# 39 year old female diabetic



## musicislife (May 6, 2012)

Initial: In the home, conscious alert and oriented x0, airway is clear from any obstructons/ no potential obstructions indicated. Breathing normally. Pulse rapid and weak. Skin condition cool, mosit, and pale. Friend states she is a diabetic. 

SAMPLE: Patient is confused, unable to provide info. Not nauseated No vials of life or anyhting around, friend only knows that she is a diabetic, and that she just finished a vigorous exercise. 

Baseline Vitals: BP: 90/70 Pulse 110bpm Respirations 12/min

Interventions. administer a small amount of cola.

Wait for EMT's to take over. (im a first responder, we dont transport: out EMT's/paramedics do)

anyhting different you would do?


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## jroyster06 (May 6, 2012)

I can see where your going. Depends on how far out the medics are? If they are close an assessment is sometimes better. I would be concerned about future airway complications and adding to stomach contents is a no-no. A glucometer would have been ideal in this situation. Our first responders carry glucometers as well as most of them oral glucose. how far out was the crew?


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## musicislife (May 6, 2012)

we were taught that a small amount of cola can only help, and the ETA is a few minutes. we were never taught to use a glucometer, so i would not bother with it in my situation. would a dab of oral glucouse (which i carry with me) do better?





jroyster06 said:


> I can see where your going. Depends on how far out the medics are? If they are close an assessment is sometimes better. I would be concerned about future airway complications and adding to stomach contents is a no-no. A glucometer would have been ideal in this situation. Our first responders carry glucometers as well as most of them oral glucose. how far out was the crew?


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## Maine iac (May 6, 2012)

I would be slightly concerned with those vitals. They just seem a little off.

Since you are a first responder I would ask no more of you. As soon as I got on scene, and you told me the story, I would clear you. Unless there was something special about this situation (obese pt).

Unless the ambulance is miles and miles away I probably wouldn't do anything else. If you really suspected this to hypoglycemia then yeah either do cola with sugar added, or your tube of glucose.

No point in only doing a little bit. If you are going to have her sip on something, add sugar and make her drink it. If you are getting out the glucose tube, try and get her to do the whole tube.

I learnt the hard way not to trust bystanders. Just because her friend says she is a diabetic does not mean this is a diabetic emergency.


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## jroyster06 (May 6, 2012)

It could if it were a true diabetic emergency, if it were a CVA it could be detrimental however a small amount of Oral G probably would not do much in way of brain necrosis but it would also not yield the results you are looking for. Say if she was having a true diabetic emergency, the Oral Glucose doesn't go as far as they teach in school when a bgl is in the 20's it takes several tubes to bring it up, in which case you would not want to admin that much without a BGL reading. Also if your operating under a services protocols, they probably dont have one that covers giving cola to a diabetic, in which case you could be found at fault.


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## NYMedic828 (May 6, 2012)

musicislife said:


> Initial: In the home, conscious alert and oriented x0, airway is clear from any obstructons/ no potential obstructions indicated. Breathing normally. Pulse rapid and weak. Skin condition cool, mosit, and pale. Friend states she is a diabetic.
> 
> SAMPLE: Patient is confused, unable to provide info. Not nauseated No vials of life or anyhting around, friend only knows that she is a diabetic, and that she just finished a vigorous exercise.
> 
> ...



You stated she just finished vigorous exercise. I would expect blood pressure to be the opposite of what it is in this case. Also with the vigorous exercise, the skin being moist is not going to be a viable diagnostic tool. (this all depends on how long she stopped exercising of course)

A diabetic enduring so much exercise certainly will drop their glucose levels rapidly but I would suspect she is smart enough to compensate for it.

Hypotension is a pretty unusual finding in the presence of hypoglycemia. If she is able to sweat that much, odds aren't she isn't dehydrated enough to get that low. The issue with oral solutions to combat hypoglycemia is they can take upwards of 10 minutes to have any effect. You aren't going to hurt anyone with a little bit soda as long as they aren't likely to vomit.

The AMS may be caused by the borderline hypotension. We don't know what her usual blood pressure is especially if shes an athlete of sorts it could be close to her baseline. Without getting more info, we can't know if blood pressure is even an issue.

Low blood pressure in the presence of tachycardia commonly indicates potential hypoperfusion. Could be an internal bleed for all we know.

