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115 Cards in this Set
- Front
- Back
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What is diabetes mellitus?
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The condition brought about by decreased insulin production or the inability of the body cells to use insulin properly (which prevents the body's cells from taking the simple sugar called glucose from the bloodstream) -- Diabetes Mellitus is a group of diseases and includes type 1 and type 2 diabetes
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What is insulin's role in the body?
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Insulin allows sugar to pass from the bloodstream to the body's cells
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What organ creates glycogen?
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The liver
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What does glycogen create?
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Glucose
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What is glucagon?
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A hormone created in the pancreas that raises blood sugar levels by breaking glycogen into glucose.
Glucagon also triggers insulin secretion so that cells can take up the newly-created glucose. |
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How is diabetes treated?
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With injections or oral medication.
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What are the two types of diabetic emergencies?
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Hypoglycemia (low blood sugar)
Hyperglycemia (high blood sugar) |
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What is the most common emergency for the diabetic patient?
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Hypoglycemia
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Is hypoglycemia life-threatening for people with diabetes?
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Yes.
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What are some causes of hypoglycemia?
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Vomiting
Unusual amount of exercised Reduced sugar intake caused by not eating Taking too much insulin |
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What are some signs and symptoms of hypoglycemia?
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Rapid onset
Intoxicated appearance, staggering, slurred speech, unconsciousness Cold, clammy skin Rapid heart rate Seizures (severe cases) Unusual or bizarre behavior Anxiety Refusal to cooperate or combativeness |
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What is hyperglycemia?
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Hyperglycemia (high blood sugar) is a slow-onset condition from decreased insulin levels in people with diabetes.
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What are some causes of hyperglycemia?
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Forgotten or insufficient insulin dose
Infection Stress Increased dietary intake |
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What are some signs and symptoms of hyperglycemia?
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Slow onset
Nausea/vomiting Acetone odor on breath Increased urination/hunger/thist Warm, red, or dry skin (normal) Abdominal cramps |
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How do you assess diabetic emergencies?
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Perform initial assessment
Perform focuses history and physical exam Get SAMPLE history Take baseline vitals |
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What conditions must be met for you to administer oral glucose.
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History of diabetes
Altered mental status Patient can swallow |
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What must you do immediately if a diabetic patient becomes unconscious?
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Stop glucose administration and secure the airway
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What do you do if glucose administration doesn't improve the patient's condition?
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Consult medical direction
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What do you do when a diabetic patient isn't conscious enough to swallow?
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Secure airway
Administer oxygen Position appropriately Request ALS and transport |
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What is a normal glucose reading?
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80-120 mg/dl
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What glucose reading indicates moderate hypoglycemia?
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60-80 mg/dl
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What glucose reading indicates severe hypoglycemia?
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Under 50 mg/dl
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What glucose reading indicates hyperglycemia?
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120 mg/dl and up
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What do you do when you get blood glucose readings that are contrary to the patient's condition?
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Question those
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What are indications for oral glucose?
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Altered mental status
Ability to swallow |
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What are contraindications for oral glucose?
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Unconsciousness
Diabetic who hasn't taken insulin for days Inability to swallow |
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What does oral glucose do?
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Increases blood sugar
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What are side effects of oral glucose?
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None, if used properly. May accidentally be inhaled.
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What do you do if you cannot rule out injury?
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Treat as a trauma patient
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What's a seizure?
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It's a sudden change in sensation, behavior, or movement caused by irregular electrical activity of the brain.
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What are some causes of seizures?
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Toxins
Brain tumor Congenital brain defects Trauma Infection/fever (#1 cause in pediatric patients 6 months to 3 year old) Epilepsy Stroke Hypoglycemia Eclampsia Hypoxia Unknown triggers |
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How do you treat a patient during a seizure?
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Place patient on floor
Position patient on side Loosen restrictive clothing Remove harmful objects Protect patient from injury -- do not hold them still or place anything in their mouth |
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How do you treat a patient after a seizure subsides?
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Protect airway with positioning and suction
If cyanotic, ventilate Treat injuries Transport |
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What happens in a simple partial seizure?
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There is tingling, stiffening, or jerking in just one part of the body (also called psychomotor or temporal lobe seizures). Patient may describe the feeling of an "aura." This could be a smell, a vision, or a vague feeling
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What is a tonic-clonic (grand mal) seizure?
