hypoglycemia emt patient care report

Can prehospital identification and treatment of severe hypoglycemia improve patient outcomes?

Since prehospital identification and treatment of severe hypoglycemia can improve patient outcomes and conserve healthcare resources by potentially reducing the need for transport to the emergency department, 12 review of prehospital hypoglycemia management is worthy of attention.

How do you treat hypoglycemia in a patient with enteral access?

treatment- mild hypoglycemia & able to take PO (back to contents) If hypoglycemia is mild and patient is able to take PO intake, provide oral carbohydrate (e.g. juice). For intubated patients with enteral access, this may be provided via orogastric tube.

How is hypoglycemia treated in patients with hepatic failure?

Patients with cirrhosis or acute hepatic failure tend to develop hypoglycemia, so monitor their glucose levels and avoid giving them insulin. Some patients with severe hepatic failure will require a continuous dextrose infusion to avoid hypoglycemia.

Can hypoglycemia be treated at the scene?

While some studies have indicated that most cases of hypoglycemia can be successfully treated at the scene, conflicting results have been reported in other cases with complications days later [5].

How does an EMT treat hypoglycemia?

Hypoglycemia is somewhat unique among prehospital emergencies because it has multiple EMT treatment options, including: Encouraging the patient to eat his or her own food. Administering the patient oral glucose. Monitoring the patient's airway and breathing while waiting for paramedics to arrive.

How do you assess a patient with hypoglycemia?

If you have signs or symptoms of low blood sugar, check your blood sugar level with a blood glucose meter — a small device that measures and displays your blood sugar level. You have hypoglycemia when your blood sugar level drops below 70 mg/dL (3.9 mmol/L ).

What should a nurse do when a patient has hypoglycemia?

Severe hypoglycemia can be treated with intravenous (IV) dextrose followed by infusion of glucose. For conscious patients able to take oral (PO) medications, readily absorbable carbohydrate sources (such as fruit juice) should be given.

How do EMTs treat hyperglycemia patients?

Treatment usually includes: Fluid replacement. You'll receive fluids — usually through a vein (intravenously) — until you're rehydrated. The fluids replace those you've lost through excessive urination, as well as help dilute the excess sugar in your blood.

When and how do nurses correct hypoglycemia?

Treatment is glucose (modality will vary based on blood glucose level, alertness of patient, and facility protocol) 15 g carbohydrate is equal to 4 oz juice, 8 oz skim milk, or 6 saltine crackers. Recheck blood sugar after 15 minutes and repeat as necessary.

What 6 things should you look for to identify hypoglycaemia?

If blood sugar levels become too low, hypoglycemia signs and symptoms can include:Looking pale.Shakiness.Sweating.Headache.Hunger or nausea.An irregular or fast heartbeat.Fatigue.Irritability or anxiety.More items...•

What are nursing interventions for hyperglycemia?

Emergency Treatment for Severe Hyperglycemia.Replacement of fluids. The patient will be given fluids — usually intravenously — until rehydration. ... Replacement of electrolytes. Electrolytes are minerals in the blood that the tissues require to function effectively. ... Insulin administration.

What is the first aid for hyperglycemia?

When your blood sugar level gets too high — known as hyperglycemia or high blood glucose — the quickest way to reduce it is to take fast-acting insulin.

How do you treat an unconscious patient with hypoglycemia?

If the person is unconscious, having seizures, or too disoriented to swallowLocate a glucagon emergency kit or glucagon nasal powder, if it's available. ... Administer the glucagon emergency kit or glucagon nasal powder. ... Turn the person on their side. ... Call 911 or your local number for emergency medical services.More items...•

How is hypoglycemia confirmed in an emergency?

Hypoglycemia is a medical emergency that must be treated immediately. An initial blood glucose reading may confirm suspicion of hypoglycemia. If the patient is alert and has a gag reflex–a good rule of thumb is if the patient can hold a glass of juice or a candy bar on their own–glucose can be administered orally.

What are the 3 P's of hyperglycemia?

The main symptoms of diabetes are described as the three polys - polyuria, polydipsia, and polyphagia.

What do you do in a diabetic emergency?

The ​​​​American Diabetes Association (ADA) recommends the following amounts: Eat 15 grams of fast-acting carbs (3-4 glucose tablets or gels, 4 ounces of fruit juice or regular soda, or a tablespoon of honey or sugar) and wait 15 minutes. Test the blood sugar to see if levels are normal –– if not, repeat this step.

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What is the NAEMSP?

The National Association of EMS Physicians (NAEMSP) is an organization of physicians and other professionals partnering to provide leadership and foster excellence in the subspecialty of EMS medicine. The NAEMSP promotes meetings, publications and products that connect, serve and educate its members, and acts as an advocate of EMS-related decisions in cooperation with organizations throughout the country.

How much dextrose is in a patent airway?

In a nutshell, a conscious patient with a patent airway can obtain oral glucose, with adults receiving approximately 25 grams of dextrose (at a concentration of 10 to 50 percent) and pediatric patients receiving 0.5-1g/kg (at a concentration of 10 to 25 percent).

When is a patient in need of transport?

Patient is in need of transport if hypoglycemic symptoms continue or if patient had a seizure at any point during the episode. Release without transport should only be considered if patient meets all of the following: Repeat glucose measurement over than 80mg/dL. Patient takes insulin or metformin to control diabetes.

Is there variability in EMS protocol?

