20/03/2024
Diabetic Emergency /Altered Mental Status🚨 🚑
A MUST READ
ALTERED MENTAL STATUS
A term used to describe a wide range of abnormal responsiveness, clarity of thought, or mood that ranges from UNCONSCIOUSNESS to slight ANXIETY.
These changed mental states can result
from damage to the brain 🧠 {traumatic brain injury}, chemical changes to the brain {caused by toxin} or metabolic changes to the brain {caused by lack of oxygen or glucose}
Regardless of the cause, altered mental status, represents a change in the way the brain is functioning.
However,, altered mental status can only be a sign of a life threatening condition. It shoukd be done in all patients, not to differentiate acute changes alone, but also to identify subtle indicators of life threatening underlying problems.
Normal consciousness is regulated by a series of neurologic circuits in the brain that comprises the reticular activating system RAS
RAS is responsible for staying awake, paying attention and sleeping. Keeping a person Alert & Oriented.
Stable mental status has AVPU as the acronym for
📍Alert - Responding with appropriate words to another person
📍 Verbal- Opening eyes 👀 to voice sounds
📍 Painful- Opening eyes 👀 to unpleasant sensation
📍 Unresponsive - Patient does nit respond at all. Although not precise.
✔️Glucose & Diabetes Evaluation
Glucose, a form of sugar, is the body's only source of energy. The cells require glucose to remain alive & ceeate energy.
We take sugars into oue body drom the food we eat it, that the digestive system converts & are absorbed into the bloodstream Glucose has large molecules that will not pass into most of the cells without the help of INSULIN.... is produced by a specialized cells in the Pancreas called "Islet of Langerhans"
The pancreas secretes Insulin when the the bloos glucose is rises above 90mg/dL. Insulin binds to receptor siteson the cells, especially cells in the Liver & Muscles 💪 allowing for passage into them.
✔️ Patients who are Diabetic do not
📍 Produce Insulin
📍 Don't produce enough Insulin
📍 Have a body that have becone resistant to the insulin that is produced.
✔️ Diabetes Mellitus
👇🏾
Results either from an underproduction of Insulin by the Pancreas, or from an inability of the body cells to use Insulin properly.
Diabetes are of two types
📍 Type 1 - occurs when pancreatic cells fail to function properly, and Insulin not secreted normally. Simply does not have enough Insulin to transfer circulating glucose into the cells.
If left untreated, glucose level will build up in the blood, while the cells starve of SUGAR.... Treated with synthetic Insulin to augment the inadequacy.
📍Type 2- occurs when the vody fails to use Insulin properly. The pancreas may be secreting enough Insulin, but the body is unable to use it to move glucose out of rhw blood into the cells... This type ia controlled by Dietary regulation and or oral anti-diabetic medicines.
DIABETIC EMERGENCIES 🚑 🚨
The most common emergency for the diabetic is HYPOGLYCEMIA.. Low Sugar
Can happen when 👇🏾
📍 Patient take too much Insulin, or takes too much of oral medication used to treat diabetes.
📍 Reduces sugar intake
📍 Over exercises, using the sugar faster than normal
📍 Vomits a meal emptying the stomach od sugars
📍 Increases metabolic raye in e.g whike having fever/shivering.
When blood sugar is reduced, brain & other cells starve. Even whe the cause is too much Insulin, the rapid uptake of sugars into the cells soon depletes the available supply in tbe blood. Altered mental status, unconscious and permanent brain damage can occur quickly if thw sugar is not replenished.
✔️ The brain 🧠 DO NOT TOLERATE low levels of sugar..This make hypoglycemia have a very rapid onset.
The body responds to it by a FIGHT or FLIGHT... Where the sympathetic nervous system signals the liver to release excess glucose stored as GLYCOGEN back into the blood, tonraise the blood glucose level.
Signs
Paleness
Sweaty skin
Tachycardia... Rapid breathing
Seizures can also occur from altered brain 🧠 Hypoglycemia is treated with ingesting oral glucose before patients becomes unconscious.
✔️ HYPERGLYCEMIA is high blood sugar. More than normal sugar in the blood stream.. Usually caused by a decrease in Insulin, which leaves sugar in the blood stream rather than helping to get into the cells. The Insulin deficiency may be due to body's inability to produce insulin or injection 💉 wwre forgotten or not in sufficient quantity.
Infection
Stress
Increasing food 🍲 intake, arw all factors in hyperglycemia.
Dwvelops ovee days, weeks, not as rapid as hypoglycemia.
📌 You can read 📖 further on Diabetic Ketoacidosis {DKA}
Treatment depends on rapid identification of a patient with an altered mental status. History
PS: It is not the job of an EMT Paramedic to determine exactly which condition has causesa diabetic emergency.
✔️ Blood Glucose Meters
Advancement in managing diabetes has been seen in the portable reliable blood glucose meters.
People with diabetes now routinely test the level of glucose in their blood, at least once a day and sometimes, often as five times a day.
By knowing the level, they can determine precisely, how much Insulin rhey should take and how often they eat.
Reducing the possibility od heart disease, kidney failure, blindness...
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