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There is often no aura or other warning. This type of seizure is characterized by unconsciousness and major motor activity.
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What's an absence seizure? (petit mal)
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A seizure in which there is no dramatic motor activity and the person usually doesn't slump or fall. There is a temporary loss of concentration or awareness.
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What is status epilepticus?
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A life threatening condition in which the patient has two or more convulsive seizures without regaining consciousness or lasting more than five minutes
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What are some signs and symptoms of stroke?
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Intoxicated appearance, slurred speech, unconsciousness
Severe headache, vision changes One-sided weakness of body Confusion Loss of bowel control Uneven pupils |
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What's a transient ischemic attack (ITA)?
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It's a mini-stroke. Shows signs and symptoms of a stroke. Often resolved before EMS arrival. Symptoms resolve without treatment in less than 24 hours. Significant risk of having a "full" stroke.
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What are key principles of treating a stroke?
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Prompt transport is critical
Identify potential stroke patients and notify the hospital Maintain airway, administer oxygen |
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Define "glucose."
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A form of sugar, the body's basic source of energy
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Define "insulin."
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A hormone produced by the pancreas or taken as a medication by many diabetics
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What type of diabetes is also called "sugar diabetes."
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Diabetes mellitus
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What condition can quickly cause an altered mental status, unconsciousness, and even permanent brain damage in a diabetic?
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Hypoglycemia
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Which diabetic is at greater risk of hypoglycemia: a child or an adult?
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Children -- they can quickly exhaust blood sugar by playing, and are often less disciplined about eating correctly and on time
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What steps must one take in order to properly assess a patient going through a diabetic emergency?
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1) Perform initial assessment and identify altered mental status
2) Performed focused history and physical exam. Gather info from patient or bystanders. Make sure to ask about interruptions in the episode, seizures, or a fever. Look for signs that the patient is a diabetic (wallet card, insulin in fridge, medical alert ID, oral medication), and perform blood glucose monitoring if local protocols permit. 3) Determine if the patient is alert enough to swallow 4) Take baseline vitals (in some jurisdictions, oral glucose will be administered before vitals are taken) |
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From where do you take blood samples to be used in a blood glucose meter?
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The finger or forearm
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What unit of measurement is used to express levels of blood glucose?
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Milligrams per deciliter (mg/dl), also called milligrams percent
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What determines whether or not an EMT is allowed to use a blood glucose meter?
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Local protocols or permission from medical direction
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If local protocols don't allow for an EMT to use a blood glucose meter, what can they do to obtain a blood glucose reading?
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Have the patient or a family member do it.
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Is it generally acceptable for an EMT to use a patient's blood glucose meter?
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No
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What steps do you take in order to properly use a blood glucose meter?
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1) Prepare the device including a test strip and a lancet
2) Use an alcohol prep to cleanse the patient's finger 3) After allowing alcohol to dry, use a lancet to perform a finger stick on the patient. Wipe away the first drop of blood that appears. Squeeze finger if necessary to obtain a second drop. 4) Apply blood to test strip 5) Read glucose meter |
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What are possible reasons for a blood glucose meter to give a false reading?
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1) Insufficient blood on test strip
2) Improperly stored or expired test strip 3) Meter needs calibration 4) Meter needs batteries |
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Is it common for a blood glucose meter to give an inaccurate reading?
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yes
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What comes first when working with a diabetic emergency -- initial assessment or blood glucose reading?
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Initial assessment
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What steps must an EMT take in order to provide emergency care for a diabetic with a diabetic emergency?
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1) Determine if the following criteria for administration of oral glucose are present:
Patient has history of diabetes Patient has altered mental status Patient is awake enough to swallow 2) Administer glucose if appropriate 3) Reassess the patient. Consult medical direction if patient doesn't approve 4) If patient is not awake enough to swallow, treat like any other patient with altered mental status |
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What are some trade names for oral glucose?
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Glutose, Insta-Glucose
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Determine if it's appropriate to administer glucose in this situation:
Patient is confused. Not oriented to time, babbling. Nurse's aide tells you she's diabetic and has been having trouble managing it. She will occasionally take insulin and not eat and vice versa. |
Patient meets criteria for glucose administration
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Determine if it's appropriate to administer glucose in this situation:
At a facility for disabled youth, a 19-year-old man recovering from a head injury was seizing prior to EMT arrival, but seizure has stopped. He responds to loud verbal stimulus. He has a history of diabetes. |
Patient is NOT alert enough to swallow. Additionally, seizure is not necessarily due to diabetes. Do not administer glucose.
