Ems 2018 treatment protocol book version 1 30 day public comment period may 24, 2018 to june 24, 2018. Jon is the owner of jon puryear ems ce, performing online live streaming and recorded ems ce classes and refreshers. First aid for diabetic emergencies first aid for free. A patient is termed diabetic with a fasting blood glucose of greater than 125 mgdl. There is always some osmotic pressure between these sides. You arrive to find a 67yearold woman sitting upright in a chair. These two lifethreatening hyperglycemic emergencies are well known conditions now. Discuss the pathophysiology, assessment, and emergency medical care of hhns slides 4852. Some ems services do administer nahco3 in the field, either 50 meq push or mixed in 1 liter of 0. High blood sugar, or hyperglycemia, is a major concern, and can affect people with both type 1 and type 2 diabetes.
The two primary emergencies that can arise in diabetic patients are very high and very low blood sugar. Hyperglycemia is defined as blood glucose levels greater than 200 mgdl. By xstreetsweeperx, november 24, 2011 in education and training. Although elevated blood glucose is not a medical emergency in and of itself, elevated bgl in the setting of ketoacidosis is. Diabetes for ems providers diabetes mellitus insulin. If possible, have the victim test the glucose level to correctly identify hypoglycemia or hyperglycemia. Paramedics and educators buck feris and steve cole contributed an excellent article about hyperglycemia in acutely ill patients to the centrelearn blog. While anyone can experience hypoglycemia, it is most common in patients who have been diagnosed with diabetes and whose natural insulin. Ems 2018 treatment protocol book version 1 30 day public. Alabama ems patient care protocols, sixth edition, june 2011 6 3. When hypoglycemia is suspected, notify ems immediately.
For courses in paramedic emergency medical services a strong, evidencebased foundation in the principles and practices of modern ems paramedic care. Suite 200 santa fe springs, ca 90670 562 3781500 562 9415835 fax email. Ems field treatment guidelines san mateo county health. The live online classes are taught in a virtual instructorled online live. Describe the primary differences between dka and hyperglycemic hyperosmolar nonketotic syndrome hhns slides 43, 48, 50. High blood sugar cray diabetes selfmanagement center glucose sugar in your blood is used for energy for all parts of your body. Diabetes has reached epidemic proportions in the us. The use or possession of the protocol book does not exempt field personnel from the responsibility to know the information in the san mateo county policy and procedures manual.
You are called to a local house for a woman with trouble breathing. Glucose should be monitored carefully throughout at least q1hr or more frequently. Oxyhyperglycemia is a special type of impaired glucose tolerance characterized by a rapid and transient hyperglycemia i. This post will give prospective students a head start on their emergency medical technician emt education and and give practicing healthcare workers a brush up on basic medical terminology. When dosing insulin in an acute care setting, its always. Emt basic orange book chapter 17 flashcards quizlet. Hyperglycemia is present whenever blood glucose levels rise above 250 mgdl.
Learning basic medical terminology can be an overwhelming and depressing aspect of beginning emt training or any medical training. Good patient outcomes require a skilled assessment of the airway, breathing and oxygenation. Blood sugar control is at the center of any diabetes treatment plan. San mateo county ems agency ems agency is the designated local authority for emt certification and paramedic local accreditation.
Your guide to collecting, analyzing and acting upon ems data the smarter way ebook. Treatments should be titrated to achieve a safe glucose level e. Ems providers should always consider dka in the differential in diabetic patients, particularly type 1 diabetes who present with hyperglycemia. The majority of patients for whom ems is called for hypoglycemia will require parenteral therapy, since attempts by family or others to resuscitate the patient with oral sugar are either impossible due to altered level of consciousness or have not produced a satisfactory result. This video is geared to help you build your ems paramedic knowledge and. Time series modelling to forecast prehospital ems demand. Hyperglycemic hyperosmolar nonketotic syndrome hhns is an emergency that the diabetes mellitus dm patient may. Ems is likely to encounter two types of diabetic emergencies. Hyperosmolarity describes a state of increased osmotic pressure. Ems providers frequently assess geriatric patients with altered mental status. The field of inpatient management of diabetes and hyperglycemia has grown substantially in the last several years. Acute diabetic emergencies are often managed by prehospital emergency medical services ems. Managing diabetes and hyperglycemia in the hospital.
