Endocrane in Critical Care

Diabetic Emergencies

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A. Signs and symptoms: Progressive lethargy and perhaps coma, deep respirations, warm skin and weak, rapid pulse, vomiting present in earlier stage, acetone to breath.

B. Patient history: Known diabetic, usually insulin dependant, may have missed or skipped recent insulin injection or have had an acute illness.


Conscious and Alert Patient


I. Primary Survey.

A. Be sure patient isn't allergic to substance being given.

B. Be prepared for patient to vomit.

III. Obtain pertinent medical history, medications, and allergies.

IV. Secondary Survey.

V. Obtain vital signs according to Patient Assessment protocol.

Unconscious or not alert patient

I. Primary Survey. Refer to Altered Mental Status protocol.

A. Protect the airway.


Observe for respiratory depression prepare to assist ventilations


B. Suction; as needed.

II. Administer oxygen.

III. Secondary Survey.

IV. Obtain pertinent medical history, look for medical alert necklaces, bracelets, anklets, and Vial of Life (Insulin).

V. Obtain vital signs according to Patient Assessment protocol.

VI. Maintain body temperature.

VII. Place a patient on side unless contraindicated.

Diabetic Emergencies



1. Continue BLS as indicated.


Observe for respiratory depression, prepare for intubation


3. Monitor EKG.

4. Start IV of NS @ TKO.and perform a glucose level test.




2. Unconsciousness may occur in diabetic patients from other etiologies as well; use unconscious patient protocol.

3. Oral glucose agents will not be given to unconscious patients.


5. Often diabetics have acute illnesses secondary to their diabetes and/or illnesses that may exacerbate their diabetic problem.

6. Find out when patient last ate.

7. Determine if and when medications were taken.