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Determine if it's appropriate to administer glucose in this situation:
Patient is behind the wheel at the scene of a collision. He is rocking back and forth, mumbling. Accident was low-speed with very minor impact. You observe a bracelet that indicates that the patient is a diabetic. |
Patient meets criteria for administration of glucose.
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What is Type I diabetes?
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Often called "juvenile diabetes," it occurs in individuals with little or no ability to create insulin. Requires supplemental insulin.
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What's type II diabetes?
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Non-insulin-dependent diabetes. It occurs in individuals who produce insulin in insufficient amounts and/or whose body cells cannot use insulin properly. Often associated with obesity, seen mostly in adults.
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What are some possible complications of advanced diabetes?
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Heart disease, kidney disease, blindness
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What are ketones?
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Ketones are compounds that appear in the blood as a byproduct of burning fat as fuel in lieu of glucose
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What is diabetic ketoacidosis?
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Ketoacidosis is a condition in which the blood turns acidic due to a concentration of ketones. This ocurs when a diabetic is hyperglycemic and sugar is floating in the bloodstream but not reaching cells. This can cause death.
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Is deep, fast breathing an indicator of hyperglycemia of hypoglycemia?
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Hyperglycemia
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Why is it unimportant to distinguish between hyperglycemia and hypoglycemia in the field?
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Because either way, you're probably going to administer glucose. The glucose won't have enough time to cause damage to a hyperglycemic patient.
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What are 7 common causes of altered mental status?
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1) Alcohol use
2) Drug overdose 3) Metabolic abnormalities 4) Head trauma 5) Brain tumor 6) Infectious diseases such as meningitis 7) Hypoxia |
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What are the three most important things an EMT can do in treating a patient with an altered mental status?
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Maintain a patent airway
Provide high-concentration oxygen Transport to the hospital |
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What other medical conditions may be accompanied by convulsive seizures? (7)
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Epilepsy
Stroke Measles/mumps/childhood diseases Hypoglycemia Eclampsia (severe complication of pregnancy) Hypoxia Heat stroke |
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What can cause epilepsy?
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It can either be a birth defect or caused by a head injury or surgery
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What are the four most important questions you can ask bystanders when assessing a seizure patient?
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1) What was the person doing before it started?
2) Exactly what did the person do during the seizure - movement by movement - especially at the beginning. Loss of bowel control? 3) How long did it last? 4) What did the patient do after the seizure? Mental status? Actions? |
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How can you care for a patient with a seizure disorder when you witness a convulsive seizure?
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1) Place the patient on floor. If no possibility of spine injury, place patient on side for drainage
2) Loosen restrictive clothing 3) Remove objects that may harm the patient 4) Protect patient but don't hold them still |
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How can you care for a patient with a seizure disorder after convulsions have ended?
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1) Protect the airway
2) If patient is cyanotic, ensure open airway and provide artificial ventilations 3) Treat any injuries caused by the seizure. Immobilize spine and neck if trauma is suspected 4) Transport |
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When should you place something in a convulsing seizure patient's mouth?
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Never
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Is it common for epileptics to refuse transport?
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Yes, because they are frequently very familiar with their condition. You should encourage transport, and if they refuse they must be accompanied by a competent companion.
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How long do seizures usually last?
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1-3 minutes max
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What is a "generalized seizure" or a "tonic-clonic seizure?"
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This is a seizure characterized by sudden onset and major motor activity.
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How many phases are there in a tonic-clonic seizure?
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Three phases:
1) Tonic 2) Clonic 3) Postical |
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What happens during the tonic phase of a tonic-clonic seizure?
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The body becomes rigid for up to 30 seconds. Breathing may stop and bowel/bladder control may be lost.
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What happens during the clonic phase of a tonic-clonic seizure?
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The body jerks around violently, usually for no more than 1-2 minutes but some can last up to 5 minutes. Patient may foam or drool, often becoming cyanotic.
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What happens during the postical phase of a tonic-clonic seizure?
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This phase begins when convulsions stop. Patient may snap out of it or enter state of altered mental status. Headache is common.
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What is a complex partial seizure (AKA psychomotor or temporal lobe seizure)?
