Hypo or Hyperglycemia: Difference between revisions

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===5.10 HYPO / HYPERGLYCEMIA===
===5.10 HYPO / HYPERGLYCEMIA===


[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01): Provide [[Medical Gases|OXYGEN]] or assist ventilations as appropriate for patient condition.
[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE (2.01)]]: Open the airway, provide OXYGEN or assist ventilations as appropriate for patient condition.
* Obtain history of time of patient's last medication dosage and patient's last meal.
* Obtain history of time of patient's last medication dosage and patient's last meal.
* Obtain and record blood sugar level.
* Obtain and record blood sugar level.
* Draw blood tubes, if available.




====BLOOD SUGAR < 100 OR SIGNS AND SYMPTOMS OF INSULIN SHOCK / HYPOGLYCEMIA:====
'''BLOOD GLUCOSE LEVEL < 100 OR SIGNS & SYMPTOMS OF INSULIN SHOCK / HYPOGLYCEMIA:'''
* If patient awake with intact gag reflex, administer GLUCOSE GEL up to 30 grams orally.
* If patient awake with an intact gag reflex, administer GLUCOSE GEL up to 30 grams orally.
* If NO response or if patient exhibits ALTERED MENTAL STATUS (5.03):  
* If NO response or if patient exhibits ALTERED MENTAL STATUS (5.03):
**[[Antidiabetics|DEXTROSE 50%]] 25 gm IVP for adults
** Administer [[Antidiabetics|DEXTROSE 50%]] (25gm) IVP for adults through a large patent IV line. Monitor closely for signs of infiltration.
** For pediatric administration dilute [[Antidiabetics|DEXTROSE 50%]] to [[Antidiabetics|DEXTROSE 25%]] and refer to Broselow Tape.
*** If [[Antidiabetics|DEXTROSE 50%]] (25gm) is not available or if the patient has poor venous access, is elderly or frail and/or where high concentration dextrose (D50W) could cause phlebitis or injury;
** If unable to obtain IV access, [[Antidiabetics|GLUCAGON]] 1 mg IM or IN. / If patient is between 10 kg (22lb) - 20 Kg (44lb) .5 mg IM or IN. Call for dosage order in pediatrics < 10 kg (22lb). [[Antidiabetics|GLUCAGON]] onset in 8-10 minutes.
**** Administer [[Antidiabetics|Dextrose 10%]] (D10) mixed in a 250 ml bag of solution IV Bolus.
* If LIMITED or NO response after initial [[Antidiabetics|DEXTROSE 50%]]:
***** The entire contents of this bag equal 25 gms of glucose.
**Repeat [[Antidiabetics|DEXTROSE 50%]] 12.5 gm IVP for adults.
***** Administer the entire bag or as much as possible while transporting.
** For pediatric administration dilute [[Antidiabetics|DEXTROSE 50%]] to [[Antidiabetics|DEXTROSE 25%]] and refer to
***** Do not wait on scene for a response. Begin transport immediately.
Broselow Tape.
** For pediatric administration dilute [[Antidiabetics|DEXTROSE 50%]] to [[Antidiabetics|DEXTROSE 25%]] if available and refer to Broselow® Tape.
* If the patient is a Trauma patient or a Stroke is suspected: Consider administration of ½ dose of D50 following Blood Sugar monitoring.
*** If [[Antidiabetics|DEXTROSE 50%]] (25gm) is not available then administer [[Antidiabetics|Dextrose 10%]]% mixed in 250 ml bag (1gm/10ml) of solution to deliver an amount as per the total grams indicated on the Broselow® tape (0.5 gm/Kg).
** If unable to obtain IV access, [[Antidiabetics|GLUCAGON]] 1 mg IM or IN.
*** If patient is between 10 kg (22lb) - 20 Kg (44lb) .5 mg IM or IN.
*** Call for dosage order in pediatrics < 10 kg (22lb).
*** [[Antidiabetics|GLUCAGON]] onset of action in 8-10 minutes.
* If LIMITED or NO response after initial [[Antidiabetics|DEXTROSE 50%]] only:
** [[Antidiabetics|DEXTROSE 50%]] 12.5 gm IVP for adults if available.
** For pediatric administration dilute [[Antidiabetics|DEXTROSE 50%]] to [[Antidiabetics|DEXTROSE 25%]] if available and refer to Broselow® Tape.
* If the patient is a trauma patient or a stroke is suspected: Consider administration of HALF (½) initial dose of D50 or D10 following blood sugar monitoring.




