# Type II diabetic treatment?



## johnguillen68 (Apr 29, 2009)

Hi everyone this is my first post on this site. I have a question regarding initial management towards a type II diabetic patient. Should I:

1. administer oral glucose
2. apply NRBM @ 15 lpm
3. assist meds
4. rapid trauma exam and vital signs

I was confused on this question and didn't know the answer. Well, the pt is confused refuses to take his meds. pt is diaphoretic, Tachycardia, and tachypneic.


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## AJ Hidell (Apr 29, 2009)

Wow!  PSL?  You're just down the street from me!

Anyhow, from the choices given, number 4 is the only possible correct answer.  Assessment always comes before treatment.


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## johnguillen68 (Apr 29, 2009)

AJ Hidell said:


> Wow!  PSL?  You're just down the street from me!
> 
> Anyhow, from the choices given, number 4 is the only possible correct answer.  Assessment always comes before treatment.


So diabetic coma results in hypoglycemia, excessive inuslin, and dehydration?

thanks I had a feeling it would be but tossed it up with O2. where are you from?


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## AJ Hidell (Apr 29, 2009)

I lived in PSL til a few months ago.  Now I'm in Jupiter.  Spend most of my time in Stuart.

You're not the one who stole the leg or sold the pot, are you?


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## johnguillen68 (Apr 29, 2009)

AJ Hidell said:


> I lived in PSL til a few months ago.  Now I'm in Jupiter.  Spend most of my time in Stuart.
> 
> You're not the one who stole the leg or sold the pot, are you?



lol. no way. I can't believe that, you have a great job and you throw it away for something illegal. Times are bad but why do it illegal? go cut some grass not grow them. The foot, it was just plain stupid. I'm still trying to get hired but its going slow. I'm applying in Georgia. but I have to renew my NREMT. So I'm taking a practice test.
I missed the hiring process in Stuart. I didn't know til it was too late.


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## fortsmithman (Apr 29, 2009)

AJ Hidell said:


> I lived in PSL til a few months ago.  Now I'm in Jupiter.  Spend most of my time in Stuart.
> 
> You're not the one who stole the leg or sold the pot, are you?



AJ I have a non EMS question and it is.
Isn't Jupiter where Burt Reynolds grew up.


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## AJ Hidell (Apr 29, 2009)

Close!  According to his Wiki bio, he grew up in Riviera Beach, which is a little south of me, closer to West Palm Beach.  I'm in the farthest north part of Jupiter, still in Martin County.


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## Sasha (Apr 29, 2009)

Boo Jupiter.


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## VentMedic (Apr 29, 2009)

AJ Hidell said:


> Close! According to his Wiki bio, he grew up in Riviera Beach, which is a little south of me, closer to West Palm Beach.


 
That is correct.

His ranch was just outside of Jupiter and his Dinner Theatre was in Jupiter.


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## Sasha (Apr 29, 2009)

AJ Hidell said:


> Wow!  PSL?  You're just down the street from me!
> 
> Anyhow, from the choices given, number 4 is the only possible correct answer.  Assessment always comes before treatment.



I've got to disagree with you. It says the patient is tachypneic. You can determine that by just looking at the patient before you touch them. I'd go with apply a NRB to take care of the airway before you move onto a trauma assesment and vital signs.


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## johnguillen68 (Apr 29, 2009)

Sasha said:


> I've got to disagree with you. It says the patient is tachypneic. You can determine that by just looking at the patient before you touch them. I'd go with apply a NRB to take care of the airway before you move onto a trauma assesment and vital signs.



thanks. as they say "load and go or stay and play" but I guess I can add O2 and go.


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## redcrossemt (Apr 29, 2009)

Welcome!



johnguillen68 said:


> 1. administer oral glucose
> 2. apply NRBM @ 15 lpm
> 3. assist meds
> 4. rapid trauma exam and vital signs



If you look at the national registry skill sheets, ABC's comes before the rapid trauma exam and vital signs. You actually fail (mandatory actions / critical point) if you do anything before assessing (and treating) ABC's. 

The patient is confused, tachypneic, tachycardic, and diaphoretic - so applying a NRBM at 15 lpm O2 is correct.


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## Ridryder911 (Apr 29, 2009)

redcrossemt said:


> Welcome!
> 
> 
> 
> ...



Wanna make a bet? 

