Asysin2leads Posted April 11, 2007 Share Posted April 11, 2007 Called for a altered mental status, 10 y/o female reported lethargic. Arrive to find a 10 y/o on bed in sister's arms, crying, obviously terrified. Mother and friend are runnig back and forth, mother is alternating between attempting to draw up Glucagon in a syringe and stating that the child is diabetic. After much cajoling, mother states that daughter is a diabetic, was found by brother slumped over while watching TV, drooling, was hard to arouse. Mother took blood glucose, which was 40, but now is at 80. Patient will not talk to you, is crying and only wants to be held by her sister. Patient does look at you, then at sister, and asks "Is this really going on?" Vitals are all good, BP 122/46, HR: 92, RR: 18. What is your plan? What else do you want to know? How else could you get this information as mother is far into hysterics land? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted April 11, 2007 Share Posted April 11, 2007 Called for a altered mental status, 10 y/o female reported lethargic. Arrive to find a 10 y/o on bed in sister's arms, crying, obviously terrified. Mother and friend are runnig back and forth, mother is alternating between attempting to draw up Glucagon in a syringe and stating that the child is diabetic. After much cajoling, mother states that daughter is a diabetic, was found by brother slumped over while watching TV, drooling, was hard to arouse. Mother took blood glucose, which was 40, but now is at 80. Patient will not talk to you, is crying and only wants to be held by her sister. Patient does look at you, then at sister, and asks "Is this really going on?" Vitals are all good, BP 122/46, HR: 92, RR: 18. What is your plan? What else do you want to know? How else could you get this information as mother is far into hysterics land? Ok well basics Airway - open she's talking to her sister Breathing - rate is 18 so that's copa setic Circulation - bp and heart rate are there so that's hunky dory Whats her sugar on your machine any chance she took something that one of the four girls in Acosell's scenario have taken??? Any evidence of pill bottles or extra substances in the room? I wonder if something more happened to her than what is presenting here hence the statement "is this really happening" or is she just nervous to see the whole gang there? Can you get anything out of her sister? Await your answers Link to comment Share on other sites More sharing options...
Asysin2leads Posted April 11, 2007 Author Share Posted April 11, 2007 No pill bottles to speak of. Sister agrees with everything mom says. Anyway, here's what we did. My biggest question was "Is this kid AMS, or just scared?" Given the mom's state, and the other bystander's state, it was really difficult to determine the child's mental status. The blood glucose wasn't reading abnormally low, and I am not for giving medications that aren't required because everyone in the room is panicking. The biggest tip off for me that she was indeed AMS was that she kept asking her sister "Is this really happening?" I took that to mean she was confused. 1 mg of glucagon calmed her down a little, enough for us to get an IV, and after 12.5 mg of D25, she became a calm, lucid, remarkably intelligent little girl. As the old adage says, if you hear hoofbeats, think horses, not zebras. Her blood sugar was low, she only had been diagnosed diabetes a year ago, and it seemed her Lantus injections needed to be adjusted. Link to comment Share on other sites More sharing options...
Dustdevil Posted April 11, 2007 Share Posted April 11, 2007 Arrive to find a 10 y/o on bed in sister's arms, crying, obviously terrified. How old is the sister, and is she hott? Mother and friend are runnig back and forth, mother is alternating between attempting to draw up Glucagon in a syringe and stating that the child is diabetic. Are either of these women healthcare professionals, or just drama queens? Her blood sugar was low, she only had been diagnosed diabetes a year ago, and it seemed her Lantus injections needed to be adjusted. Just as likely, if not more so, is that her diet needs to be adjusted. Lantus isn't known for pronounced peaks. Events like this are usually precipitated by skipping a meal or two. How long has she been on Lantus, and how long has she been on the current dosage? What time of day was this run, when did she last eat, and when did she Last take her Lantus? Link to comment Share on other sites More sharing options...
Asysin2leads Posted April 11, 2007 Author Share Posted April 11, 2007 How old is the sister, and is she hott? Are either of these women healthcare professionals, or just drama queens? Just as likely, if not more so, is that her diet needs to be adjusted. Lantus isn't known for pronounced peaks. Events like this are usually precipitated by skipping a meal or two. How long has she been on Lantus, and how long has she been on the current dosage? What time of day was this run, when did she last eat, and when did she Last take her Lantus? She had last eaten at school before coming home, her Lantus injection was iin the morning, and she had 8 units of Novolog at noon. Now that you mention it, it does seem that she was missing a meal. See, this why I don't get to play with the insulin. No, her sister wasn't hot, but her mom was definitely in the MILF range. Any tips you can give us about dealing with Lantus/Novolog patients, Dust? Link to comment Share on other sites More sharing options...
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