Altered Mental Status

1. Altered Mental Status Diabetes

2. Altered Mental Status A significant indication of illness or injury in a patient Central nervous system affected in some manor Causes Trauma Altered blood sugar levels Altered oxygen levels

3. Scene Size-Up/Unknown History Dispatch information Scan the scene Patient Bystanders Look for clues as you approach patient Alcohol bottles Drug paraphernalia Home oxygen tanks Chemicals Patient�s medications

4. Look in refrigerator for insulin More than one one patient suspect hazardous gas Scene Size-Up/Unknown History Cont..

5. Initial Assessment Ensure airway Prepare to suction Ensure adequate breathing with NR or positive pressure using Big O�s All patients with altered mental status must receive high flow oxygen therapy

6. Focused History & Physical Exam Have partner get baseline vital signs Gather info from patient, relatives, or bystanders (SAMPLE) If possible, use patient as main historian Assess all areas for any DCAPBTLS if patient is unresponsive

7. Signs & Symptoms/Trauma Obvious DCAPBTLS Abnormal respiratory pattern Tachycardia or bradycardia Unequal pupils Hypertension or hypotension Discoloration around eyes or behind ears Pale, cool, moist skin Posturing

8. Abnormal respiratory pattern Dry or moist skin Cool or hot skin Pinpoint, mid-size, dilated, or unequal pupils Stiff neck Lacerations to tongue (seizure activity) Hypertension and bradycardia Loss of bowel or bladder control Signs & Symptoms/Medical

9. Emergency Care Maintain spinal stabilization Ensure patent airway Suction if necessary Big O�s Be prepared to assist ventilations Position patient Left lateral recumbent Rotate spine board Transport Perform ongoing assessment

10. Causes of Altered Mental Status Shock Poisoning or overdose Postictal seizure Infection Traumatic head injury Decreased oxygen levels Alcohol intoxication Stroke (Brain attack) Diabetes

11. Diabetes Mellitus Altered relationship between glucose and insulin Lock and key system Insulin - hormone secreted by the pancreas Glucose - simple sugar, body�s main source of energy

12. Type I Diabetes Mellitus Develops in childhood Cannot produce insulin Must take injections daily

13. Type II Diabetes Mellitus Developed in adulthood Some insulin secreted Controlled by diet, exercise, oral medications, or insulin

14. Assessment Scene size-up Initial Assessment Look for medical alert tags Focused history & physical exam SAMPLE History Ongoing assessment Remember oral glucose may not take affect for about 20 minutes.

15. Medications Often Taken Insulin Diabanese Orinases Micronase Glynase

16. Signs & Symptoms Rapid onset of altered mental status Intoxicated appearance Tachycardia Cool moist skin Hunger Seizure activity Bizarre behavior, combativeness Anxiousness and restlessness Bruising on the abdomen Signs and symptoms that mimic stroke (elderly)

17. Oral Glucose Intsta - glucose (Trade name) Indications Altered mental status History of diabetes controlled by medication Ability to swallow Contraindications Unresponsive or unable to swallow Form - gel Actions - increases sugar levels in the blood Dosage - one tube but not all at once Side affects - none

18. Hypoglycemia/ Insulin Shock Too much insulin and not enough food eaten that can be converted to sugar Sugar moves rapidly out of the bloodstream and into the sugar storing cells Results in not enough sugar to be utilized by the brain

19. Causes of Hypoglycemia Patient took insulin and skipped a meal Took insulin, ate and vomited Took too much insulin Took insulin, ate, and over exercised Change in dose or diet

20. Signs & Symptoms Rapid onset of altered mental status Intoxicated appearance Tachycardia Cool moist skin Hunger Seizures Bizarre or combative behavior Anxiousness or restlessness Weakness or paralysis that mimic stroke (elderly patients)

21. Hyperglycemia/DKA Not enough insulin to help sugar molecules move into cells Lack of sugar forces fats to be used as primary source of energy By products of fat are strong organic acids called ketones Excessive urination and dehydration caused by sugar from blood spilling into urine.

22. Signs & Symptoms Slow onset (as long as 12 to 48 hrs.) Nausea & vomiting Fruity odor on breath Warm and dry skin May have fever and abdominal pain Coma

23. Causes Infection Patient discovers for the first time that they are a diabetic Inadequate dose Steroids Physical stress (pregnancy, surgery) Change in diet, overeaten, increased sugar intake

24. Hyperosmolar Hyperglycemic Nonketonic Coma (HHNC) May see in patients over 60 yrs. Old Produce and secrete small amounts of insulin Prevents ketone formation but is not adequate enough to reduce blood sugar levels Causes frequent urination and dehydration Severe dehydration leads to altered mental status and commonly coma

25. Determination You are not expected to determine hyperglycemia from hypoglycemia. If unsure, give glucose Hypoglycemia is the worst of the two conditions

26. Trick of the Trade Warm and dry, sugar high. Cool and clammy, give them candy

27. Emergency Care Ensure airway Determine if patient is alert enough to swallow Administer oral glucose Transport (Lateral recumbent)