*What was her age?
*
Without further details of assessment we really can't diagnose her over the internet.


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## Anjel (May 6, 2012)

NYMedic828 said:


> *What was her age?
> *



Idk....but I think the title of the thread says 39 year old female diabetic.

So...maybe 39?


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## Handsome Robb (May 6, 2012)

NYMedic828 said:


> *What was her age?
> *



I'm guessing 39 but that's just me  Check the title. 

Everyone already said what I was thinking, I wont be repetitive.

edit: Anjel beat me to it...


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## Anjel (May 7, 2012)

NVRob said:


> I'm guessing 39 but that's just me  Check the title.
> 
> Everyone already said what I was thinking, I wont be repetitive.
> 
> edit: Anjel beat me to it...



Its all those awesome medic observational skills we are learning.


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## Akulahawk (May 7, 2012)

What _you_ can do and what _I_ can do are two very different things. My gut feeling is that she's hypoglycemic because she did not take into account the calorie burn that she would get from exercise. From my understanding, this is not uncommon. Given what you know of this patient's background, if she can pass a swallowing test of water, a small amount of cola would probably not be inappropriate. You do however, need to know what you're protocols allow for your level of responder to do when dealing with administering sugar to patients that are possibly diabetic or are known diabetic.

I personally think she was hypoglycemic, but whether or not I think the administration of cola was a good idea really depends upon seeing the patient... I'd honestly want to evaluate the patient for myself and, if possible, get a BGL on her. It's easier to see you're on the right track when you can see before/after tx results. 

Oh, and once again, I can't stress enough that you need to know what you can do at your level of care because you really do NOT want to exceed that and possibly get your backside in much trouble because you exceeded your scope and did the wrong thing that you _thought_ was correct or didn't know you weren't allowed to do something...


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## OzAmbo (May 7, 2012)

musicislife said:


> Initial: In the home, conscious alert and oriented x0, airway is clear from any obstructons/ no potential obstructions indicated. Breathing normally. Pulse rapid and weak. Skin condition cool, mosit, and pale. Friend states she is a diabetic.
> 
> SAMPLE: Patient is confused, unable to provide info. Not nauseated No vials of life or anyhting around, friend only knows that she is a diabetic, and that she just finished a vigorous exercise.
> 
> ...



Someone said as a first responder you cant be expected to do more than this so good job to you.

I'll make the assumption that you cant take BGL - is she insulin deendent? if so, see if she keeps a diary of her insuline adminstration, the dose doesn't matter but they will also record what her BGL has been doing.

If she is truly hypoglyceamiac from exercise it must have been an epic workout. Most hyos ambulance attend are essentially 
insulin overdoses. Diabetes is a disorder of hyerglyceamia, but if she were having a hyper we would expect her resp rate to be elevated.

like someone else said, the hypotension is interesting and the skin is unreliable. What you vould do (if you allowed to) is let them have the cola but keep it in their mouth so the glucose is absrobed via their bucal mucosa. If this is something else coke makes a mess if they deteriorate and lose airway control

Did the cola make any difference?

Of course, this is all conjecture

Strong work


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## CritterNurse (May 7, 2012)

Just make sure it isn't diet cola. Otherwise, it would be completely useless.


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## Handsome Robb (May 7, 2012)

If you've got oral glucose I'd use that personally. Put a big ol glob on a tongue depressor or something similar and stuff it in her cheek. Like everyone said it'll take a lot if her sugar is really low and it'll take a while to see the effects but at least you can get the process moving in the right direction for the incoming crew.


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## NYMedic828 (May 7, 2012)

Doh. Didn't even read the title


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## Veneficus (May 7, 2012)

NYMedic828 said:


> but I would suspect she is smart enough to compensate for it.



I never expect patients are smart enough to do anything.

If they were that smart, they would have no need of help.


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## NYMedic828 (May 7, 2012)

Veneficus said:


> I never expect patients are smart enough to do anything.
> 
> If they were that smart, they would have no need of help.



Point taken.


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## Firemedic1989 (Jun 28, 2012)

As a FR I believe the most appropriate thing to do in this case is to get a good basic assessment and history on the patient so that when the transporting crew does arrive, you can paint them a good picture on what road they should take. Also saves time for the Medics on scene


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