Course Agenda :1 Course Agenda Lecture/Discussion 1 to 1.5 hours Lab Lab 1 hour Evaluation 1 to 1.5 hours Total hours 3 to 4 hours of classroom time


Course Objective :2 Course Objective Upon completion of this course, the EMT-Basic will demonstrate the ability to perform a blood glucose test on a patient and act appropriately to the findings without compromising the patient’s care or safety.


Course Task List :3 Course Task List Correctly identify patients who need blood glucose level evaluation. Identify the glucometer and its function. Identify pertinent body substance isolation practices. Describe and demonstrate process of measuring blood sugar. Interpret results of blood glucose testing and determine appropriate treatment. Understand maintenance needs for glucometers.


Cellular Metabolism :4 Cellular Metabolism Glucose is fuel Fats and Proteins are less efficient fuels By products of metabolism The role of insulin in using glucose Cell permeability


Cellular Metabolism :5 Cellular Metabolism Glucose is fuel Fats and Proteins are less efficient fuels By products of metabolism The role of insulin in using glucose Cell permeability


Brain Cell Metabolism :6 Brain Cell Metabolism Brain cells do not need insulin to utilize glucose. They do, however, need adequate levels of glucose in order to function properly! When glucose levels drop too low, the brain cells cease to function normally and changes in behavior and LOC follow. There is no “set” level at which patients show S/S of low blood glucose as it differs from person to person.


Normal Blood Glucose Levels :7 Normal Blood Glucose Levels Normal ranges for blood glucose levels: Infant (40 – 90 mg/dl) Child 2 years to Adult (70 – 105 mg/dl) Elderly patients (50 y/o +) often have a slightly elevated blood glucose level, but should not normally exceed 126 mg/dl. These readings will be altered by time of day and last oral intake. Values reflected are fasting values.


Increased Blood Glucose Levels :8 Increased Blood Glucose Levels Indicative of several potential processes: Diabetes mellitus Acute stress response Cushings disease Diuretic therapy Corticosteroid therapy


Decreased Blood Glucose Levels :9 Decreased Blood Glucose Levels Indicative of several potential processes: Insulinoma Hypothyroidism Addison’s disease Extensive liver disease Hypopituitarism Pancreatic disease or cancer


Why monitor Blood Glucose? :10 Why monitor Blood Glucose? Knowing the blood glucose level fills in some of the blanks in patient assessment and allows the EMT-Basic to determine an appropriate course of treatment for the patient. Provides information that is valuable to advanced life support providers and the hospital personnel.


Types of Diabetes :11 Types of Diabetes Type I (Juvenile Onset) Generally insulin dependent Can develop in childhood or later in life Patients are likely to have complications from the effects of the disease Type II (Adult Onset) May be controlled by diet or oral medications Less likely to have insulin dependency Less likely to experience hypoglycemia Still at risk for complications for the effects of the disease


Clinical Presentation :12 Clinical Presentation Hypoglycemia (BS 200 mg/dl) Kussmaul respirations Dehydration with dry, warm skin and sunken eyes A sweet or fruity (acetone) odor to breath Rapid and weak pulse Normal or slightly low BP Varying degrees of unresponsiveness that onsets more slowly than in hypoglycemia


Emergency Treatment :13 Emergency Treatment Hypoglycemia Scene size up & BSI Initial Assessment Determine need for rapid transport Focused H&P Medical with vitals Blood glucose check If < 80 mg/dl, give oral glucose if LOC intact If < 80 mg/dl and LOC is ↓, activate ALS assistance Detailed, on-going assessments with transport to appropriate facility Supportive care as needed


Emergency Treatment :14 Emergency Treatment Hyperglycemia Scene size up and BSI Initial Assessment with O2 and determine need for rapid transport Focused H&P Medical with vitals Monitor blood glucose level If blood glucose is > 200 mg/dl the patient may need re-hydration and insulin per physician direction Consider ALS Assistance if vitals signs compromised Detailed, on-going assessments with transport to appropriate facility Supportive care as needed


