emt 22

Hyperglycemia vs hypoglycemia

 hyperglycemia develops over days/weeks, hypo has rapid onset

Hyperglycemia mechanism

glucose levels in the blood creep up while the body’s cells starve from thirst and hunger

Hyperglycemia effects:

water is pulled away from cells, brain cells are damaged from dehydration causing altered mental status

Hyperglycemia symptoms

signs of shock, tachycardia, rapid breathing, and dropping BP, increased urination, nausea

Diabetic ketoacidosis (DKA):

last resort hyperglycemia measure in which cells begin to break down fats and proteins giving off of ketones + other waste products along with dehydration

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)

when ketones play no role in diabetic ketoacidosis—common in older adults undiagnosed w/ T2, same symptoms as DKA accept patients have no breath odor

Glucose meters

used by diabetics to monitor glucose levels at least one a day, helps determine how much insulin they should take and lessens potential diabetic complications emt cannot use them use your own meter

Continuous glucose monitor parts

sensor: placed under the skin, transmitter: sends data from sensor, receiving device: records and displays data

Hypoglycemic blood sugar

below 60mg/dL in a symptomatic diabetic, administer glucose

Hyperglycemic blood sugar:

above 140mg/dL, anything above 300 for prolonged periods is serious

Causes of inaccurate sugar readings

 insufficient blood on testing strip, expired strip, or if meter needs calibration

High/low readings on glucometers

high = 500+, low = below 15

Patient is not awake enough to swallow glucose

focus on securing airway, giving artificial vents if needed, and preparing for possible CPR 

Blood glucose monitoring and any examining should never be done before primary assessment is completely finished

3 differences between hypo/hyperglycemia

hypER has a slower onset, hypO is quicker and may cause seizures, hypER patients have warm, red, dry skin, hypO patients have cold, pale, moist skin, hypER patients have acetone like breath odor, hypO patients don't

Diabetes rule of thumb

“sugar is for everyone” supplemental sugar does not have enough time to harm hyper patients during transport

3 causes of altered mental status:

seizure disorders, stroke, and dizziness or syncope 

Seizures

irregular electrical activity in the brain causing violent muscle contractions (convulsions)

Partial seizures

aka focal motor, focal sensory, or jacksonian seizure. affect one part of the brain and one part of the body, patient does not lose consciousness

Generalized seizures

affect the entire brain and consciousness, characterized by major motor activity

Tonic-clonic seizure

generalized seizure where the patient loses consciousness and has jerking movements

Tonic phase:

first phase, body becomes rigid for 30s max, breath may stop, patient may bite tongue (rare), or loose bowel control 

Clonic phase

body jerks violently 1-2min max, patient may foam at mouth and drool, face becomes cyanotic

Postictal phase

convulsions stop, patient regains consciousness but is confused with headache and unilateral weakness

Aura

sensation experienced right before a seizure may be a smell, sound, or general feeling

Most common cause of seizures (adults and kids):

adults = failure to take anti-seizure meds, infants/kids 6mo-3yrs = high fevers (febrile seizures)

Epilepsy

medical condition that causes seizures from an unknown cause 

Vagus nerve simulator

watch-sized device implanted in the chest with a worse that sends electrical impulses to the left vagus nerve into the neck, can reduce the frequency or intensity of seizures when medications cannot fully control them

Status epilepticus

when a patient has 2+ seizures in a row w/out gaining consciousness or seizes for more than 10min. High priority, life threatening, call ALS maintain airway, give intravenous fluids, and emergency meds

Partial seizures characteristics:

tingling, jerking, or stiffening in just one part of the body, may be an aura, seizure may turn tonic-clonic

Complex partial seizure characteristics:

aka psychomotor or temporal lobe seizure, aura, abnormal behavior, confusion, glassy stare, aimless moving, lip smacking, fidgeting w clothes. Patient is not violent but may struggle if restrained. No loss of consciousness but no memory of seizing

absence seizure

type of general seizure, less than 10s w loss of awareness, kids can have 100s a day but stop before adulthood

Pediatric seizures

high fevers/sudden rises in temp are most common cause. mostly idiopathic seizures (seizures w unknown causes), rarely life threatening

Stroke

aka cerebral vascular accident (CVA) death or injury of brain tissue that is deprived of O2

Stroke causes

blockage of an artery supply the brain w O2, bleeding from a ruptured vessel

Ischemic strokes

obstructive blood clot inside a blood vessel within the brain 

Hemorrhagic strokes

strokes caused by bleeding in the brain, caused by hypertension or weak area of an artery

Aneurysm

rupture of a weakened artery, can cause hemorrhagic strokes where the brain is forced into smaller than normal space within the skull

Signs that stroke occured

hemiparesis (difficulty moving one side of the body), facial drooping, speech difficulty—headaches may signal bleeding from a ruptured vessel

Subarachnoid hemorrhage strokes

particular bleeding from an artery under the arachnoid layer of the meninges

Large vessel obstruction (LVO):

clogs in large arteries in the brain, patients are completely unaware and cannot control body parts 

Transient ischemic attack (TIA)

aka minstroke, patient appears to be having a stroke but symptoms dissolve in 24 hours, small clots temporarily block circulation in the brain due to a short period of hypoxia.

Stroke patient assessment

evaluate face droop, arm drift, and speech

Syncope causes

hypoglycemia, hypovolemia, hypoxia, anything interfering with normal brain function

Cardiovascular syncope

caused by abnormal heart rate, can be an MI sign, pumping issues, or structural problems

Carotid sinus

cardiovascular cause of syncope unrelated to the heart's electrical activity

Vasovagal syncope

aka simple fainting, caused by stimulation of the vagus nerve which signals the heart to slow down can be stimulated through fear or emotional distress (hypovolemic syncope)

Hypovolemia

aka low blood volume, commonly caused by dehydration, internal bleeding or trauma

Structural/metabolic syncope

caused by alterations of brain structure or chemistry (ex, hypoglycemia)

Environmental/toxicologic syncope:

caused by imbalances in the environment/toxins (ex. Alcohol, CNS depressants, CO poisoning, panic attacks)

priority when assessing stroke patients

recognizing the signs of a stroke

transient ischemic attack signs

altered mental status, confused, left-sided weakness, and sudden recovery