavior
• anxious
• combative

• onset - rapid or slow (OPQRST)
• duration
• associated symptoms
• evidence of trauma
• seizures
• fever

• administration of one tube of glucose is covered by standing orders
• additional glucose administration requires Medic Unit contact

physical findings or changes in behavior that occur after an episode of abnormal electrical activity in the brain

a seizure caused from a rapid onset of fever, usually occurring in children 6 month to 6 years old

• the unconcious period after a seizure
• pt is lethargic, disoriented, possibly incontinent

the rhythmic jerking phase in that occurs during a seizure

the phase in seizures when all muscles contract simultaneously

• prolonged seizure or repeated seizures without regaining consciousness in between
• life threatening emergency
• most common in children younger than 2 years

AEIOUTIPPS

• A-alcohol/acidosis
• E-epilepsy/endocrine/electrolyte
• I-insulin
• O-overdose
• U-underdose/uremia
• T-trauma
• I-infection
• P-pump/poison
• P-phsycosis
• S-stroke/shock

• actively seizing upon arrival
• first time seizure or unknown history
• seizure with pregnancy, street drug use, recent head injury, or abrupt onset of severe headache

• protect pt from trauma if still seizing (move furniture out way, etc)
• general pt care procedures
• for febrile seizures, remove clothing down to diaper

fainting

• altered or decreased LOC
• severe abdominal or back (indicating AAA)
• severe headache (indicating head bleed)

ischemia of the brain

blockage of an artery in the brain, often by a clot traveling from somewhere else in the body

ruptured blood vessel causing bleeding in the brain

• F-facial droop
• A-arm drift
• S-slurred speech
• T-time

symptoms to look for in a stroke patient

• altered LOC
• uncontrolled nausea/vomiting
• systolic BP greater than 250 or diastolic greater than 110 with new onset of stroke symptoms
• dysarthria (impaired speech) with absent gag reflex

impaired speech

inability to communicate

inability to swallow

• general pt care procedures
• if pt has dysarthria, check for gag reflex with tongue depressor
• if pt is diabetic, have family check bG lvl, if possible
• obtain an accurate "time when last seen normal"

3.5 hours

• small stroke that has no lasting effects or permanent neurological damage
• these pts have a much higher risk of having actual stroke

temporary paralysis in an post seizure patient

• altered or decreased LOC
• severe or multiple episodes of vomiting
• systolic greater than 250 or diastolic less than 110
• when asked "how does this compare to other headaches you've had?" pt states "worst headache of my life"
• lateralizing signs
• seizure