RPI AMBULANCE
Topics to Cover
• Indications for Blood Glucose testing
• Symptoms/Differences of Hypoglycemia and
Hyperglycemia
• Treatment for hypoglycemia and
hyperglycemia
• Required equipment to test Blood
Glucose levels
• How to use the equipment
Indications for Blood Glucose Testing
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Altered Mental Status
Abnormal Behavior
Syncope
Seizures
Diabetic Related Emergency (or if someone has a history of
diabetes, and has AMS)
Stroke
Overdose of hypoglycemic agents (e.g. Insulin)
Unconscious or Unresponsive Patients
Poor nutritional status or fasting
General Illness
Have symptoms of Hypoglycemia/Hyperglycemia
Hypoglycemia
• Hypoglycemia is having abnormally low blood
glucose levels. (Under 80mg/dL)
• Symptoms of low BG include: fatigue, mental
confusion (AMS), Unconsciousness or
Unresponsiveness, Diaphoresis (cool, moist,
clammy), Dizziness/light-headedness.
• Patients with low BG may APPEAR drunk. This is
why it is important to take the blood glucose of
any pt who you suspect to be drunk. Even if they
admit to drinking.
• *note that although it is rare, non-diabetic
patients can have low blood sugar.
Hyperglycemia
• Hyperglycemia is having abnormally high blood
glucose (above 120mg/dL).
• Symptoms/complications with high BG usually
occur when the BG is much higher than 120, this
can result in a diabetic coma or ketoacidosis.
• Symptoms of high BG include: Frequent
urination, increased thirst or dry mouth,
shortness of breath, breath that smells fruity
(from the ketones), nausea and vomiting.
Treatment
• EXACT REMO PROTOCOL for diabetic emergency:
– ABCs and Vitals.
– Airway management and appropriate oxygen therapy.
– Check blood glucose level, if equipped.
– If blood glucose is known or suspected to be low and
patient is able to self administer and swallow on
command, give oral glucose one unit dose.
– If blood glucose is CONFIRMED to be high do not
administer oral glucose.
– Call for ALS intercept if unable to swallow on
command, or mental status remains altered
following administration of oral glucose.
Treatment
• Just as a reminder, hypoglycemia and hyperglycemia
are both diabetic emergencies. Don’t forget ALS!
• Treatment for hypoglycemia (as BLS): Oxygen, if pt
can swallow/self administer on command then give
pt one unit of liquid glucose (a tube), Treat for shock!
• As any other medication, reassess the pt before and
after administered including vitals. Retake the BG a
minute or two after administration.
• Treatment of hyperglycemia (as BLS): Transport,
oxygen, monitor pt. Keep in mind that ALS can’t do
anything else for the pt than that unless the BG is
over 400mg/dL
The Equipment!
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Blood Glucose Test Machine (Precision Xtra)
Test Strips made for Precision Xtra
Lancets
Alcohol Preps
4x4 Gauze or Band-Aids
Interactive Demo.
• http://www.abbottdiabetescare.com/static_di
visional/abbott_diabetes_care/application/ht
ml/precision_xtra_demo.html
That’s within
normal range!
*Open link with
Internet Explorer
Calibrating the Glucometer
• The Glucometer has to be re-calibrated every
time new test strips are being used. This is to
ensure that they are reading accurately.
• Make sure the five digit code on the calibrator
strip matches the one on the test strips.
• Insert the calibrator(the side with the bars)
into the monitor.
• Verify that the five digit lot number on
monitor matches the one on the calibrator.
Control Testing
• Control testing is to ensure that our glucometer is
working properly.
• After calibrating the new test strips, insert a test strip
into the glucometer. The side with the bars go into the
slot on the bottom side of the monitor, the side with
the “white box” is where the sample (blood or control
solution) goes.
• Wait for the symbols indicating the monitor is ready for
the control/blood.
• Shake the control solution, then apply a drop
to the end of the test strip.
• Wait for count down to end, then verify
that the number is in the correct range.
Taking a Blood Sugar
• Start by cleaning the area you plan to lance with
an alcohol prep. This area should be any of the
finger tips excluding the thumb.
• Open the test strip and band-aid. Insert the test
strip just enough so it stays in but does not show
the applying blood symbols.
• Use a lancet to lance the fingertip.
• Push the strip in till appropriate screen is shown
and place blood on end of test strip.
• Wait for countdown to end. If normal,
BG will be between 80 and 120mg/dL.
• Put a 4x4 or band-aid on finger.
Special Considerations
• If it is cold outside, or the patients hands are
cold, it may be difficult to get enough blood to
apply to the test strip! Try to warm up patients
hands!
• Remember: Patients can refuse any treatment
you want to give them. If patient refuses
having their BG taken and they are
alert and oriented, document and
tell the hospital staff.
That’s it!
Thanks!
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