Indications for Blood Glucose Monitoring :15 Indications for Blood Glucose Monitoring Altered LOC in any patient from any cause Shakiness, weakness Rapid pulse and respiratory rate Neurological deficit Seizures Known diabetic


Body Substance Isolation :16 Body Substance Isolation Refer to your specific departmental infection control plan As a rule, in monitoring blood glucose, you will need: Exam gloves Spurting blood is NOT anticipated Eyewear, mask, and gown are generally NOT indicated for this procedure


Use of Glucometer :17 Use of Glucometer Equipment needed: Exam gloves Alcohol prep pads Glucometer Test strips Cotton balls or gauze pads Band-aid Lancets Sharps container and proper waste disposal container


Use of Glucometer :18 Use of Glucometer Identify the appropriate puncture site Adult and child over 1 year, select 3rd or 4th fingers on palmar side or central fleshy area Contraindications to the typical puncture site Old puncture sites Visible damage Desire of the patient


Preparation of the Site :19 Preparation of the Site Cleanse with 70% isopropyl alcohol using a scrubbing motion Do NOT use iodine Allow alcohol to dry


Preparing the Glucometer :20 Preparing the Glucometer Some glucometers require loading the test strip PRIOR to applying the blood sample, while others load the test strip after applying the blood sample Ensure the glucometer is “ON” and the test strip matches the glucometer code


Acquiring Blood Specimens :21 Acquiring Blood Specimens Using the lancet, stick the site Form a small drop of blood and apply to the test strip as directed by the glucometer instructions Allow the glucometer to process the information and return a reading Hold pressure on lancet site and apply band-aid Record the findings


Maintenance :22 Maintenance Set up requires identification of: Proper batch numbers for test strips Routine control testing Calibration when necessary


Care of the Blood Glucometer :23 Care of the Blood Glucometer Handle with care! Do NOT expose to excessive heat, humidity, cold, dust, or dirt Clean as directed by manufacturer Store the glucometer in the case provided by the manufacturer


Trouble shooting :24 Trouble shooting Manual covers MOST issues for specific glucometers Display goes blank . . . Function number is different from test strip number . . . Result is “Out of Range” . . . Meter does NOT count down . . . Display segments are incomplete . . . Meter reads “Lo” . . . Meter reads “Hi” . . . Control tests are inconsistent or within a specified range . . .


Glucose Administration :25 Glucose Administration Different names of product . . . Indications . . . Contraindications . . . Actions . . . Dosage . . . Route . . . Side Effects . . .


Case Study 1 :26 Case Study 1 Your unit receives a call for an insulin reaction. You find, upon arrival, a 44 year old female patient who presents giddy and nervous. The family states that she is an insulin dependent diabetic who had her insulin today and has not eaten. What are the treatment steps for this patient?


Case Study 2 :27 Case Study 2 Your unit receives a call for an unconscious subject. Upon arrival at the business, you find a 22 year old male patient who is supine on the floor and unresponsive. There is vomitus on the floor beside him and around his mouth. He is breathing and has a strong pulse. He has no identification or medic alert tags on him. What are your treatment steps for this patient?


Case Study 3 :28 Case Study 3 Your unit receives a call for a traffic crash. Upon arrival you find an elderly patient behind the wheel of a car that has gone off of the road and is up against a tree by a creek. The patient presents unresponsive, but with no specific signs of injury. Vitals are stable except for the decreased LOC, which is found to be responsive to painful stimuli. What are your treatment steps for this patient?


Case Study 4 :29 Case Study 4 Your unit responds to a home for the report of a diabetic who if found unresponsive. You find the patient unresponsive and breathing shallow. Skin is warm and dry. Vitals are within normal limits. The patient, a 77 year old female is an insulin dependent diabetic who has eaten today, but it is unknown if she had her insulin. What are your treatment steps for this patient?


Developed for the Kansas Board of Emergency Medical Services by: :30 Developed for the Kansas Board of Emergency Medical Services by: Jon E. Friesen, BS MICT I/C Captain, Sedgwick County EMS Sedgwick County, Kansas Copyright to this program is owned by the Kansas Board of EMS. Use and reproduction of this program is granted by the Kansas Board of EMS.