Hypo or Hyperglycemia: Difference between revisions
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* If LIMITED or NO response after initial [[Antidiabetics|DEXTROSE 50%]] only: | * If LIMITED or NO response after initial [[Antidiabetics|DEXTROSE 50%]] only: | ||
** [[Antidiabetics|DEXTROSE 50%]] 12.5 gm IVP for adults if available. | ** [[Antidiabetics|DEXTROSE 50%]] 12.5 gm IVP for adults if available. | ||
* 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. | * 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. | ||
Revision as of 19:00, 25 April 2016
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):
- For pediatric administration refer to Handtevy System.
- 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.
- If the patient responds quickly to D10, follow treat and release guidelines below.
- Administer Dextrose 10% (D10) mixed in a 250 ml bag of solution IV Bolus.
- 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;
- If unable to obtain IV access, GLUCAGON 1 mg IM or IN.
- GLUCAGON onset of action in 8-10 minutes.
- If LIMITED or NO response after initial DEXTROSE 50% only:
- DEXTROSE 50% 12.5 gm IVP for adults if available.
- 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 > 400 WITH SIGNS & SYMPTOMS OF HYPERGLYCEMIA / KETOACIDOSIS:
- Administer a fluid bolus of NaCl 200 - 300 ml. Continue IV infusion KVO.
NOTE: Prehospital treatment of HYPERGLYCEMIA is not indicated when only an elevated blood glucose level is present without any other signs and symptoms.
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;