| Black Belt CONDITIONS DIABETES UNCONSCIOUSNESS SPINAL INJURIES Archie Cuthbertson – Class Facilitator |
DIABETES
NATURE OF DIABETES
Diabetes Mellitus is a disorder in which there is inadequate insulin for carbohydrate metabolism. Glucose absorbed from the gastro-intestinal tract cannot be metabolized or stored and so reaches higher than normal levels in the bloodstream.
Diabetes Insipidus is a rare form of diabetes. It’s due to inadequate anti-diuretic Hormone (ADH); water absorption from the kidneys is deficient, leading to excretion of excessive amounts of urine (polyuria), often more than 10 liters daily. This often causes dehydration and extreme thirst (polydipsia).
DIABETES MELLITUS
There are two types;
- Insulin Dependant Diabetes Mellitus (Type 1 – IDDM)
- Non-insulin Dependant Diabetes Mellitus (Type 11 – NIDDM)
INSULIN DEPENDANT DIABETES MILLITUS (Type 1)
This occurs mainly in children and young adults, but can occur at any age. The onset is usually sudden and the deficiency or absence of insulin is due to the destruction of the ‘Islets of Langerhanns’ cells within the pancreas. The causes are unknown but there is a familial tendency, suggesting genetic involvement. In many cases antibodies to the ‘Islets of Langerhanns’ cells are present, probably due to cells previously damaged by infection.
Insulin is the treatment for all patients with type 1 diabetes and for type 11 diabetes who are not adequately controlled by diet or oral hypoglycaemic agents.
NON-INSULIN DIABETES MILLITUS (Type 11)
This is the most common form of diabetes often occurring in women over75 years and men over 65 years, patients are normally obese, but the cause is unknown. Treatment by diet control or diet and tablets may be sufficient to control blood glucose levels. Compared with Type 1, signs are less acute and include weight loss, excessive thirst (polydipsia), and increased urine output (polyuria).
DIAGNOSES
- excessive high glucose level in the bloodstream
- Testing the patient’s urine
Blood sugar tests are the most reliable means of diagnoses.
DIABETES
COMPLICATIONS
- Cardiovascular disease
- Infection
- Renal failure
SIGNS and SYMPTOMS
HYPOGLYCAEMIA HYPERGLYCAEMIA
* Rapid onset * Gradual onset
* Pale, sweaty skin * Dry skin
* Normal to shallow resps. * Deep and sighing resps.
* Rapid and full pulse * Rapid weak pulse
* Confused, aggressive, irritable * Restless, drowsy and lethargic
* Hunger * Sweet, fruity breath odour
* Headache * Abdominal pain, nausea
* Dizziness * Polyuria (excessive urination)
* Seizures (late stages) * Polyphagia (excessive food intake)
* Polydipsia (excessive thirst)
* Low blood pressure
MANAGEMENT
* AVPU-ABC Ensure open airway * ensure open airway
* BM, If conscious, give oral glucose * If unconscious, recovery position
* Recovery position if unconscious * Administer oxygen therapy
* Administer glucogen as JRCALC * Keep Patient warm
* Administer oxygen therapy * Place on Monitor/BP/Spo2
* Reassure the patient
REMEMBER
Hypoglycaemia patients may appear drunk although alcohol may also cause Hypoglycaemia. Never discount the possibility that a patient who appears to be drunk may in fact be hypoglycaemic.
UNCONSCIOUS PATIENT
UNCONSCIOUSNESS
Unconsciousness is fundamentally a sign of impairment of the activity of some or all of the brain.
THE MAIN CAUSES OF UNCONSCIOUSNESS
· C – cardiac arrest
· H – head injury
· I - infantile convulsion (febrile)
· E – electric shock
· F - faint
· S - stroke (CVA)
· A - asphyxia - hypoxia
· P - poisons
· H - hypothermia/Hyperthermia
· E - epilepsy
· A - Asthma
· D - diabetes
REMEMBER
· A clear airway must be maintained
· If there are obvious signs of obstruction, It must receive priority treatment as it will kill in a matter of minutes.
MANAGEMENT OF THE UNCONSCIOUS PATIENT
PRIMARY SURVEY
· Checking for hazards to yourself and the patient
· Noting obvious signs and position of the patient
· Speaking to the patient and applying stimulus (painful if necessary to assess the level of consciousness)
· Ensuring an open airway
· Checking breathing
· Checking the pulse
Deal with any life threatening problems first, and if these allow progress to the secondary survey. (see page 2)
UNCONSCIOUS PATIENTS
SECONARY SURVEY
HEAD CHECK
· Skull for irregularity or scalp wounds
· Ears for fluid (blood – CSF)
· Eyes for pupil size and reaction
· Lips for colour (cyanoses)
· Jaw for displacement
· Mouth for loose teeth or abnormal staining
· Airway and insert oro-pharyngeal airway
· Skin; colour (pale or flushed)
Texture (dry or moist)
Temp. (hot or cold)
THORAX CHECK
· Clavicals for fractures
· Sternum for fractures
· Ribs for fractures
ABDOMEN CHECK
· Pelvis for fractures, abnormal movements or guarding
· Groin for dampness
BACK CHECK
· Spine for irregularity
· Scapulas for fractures
LIMB CHECK
· Irregularity, deformity and fractures
· For flexion of the joints (if no injuries)
· For signs of drugs abuse (needle marks)
IDENTIFICATION CHECK
· Identification, medical cards or bracelets
UNCONSCIOUS PATIENT
PATIENT POSITIONING
Having examined the patient and decide there is no injuries to be cared for, or you have treated any injuries, you may place the patient: -
· In the recovery position
· In the ambulance, continue observation
There may be occasions when it is not possible or desirable to transport an unconscious patient in the recovery position. If this is the case: -
· Insert an oro-pharyngeal airway
· Continue constant observation of the airway
· Keep suction equipment handy
· Use postural drainage position
· Apply cervical collar, if head injury present, (or spinal injury)
CONTINUE TO OBSERVE
· Airway
· Respiratory rate/rhythm/depth (Administer 100% Oxygen)
· Pulse rate/volume – Place on Cardiac Monitor
· SPO2
· Blood Pressure
· Bleeding is arrested
· facial colour
REMEMBER
&nbs
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