This book is distributed under the terms of the creative commons. The use or possession of the protocol book does not exempt field personnel from the responsibility to. Currently, nearly 29 million americans have diabetes, with about 11% of those with type 2 diabetes being undiagnosed. Diabetic ketoacidosis dka and hyperglycemic hyperosmolar state hhs are hyperglycemic emergencies that. As such, they are designed to provide a resource to clinical practice and to maximize patient care, safety. Hyperglycemia in diabetes diagnosis and treatment mayo clinic. The aims of this study were to model the temporal trends and provide forecasts of prehospital attendances for diabetic emergencies. Verify, run some fluids if there were no contraindications, transport. Hyperglycemia is the major risk factor for microvascular complications 6, and reduction in chronic exposure to high glucose levels, indicated by glycated hemoglobin hba1c, decreases the incidence of nephropathy, retinopathy, and neuropathy 7. However, we now know that children with type 2 diabetes may also present with dka 1,2. More recently, hyperosmolar hyperglycemic syndrome hhs has also been reported in children with type 2 diabetes. Yes, it can be controversial not knowing the abgph yet some ems units do have abg units on them as well. In first aid, it is important to be able to recognize the warning signs of both low and high blood sugar levels.
People with dka and hhs are best managed in an intensive care unit or stepdown setting 1,31,32 with specialist care 39,40. No pediatric nausea protocol the addition of a pediatric nausea protocol. First aiddiabetes wikibooks, open books for an open world. Osmotic pressure refers to the amount of pull fluids experience between the two sides of a semipermeable membrane. Acute hyperglycemic emergencies in children with type 2. Optimally, these emergeny states can be avoided by proper education of the diabetic patients at the time of.
Enter your mobile number or email address below and well send you a link to download the free kindle app. Please see the appropriate section below for information on licensure and accreditation in san mateo county. Developed to stay ahead of current trends and practices, all five volumes are based on. Protocols and insulin management software systems 41 may be beneficial 42,43, but there can be challenges with achieving adherence 44,45. Basic medical terminology for the emt emt training base.
Hyperglycemia, diabetes and vascular disease clinical. Hyperglycemia signs and symptoms blurry vision headache increased thirst fatigue increased urination dry mouth large amounts of glucose in blood or urine treatment for reactions check blood glucose level check urine or blood for ketones. Management of hyperglycemia and diabetes in the emergency. Volume status including fluid intake and output, vital signs. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Diabetic emergencies hyperglycemia dka ems quick study. Ems agencies, but to unify multiple sources of information in a single.
Hyperglycemia, diabetes and vascular disease is based on a 1989 faseb symposium offered by the american physiological society, and is a volume in the societys clinical physiology series. This body of knowledge is summarized in this book, so it can reach the audience of hospitalists, endocrinologists, nurses and other team members who take care of hospitalized patients with diabetes and hyperglycemia. Upon arrival you find a 25yearold male lying on the bed. Pt had no hx of brain bleed, on coumadin, and last known normal was 2 hours pta.
Your unit has responded to a general sickness call. It is the responsibility of each ems provider to be familiar with all of the maryland medical protocols for ems providers. Diabetes for ems providers free download as powerpoint presentation. Hypoglycemia is most dangerous among intubated and sedated patients, because mental status changes wont be immediately evident. Both diabetic ketoacidosis and hyperglycemic hyperosmolar state are serious hyperglycemic emergencies and must be treated promptly and effectively. The focus of these guidelines is solely patientcentric. In medical terms, high blood sugar is called hyperglycemia, low blood sugar is called hypoglycemia.
The complexity of the question that led to this article gave me hope that there are paramedics that desire more knowledge, rather than paramedics that decline new knowledge. Webmd explains the causes, symptoms, and treatment of hypoglycemia, or low blood sugar, a common problem in people with diabetes. The pt was weak on the entire right side of her body with minor right facial paralysis. Compare and contrast the speed of onset and the signs and symptoms of hypoglycemia and hyperglycemia slides 34, 45. Ems personnel should familiarize themselves with insulin pumps and their characteristics. Prolonged severe hypoglycemia can cause permanent brain damage, similar to anoxic brain injury. Not long ago, diabetic ketoacidosis dka was thought to be pathognomonic of type 1 diabetes in children. I routinely will call medical control and get an order for a bicarb drip.
The nasemso national model ems clinical guidelines are not mandatory nor are they meant to be allinclusive or to determine local scope of practice. Overall, hypoglycemia is far more dangerous than hyperglycemia. Hyperglycemia in the emergency department ed is being recognized as a public health problem and presents a clinical challenge. This session of the monday minutes focuses on dka or diabetic ketoacidosis.
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