A clear cause of the hypoglycemia is identified (e.g. skipped meal). Regardless of national EMS guidelines established for hypo glycemia, there is still variability in EMS protocols throughout the U.S. [10-12]. Further studies are required to determine the reasons underlying these variations and patient outcome.

Is 80 years old a high risk for hospitalization?

As reported by NEISS-CADES, patients over 80 years old have a higher risk of being hospitalized due to hypoglycemic events, since neuroglycopenic symptoms can mimic other cardiovascular and neurologic conditions.

Can a patient eat carbohydrate after receiving glucose?

Patient returns to normal mental status, with no focal neurologic signs or symptoms after receiving glucose/dextrose. Patient can promptly obtain and will eat a carbohydrate meal. Patient or legal guardian refuses transport and EMS providers agree transport not indicated. A reliable adult will be staying with patient.

What causes altered mental status in patients?

Despite the high prevalence of alcohol usage in young adults, estimated at approximately 57% of those aged 18 to 25, 1 hypoglycemia is one of the most common causes of altered mental status in the prehospital setting. 2 It is most often a complication of medications used to treat diabetes mellitus (“diabetes”); hypoglycemia may also occur acutely in the setting of reduced food intake in non-diabetics, and other less common causes include alcohol consumption, critical illnesses such as organ failure or sepsis, hormone deficiency, nonislet cell tumors, and endogenous hyperinsulinism. 3 Concern for hypoglycemic emergencies is increasingly relevant – the prevalence of diabetes continues to increase globally 4 and, as of 2015, the prevalence of diabetes in the United States in the 18-44 age group is estimated at 2.6%. 5

What is considered hypoglycemia?

Hypoglycemia is defined as a blood glucose measurement below 70 mg/dL by the American Diabetes Association (ADA) 9 and below 60 mg/dL in NASEMSO’s National Model EMS Clinical Guidelines. 13 Severe hypoglycemia refers to a hypoglycemic event that a patient is unable to self-treat without assistance. 18 A patient’s ability to detect the onset of a hypoglycemic episode by identifying the presence of symptoms, rather than obtaining a low blood glucose measurement, is referred to as hypoglycemic awareness. Impairment of this awareness – also referred to as hypoglycemia-associated autonomic failure 8 – results from deficiencies in counter-regulatory mechanisms, thereby compromising a patient’s ability to identify and treat early hypoglycemia before it progresses to a severe episode. 19

What happens after dextrose is administered?

After treatment has been administered, reassessment of the patient’s vital signs and mental status is essential . National clinical guidelines suggest that repeat blood glucose monitoring should be performed if hypoglycemia and altered mental status persist but is not needed if mental status has returned to normal. If a maximal field dosage of dextrose solution has been administered and the patient does not achieve normal blood glucose levels and mental status, transport to an appropriate facility should be initiated while alternative causes of altered mental status are investigated. 13

What is the best treatment for hypoglycemic patients?

For a patient confirmed to be hypoglycemic, several options for prehospital treatment exist: oral glucose, intravenous (IV) or intraosseous (IO) dextrose, and intramuscular (IM) or intranasal (IN) glucagon.

How does glucagon work?

Glucagon, secreted by alpha cells, works to increase the concentration of glucose in the blood by stimulating the liver to break down stored glycogen and activate gluconeogenesis, the process by which the body synthesizes glucose from organic molecules. Figure 1. Basic physiological process of glucose regulation.

What is the purpose of the guidelines?

The Guidelines – based on the best available evidence and expert consensus, in the absence of sufficient evidence – provide a standardized model set of guidelines for patient care that can be adapted for use by leadership at the state, regional, or local level.

How does the pancreas react to blood glucose?

In healthy individuals, endocrine tissue in the pancreas reacts to variations in blood glucose by adjusting secretion of the regulatory peptide hormones insulin and glucagon. Insulin, secreted by beta cells, decreases blood glucose levels by inducing cells in various tissues to increase their glucose uptake.

What Is a Patient Care Report?

We often hear of care reports based on by medical teams or by medical authorities. Yet, we are not sure how this differs from the kind of report that is given to us by the same people. So this is the time to make it as clear as possible.

How to Write a Patient Care Report?

Where do you even begin when you write a patient care report? A lot of EMS or EMTs do know how to write one since they are trained to do so.

What is a patient care report?

A patient care report is a document made mostly by the EMS or EMTs. This documented report is done after getting the call. This consists of the information necessary for the assessment and evaluation of a patient’s care.

What should not be written in a patient care report?

What should be avoided in a patient care report is making up the information that is not true to the patient. This is why you have to be very careful and very meticulous when writing these kinds of reports. Every detail counts.

Who is in charge of reading the patient care report?

The person or the people who will be reading the report are mostly medical authorities. When you are going to be passing this kind of report, make sure that you have all the information correctly. One wrong information can cause a lot of issues and problems.

Introduction

National Model Guidelines

Clinical Definitions & Mechanisms

• Hypoglycemia is defined as a blood glucose measurement below 70 mg/dL by the American Diabetes Association (ADA)9 and below 60 mg/dL in NASEMSO’s National Model EMS Clinical Guidelines.13 Severe hypoglycemia refers to a hypoglycemic event that a patient is unable to self-treat without assistance.18 A patient’s ability to detect the onset of a hypog...

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Clinical Presentation & Assessment

Guidelines For Treatment

Reassessment & Transport

Conclusions