R/r 911


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## Sasha (Apr 29, 2009)

Ridryder911 said:


> Wanna make a bet?
> 
> R/r 911



Are you suggesting that at a basic level with a basic education that they ignore the fact the patient is tachypneic, take a set of vitals and do a rapid trauma head to toe before administering oxygen?

Oxygen is basically all a basic can do.


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## AJ Hidell (Apr 30, 2009)

Sasha said:


> Are you suggesting that at a basic level with a basic education that they ignore the fact the patient is tachypneic, take a set of vitals and do a rapid trauma head to toe before administering oxygen?


I'm suggesting that you should make at least a rudimentary attempt to assess the etiology of the symptoms before blindly treating them with cookbook therapeutics.  We have no idea what is wrong with this patient, and we cannot assume that it is just a DM problem simply because he is Type II.  The very same symptoms could be the result of a head injury, in which case high concentration oxygen may be contraindicated, and spinal immobilization may be a priority.


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## Ridryder911 (Apr 30, 2009)

Sasha said:


> Are you suggesting that at a basic level with a basic education that they ignore the fact the patient is tachypneic, take a set of vitals and do a rapid trauma head to toe before administering oxygen?
> 
> Oxygen is basically all a basic can do.




As well on top of of what AJ has described, we are attempting to make those *THINK* about the care they are delivering. Do you really want 15 lpm on a tachypneic patient? Are they hyperventilating or is it Kussmauls respiration's? Is their tidal volume adequate enough or do you need to ventilate and assist them because they are tachypneic? 

We are seeing such display of memorization treatment and not treatment geared for that specific patient needs. Remember protocols are for your patient, not just plugging your patient into a protocol. 

I did not say it was not the right answer, I just asked "wanna bet?". Implying are you sure? 

The question was a poorly written question. Truthfully, there is not a correct answer because not enough data was given. 

R/r 911


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## redcrossemt (Apr 30, 2009)

While I think it is good idea to do an assessment before providing any treatment, and would personally not jump right to a NRBM in the field; if this specific question was asked by an NREMT test, I believe the correct answer is oxygen. If spinal immobilization, put on gloves, or another prior intervention or consideration was listed; you would choose that, because it's the best answer. If RTS was by itself, I would consider it a possibility. But the NREMT skill sheets, however right or wrong in real life, put "Does other detailed/focused history or physical exam before assessing/treating threats to airway, breathing, and circulation" as a critical criteria. It goes Scene Sizeup - Initial Assessment/Resuscitation - Focused History & RTS (including vitals) - Detailed Physical Exam.

I've read many similar questions in study guides and had several in practice tests and for class exams - they want to know that by your initial assessment (A&O: confused, airway: open, breathing: tachypneic, circulation: tachycardic) you would recognize a problem and provide the "cookbook" high-flow oxygen.

R/r, you didn't write this one, did ya?


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## Sasha (Apr 30, 2009)

AJ Hidell said:


> I'm suggesting that you should make at least a rudimentary attempt to assess the etiology of the symptoms before blindly treating them with cookbook therapeutics.  We have no idea what is wrong with this patient, and we cannot assume that it is just a DM problem simply because he is Type II.  The very same symptoms could be the result of a head injury, in which case high concentration oxygen may be contraindicated, and spinal immobilization may be a priority.



You seem to be forgetting this is the basic exam, for basics. So you have to think about the answer at the basic 110 hour level where they are taught immediate 15 litres for everything from a stubbed toe to CHF.


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## Ridryder911 (Apr 30, 2009)

Sasha said:


> You seem to be forgetting this is the basic exam, for basics. So you have to think about the answer at the basic 110 hour level where they are taught immediate 15 litres for everything from a stubbed toe to CHF.



Actually, they should not be taught such crap. Unfortunately, we have too many instructors that rather have "robots" than practitioners. Even within the text (which is why many become confused) it is attempts to sway from "cookbook" medicine. 

Ironically, which everyone loves to refer to the NREMT skills sheets is just suggestions. As the NREMT does *NOT* have a Basic Skill Practical Test, *only* the Advanced level. They only produce the sheets for recommendation and suggestion, it is upon the State or School to authorize and ensure the student has met those requirements.

p.s. No, I did not write such question. Ours was much better but I will say more difficult as well. Remember, the new scope/curriculum will include a  lot more pathophysiology.


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