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Medical Emergencies

Medical Emergencies. By Dr Hana omer. Diabetic Emergencies. Diabetic Emergencies. Diabetes Type I (insulin-dependent diabetes): Body produces little or no insulin. Type II: Body produces some insulin, but not enough (insulin resistance). Type II DM:. Diabetic Emergencies. Hyperglycemic

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Medical Emergencies

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  1. Medical Emergencies By Dr Hana omer

  2. Diabetic Emergencies

  3. Diabetic Emergencies • Diabetes • Type I (insulin-dependent diabetes): Body produces little or no insulin. • Type II: Body produces some insulin, but not enough (insulin resistance)

  4. Type II DM:

  5. Diabetic Emergencies • Hyperglycemic • HHNC: Hyperosmolar Hyperglycemic Nonketotic Coma • DKA: Diabetic Ketoacidosis • Hypoglycemic • Diabetic Coma or Insulin Reaction

  6. Hyperosmolar Hyperglycemic Nonketotic Coma (HHNC) • Effects Type 2 Diabetics • Prominent later in life • Elevated Blood Glucose with increases serum osmolarity. • This results in Diuresis and Fluid Shift. • Increased Urination causes body wide depletion of Water and Electrolytes (Extreme Dehydration).

  7. Causes: • Hyperglycaemia (Develops slowly) • Causes: 1. Diabetic does not produce enough natural insulin to take sugar out of the blood and into the cells. 2. Patient has not taken enough insulin to make up for this deficiency. 3. Patient has forgotten to take insulin. 4. Patient has an infection that has upset his/her insulin/glucose balance.

  8. Physical Signs Tachycardia Orthostatic Vitals Dry, red, warm skin. Poor Skin Turgor. Drowsiness and lethargy Delirium Coma Symptoms Nausea/vomiting Abdominal pain Polydipsia Polyuria

  9. Treatment: • IV FLUIDS !!!!! • Bolus of Normal Saline will help to reverse the overwhelming dehydration • EMS provides important early intervention • Insulin?

  10. DKA: Diabetic Ketoacidosis • Dereased Insulin or Insulin resistance leads to Elevated Blood Glucose levels. • However, Cellular Glucose is Low without insulin. It is equivalent to Starvation. • As a result the body attempts to Compensate • Uses Glucose stores • Breaks Down Fat and Protein

  11. In an attempt to save the Heart and Brain, the body produces Ketone Bodies from fatty acids • Acetoacetate, Beta-hydroxybutyrate, And Acetone • Excessive Ketones lead to Acidosis.

  12. Physical Signs Altered mental status without evidence of head trauma Tachycardia Tachypnea or hyperventilation (Kussmaul respirations : rapid and shallow respiration ) Normal or low blood pressure Increased capillary refill time Lethargy and weakness Fever Acetone odor of the breath reflecting metabolic acidosis Symptoms Often insidious Fatigue and malaise Nausea/vomiting Abdominal pain Polydipsia : need water . Polyuria : excessive urination . Polyphagia ; excessive drinking . Weight loss Fever

  13. Treatment: • Fluids!!!!! • It is important for EMS to initiate Fluid Resuscitation prior to arrival in the Hospital. • Begin With Normal Saline. • Insulin • This Will Start in the Emergency Dept. • Must Control Electrolyte Problems First.

  14. DKA vs. HHNC • No Difference in Treatment for EMS. • Will Present as Altered Mental Status. • ABC’s. • Supplemental Oxygen. • IV Fluids. • Vitals / Monitor. • Glucometry.

  15. Hypoglycemia • Effects Type 1 & 2 Diabetic • Secondary to Insulin or Oral Hypoglycemic Medication • More Common with Insulin Use • Serum Glucose Levels Fall Below Normal Levels

  16. Causes: • Hypoglycaemia (Develops rapidly) is the most medical emergency for the diabetic. • Causes: • Takes too much insulin, (or less commonly, oral medication used to treat diabetes) • Reduces sugar intake by not eating • Over exercises or overexerts himself, thus using sugars faster than normal. • Vomits a meal, emptying the stomach of sugar as well as other food.

  17. Serum Glucose Levels • Normal: • 70-110 mg/dL • Hypoglycemia: • <50gmg/dL in men • <45 mg/dL in women • <40 mg/dL in infants and children • Protocol: <80 mg/dl

  18. Physical Signs Sweating (cold clammy skin). Tremor Tachycardia Respiratory Distress Vomiting Combative or agitated Coma Symptoms Anxiety Nervousness Confusion Personality changes Nausea Vomiting

  19. Treatment • Patients will present with Altered Mental Status. • ABC’s. • Supplemental Oxygen. • Vitals. • IV Fluids Monitor. • Glucometry • Glucose < 80 mg/dL, Considered Hypoglycemia by ALS Protocol

  20. Treatment • Glucose Supplementation • Oral Glucose • Juice, Non- Diet Soda & Oral Glucose Solution • Glucagon • Naturally Occurring Hormone, From Pancreas Alpha-Cells • Breaks Down Stored Glycogen to Glucose • 1U = 1mg Given IM/SC

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