Gypsy Posted June 11, 2009 Share Posted June 11, 2009 (edited) You get a call to go to a local preschool. The director meets you outfront and takes you into the downstairs kitchen for the school. You see your patient sitting in a stool drinking water looking like she's been hit by a mac truck. Her assissant is standing next to her. The assissant explains she's the one that called because the patient was not acting or thinking straight. It had gotten to the point she was scared and worried that "Karen's" sugar might be dangeriously high. She does know the patient has a history of diabeties but doesn't know any more than that. Take it away boys and girls. Please keep it more or less at a basic level. Name was replaced to protect the patient's identity. Edited June 11, 2009 by Gypsy Link to comment Share on other sites More sharing options...
mobey Posted June 11, 2009 Share Posted June 11, 2009 Alert/awareness? BGL? Vitals? Temp? Link to comment Share on other sites More sharing options...
Gypsy Posted June 11, 2009 Author Share Posted June 11, 2009 Alert/awareness? She looks at you and nods but she seems almost out of breath and not really with it. BGL? 226mg Vitals? BP: 150/90 P=100 RR=20 Temp? 100 It is alittle hot in the kitchen because all 3 ovens are on and cooking. Not unbarable but you can tell cooking is going on. (( Yes by the way this did happen today. Though instead of calling 911 boss drove her to the local hospital.)) Link to comment Share on other sites More sharing options...
Chief1C Posted June 12, 2009 Share Posted June 12, 2009 (edited) Please keep it more or less at a basic level Well.. You have the vitals.. Take away her water, apply o2 and transport. Is the patient talking at all? Toss out a few simple yes/no questions, if she fudges them up, don't ask anything important. Get a rough history, ask for a phone number of a family member - you can also ask that at the preschool. They should have an emergency contact number on file. IMO, and it all depends on the victim, esp. tolerances, weight, etc.. 226 isn't deathly high. I've had many patients that had levels way beyond 500 that were just as lucid as they normally are. Not every patient is the same, of course, which is why it's important to look for alternate ways to get a Hx. But I wouldn't waste too much time at the scene doing that, even a phone number should be helpful. If she is diabetic, she probably has medications in some form with her, ask her for permission to look in her purse (if she has one, or ask if she has any sort of meds with her). Of course, if you get a number and can call a husband, significant other, etc., then that could be a big help. Edited June 12, 2009 by 4c6 Link to comment Share on other sites More sharing options...
FireMedic65 Posted June 12, 2009 Share Posted June 12, 2009 If we are keeping this at the basic level... Approach the girl in a friendly manner, identify yourself, kneel down to their level. Explain everything you are doing. Remove her from the heated environment. Cool her down with ice packs. Take vitals, get best history from the girl you can, obtain info from school (they should have that stuff on record or from the nurses station). Perform your assesment, get a general impression of the girl. It was said she might have a high sugar, is she diabetic? If you can obtain BGL, do it. If not, call for ALS, if they weren't already dispatched like they should have been. Link to comment Share on other sites More sharing options...
Katiebug Posted June 12, 2009 Share Posted June 12, 2009 Does she hve insulin? Sliding scale? Help her administer it. If not, all you can do is bolus some fluids to bring down the BGL and txpt. Link to comment Share on other sites More sharing options...
Kiwiology Posted June 12, 2009 Share Posted June 12, 2009 If she has been in a super hot kitchen and is that hyperglycemic she is probably massively dehydrated; need to start some fluids so either do an intercept with ALS or take her to ED Link to comment Share on other sites More sharing options...
FireMedic65 Posted June 12, 2009 Share Posted June 12, 2009 Definitely! She needs advanced care. The person with the scenario stated it was at a basic level. Not much you can do besides what all was stated and getting more advanced care. Depending on your area and scope of practice, there are other options available of course. Link to comment Share on other sites More sharing options...
Katiebug Posted June 12, 2009 Share Posted June 12, 2009 What options? Either she gets help with insulin she has on her and/or you bolus fluids and transport. There's nothing ALS can do with this that BLS can't do. That is as long as BLS can do IVs in your area. Also take into account txpt time vs intercept time. While her BGL is high, at 226 she's not approaching DKA. She shouldn't be huffing of CO2 at this point. If BGL was 400+, then it's time to scoop and run with a wide open IV. 262 needs to be immediately dealt with, but it's nothing to panic over. Keep it basic and go to the ER with it. Link to comment Share on other sites More sharing options...
FireMedic65 Posted June 12, 2009 Share Posted June 12, 2009 I was referring to handling this at the basic level. I don't of any basic's allowed to do IV therapy and give fluid boluses, let alone give insulin. Intermediates, yea maybe, but still don't think they are allowed to give insulin. Link to comment Share on other sites More sharing options...
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