Читать книгу Emergency Medical Services - Группа авторов - Страница 443

The initial evaluation of a diabetic emergency starts with the public safety answering point telecommunicator when 9‐1‐1 is notified. Important information may be obtained while the response unit is dispatched. Treatment may begin with prearrival instructions. The telecommunicator can often identify a diabetic‐triggered event, despite challenges of obtaining medical information during a 9‐1‐1 call [7]. However, medical oversight is vital to ensure quality within the interrogation protocols and that prearrival instructions are appropriately given (see Chapter 88).

Once EMS personnel arrive, scene safety is a priority, given that patients experiencing diabetic emergencies may have altered mental status and act in unpredictable ways. While some calls for diabetic emergencies may specify the exact condition, such as hypoglycemia, many patients will have nonspecific complaints such as nausea, vomiting, dizziness, or abdominal pain, requiring EMS clinicians to gather information to determine the cause of the illness.

Table 20.1 Key elements in the prehospital assessment of diabetic emergencies

Evaluation of ABCs and level of consciousnessABCs (airway, breathing, circulation)AVPU scale (alert, verbal, painful, unresponsive)Vital signsGlucose checkHistoryPast medical history, diabetes mellitus?Recent illness or injuryPregnancyPrecipitating factorsPhysical examinationGeneral impressionFocused examination

As with any other patient presentation, EMS clinicians should obtain a thorough history, review all medications, and conduct a comprehensive physical examination. (Table 20.1) A patient experiencing a diabetic emergency should be placed on a cardiac monitor, if available, due to the possibility of electrolyte disturbances. The history is particularly important, as gathered information may focus treatment plans, especially in patients with altered mental status. Key elements in the assessment of a patient with altered mental status should include 1) a medical history, especially history of diabetes; 2) medications; 3) onset of symptoms; 4) complete set of vital signs; and 5) measurement of glucose. A diabetic patient may receive insulin through a subcutaneous insulin pump, which allows insulin to be absorbed gradually. A physical exam is important, as this device may be hidden from view during the initial assessment. Insulin pumps administer rapid‐acting insulin that is provided around the clock at a specific rate. Increased exercise, illness, or decreased food intake may promote hypoglycemic episodes. These devices may be removed in hypoglycemic patients, and local EMS protocols should provide guidance in this regard.