====BLOOD SUGAR LEVEL > 250 WITH SIGNS AND SYMPTOMS OF HYPERGLYCEMIA / KETOACIDOSIS:====
'''BLOOD GLUCOSE LEVEL > 250 WITH SIGNS & SYMPTOMS OF HYPERGLYCEMIA / KETOACIDOSIS:'''
* Administer a fluid bolus of 200 - 300 ml. Continue IV infusion KVO.
* Administer a fluid bolus of NaCl 200 - 300 ml. Continue IV infusion KVO.




====PATIENT REFUSALS====
'''PATIENT TREATED AND RELEASED'''
If a patient has been treated for hypoglycemia or seizures, transport is not required if:
If a patient has a KNOWN history of Diabetes or Hypoglycemia that has been evaluated by a physician and EMS personnel provided treatment for the hypoglycemia, transport is not required if:
* The patient is stable
* The patient’s blood glucose is stable;
AND
:'''AND'''
* The patient has a competent adult that will remain with the patient for hours
* The patient has a competent adult that will remain with the patient for hours;
AND
:'''AND'''
* The patient understands and agrees to eat, re-check blood sugar and call back if necessary.
* The patient understands and agrees to eat, re-check blood glucose and call back if necessary;
 
:'''AND'''
[[Category:Medical]]
* The patient was not placed on a D10 glucose infusion. ALL PATIENTS being treated with a D10 glucose infusion SHALL be transported to the hospital.

Revision as of 13:46, 18 March 2013

Section 5 -MEDICAL

5.10 HYPO / HYPERGLYCEMIA

INITIAL MEDICAL CARE (2.01): Open the airway, provide OXYGEN or assist ventilations as appropriate for patient condition.

  • Obtain history of time of patient's last medication dosage and patient's last meal.
  • Obtain and record blood sugar level.


BLOOD GLUCOSE LEVEL < 100 OR SIGNS & SYMPTOMS OF INSULIN SHOCK / HYPOGLYCEMIA:

  • If patient awake with an intact gag reflex, administer GLUCOSE GEL up to 30 grams orally.
  • If NO response or if patient exhibits ALTERED MENTAL STATUS (5.03):
    • Administer DEXTROSE 50% (25gm) IVP for adults through a large patent IV line. Monitor closely for signs of infiltration.
      • If DEXTROSE 50% (25gm) is not available or if the patient has poor venous access, is elderly or frail and/or where high concentration dextrose (D50W) could cause phlebitis or injury;
        • Administer Dextrose 10% (D10) mixed in a 250 ml bag of solution IV Bolus.
          • The entire contents of this bag equal 25 gms of glucose.
          • Administer the entire bag or as much as possible while transporting.
          • Do not wait on scene for a response. Begin transport immediately.
    • For pediatric administration dilute DEXTROSE 50% to DEXTROSE 25% if available and refer to Broselow® Tape.
      • If DEXTROSE 50% (25gm) is not available then administer Dextrose 10%% mixed in 250 ml bag (1gm/10ml) of solution to deliver an amount as per the total grams indicated on the Broselow® tape (0.5 gm/Kg).
    • If unable to obtain IV access, GLUCAGON 1 mg IM or IN.
      • If patient is between 10 kg (22lb) - 20 Kg (44lb) .5 mg IM or IN.
      • Call for dosage order in pediatrics < 10 kg (22lb).
      • GLUCAGON onset of action in 8-10 minutes.
  • If LIMITED or NO response after initial DEXTROSE 50% only:
  • If the patient is a trauma patient or a stroke is suspected: Consider administration of HALF (½) initial dose of D50 or D10 following blood sugar monitoring.


BLOOD GLUCOSE LEVEL > 250 WITH SIGNS & SYMPTOMS OF HYPERGLYCEMIA / KETOACIDOSIS:

  • Administer a fluid bolus of NaCl 200 - 300 ml. Continue IV infusion KVO.


PATIENT TREATED AND RELEASED If a patient has a KNOWN history of Diabetes or Hypoglycemia that has been evaluated by a physician and EMS personnel provided treatment for the hypoglycemia, transport is not required if:

  • The patient’s blood glucose is stable;
AND
  • The patient has a competent adult that will remain with the patient for hours;
AND
  • The patient understands and agrees to eat, re-check blood glucose and call back if necessary;
AND
  • The patient was not placed on a D10 glucose infusion. ALL PATIENTS being treated with a D10 glucose infusion SHALL be transported to the hospital.
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