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Often preceded by an aura. Abnormal behavior that varies widely from person to person ensues. It may involve confusion, a glassy stare, aimless moving about, lips smacking, fidgeting. Person may appear to be intoxicated.
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Can partial seizures develop into tonic-clonic seizures?
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Yes
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What is an outdated term for a stroke?
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Cerebral vascular accident (CVA)
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What is a stroke?
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A condition of altered function caused when an artery in the brain is blocked or ruptured.
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What is a hemorrhagic stroke?
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A stroke caused by bleeding into the brain.
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What is the term for a stroke caused by bleeding into the brain?
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Hemorrhagic stroke
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What is an ischemic stroke?
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A stroke caused by the blockage of an artery due to atherosclerosis or a clot or embolism.
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Define "aphasia"
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A general term describing difficulty in communication.
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What's a Transient Ischemic Attack (TIA)?
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This is a "mini stroke." This is usually a good indicator of an impending full-scale stroke. This is an occlusion or bleeding of an artery in the brain that resolves its symptoms on its own within 24 hours.
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What is the Cincinnati Prehospital Stroke Scale?
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This is a method by which you can determine whether a patient is experiencing a stroke. If any one of the three following tests are failed, the patient has a 70 percent chance of having an acute stroke.
1) Ask the patient to smile. Demonstrate how to smile, showing teeth, and look for unequal or absent movement. 2) Ask the patient to close his eyes and extend his arms straight in front of him for ten seconds. Watch to see if one arm drifts or stays still. 3) Ask the patient to repeat a sentence, and look for slurred or absent speech. |
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How do you care for a conscious patient undergoing a stroke?
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Calm and reassure the patient.
Monitor and maintain the airway. Administer high-concentration oxygen. Transport in semi-sitting position. |
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How do you care for an unconscious patient undergoing stroke, or a patient that cannot maintain his airway?
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Maintain open airway
Provide high concentration oxygen Transport with patient lying on the affected side |
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What conditions can mimic a stroke?
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Tumors
Infections in the brain Head injury Hypoglycemia |
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What are the three criteria that must be met in order for a patient to be a candidate for clot-busting (thrombolytic) drugs?
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Definite onset of stroke symptoms less than 3 hours prior to the administration of the drug
An emergency CT scan of the brain confirms no evidence of hemorrhagic stroke Blood pressure is not excessive |
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What are common symptoms of stroke?
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Confusion
Dizziness Numbness, weakness, or paralysis, usually on one side Loss of bowel/bladder control Impaired vision High blood pressure Difficult respiration/snoring Nausea/vomiting Seizures Unequal pupils Headache Loss of vision in one eye Unconsciousness (uncommon) |
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What is one of the most important things that an EMT can document when assessing a stroke victim that can aid their further care?
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The time of the onset of symptoms.
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Define "syncope"
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fainting
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Who most commonly suffers from syncope and fainting?
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The elderly
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Are dizziness and syncope always related?
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Not always, but sometimes
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How long does syncope last?
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Usually a few seconds.
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What are some common warnings that a syncopal episode or fainting spell is about to occur?
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Lightheadedness
Dizziness nausea weakness Vision changes Sudden Pallor Sweating Loss of bowel/bladder control (only occasionally) |
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Problems in or near what brain are generally responsible for syncope and dizziness?
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The brain
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What is the most common cause of syncope or dizziness?
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Inadequate blood flow to the brain
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What are the four categories that include most causes of dizziness and syncope?
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Hypovolemic
Metabolic Environmental/Ecological Cardiovascular |
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Define "hypovolemia"
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Low fluid/blood volume
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What is the most common cause of hypovolemia?
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Dehydration
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What is the most serious cause of hypovolemia?
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Bleeding
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What is "vasovagal syncope?"
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This is fainting due to stimulation of the vagus nerve. This falls under the "cardiovascular" category since the vagus nerve slows cardiac output when triggered
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What area, located in the carotid artery under the mandible, can cause syncope when stimulated?
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The carotid sinus.
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What is the number 1 cause of seizures in patients between the ages of 6 months and 3 years?
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Infection/fever
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What's an idiopathic seizure?
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A seizure that occurs spontaneously for an unknown reason.
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What is the most common reason for seizures in adults?
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Failure to take seizure-control medication
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What's a febrile seizure?
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A seizure associated with a significant rise in body temperature.
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