Doctor, My husband is a diabetic. He has suddenly become unconscious half an hour back.
The first aim is to decide whether it is a Hypoglycemic coma, or hyperglycemic coma?
Suspect Hypoglycemia: if the patient has taken his tablets or insulin, but missed his meals, or had severe exertion. Onset of hypoglycemia is sudden.
Suspect Hypoglycemia: if the patient is irregular in taking his medicines, or has an infection, cough or fever, and when the onset is insidious.
Keep your hand on the pulse, and watch the breathing
Hypo = slow, bounding, good volume pulse with quiet breathing.
Hyper= Rapid, thready pulse, Low Blood pressure, tachypnoea, and sweet (acidotic) smell to the breath.
Hypoglycemia = overall, the patient looks healthy, as if he is quietly sleeping.
Hyperglycemia = Patient would look toxic, ill, febrile
Looks of evidence of infection.
Auscultate the chest for rales.
Examine the limbs, buttocks & feet for cellulites or abscess.
Action:
Take out blood sugar strip from your emergency bag & check the sugar before commencing treatment. If hypo, or if in doubt – I.V. 25% 3-4 ampules. If the patient wakes up, give me or 25% glucose, and continue with 10$ Dextrose drip
If Hyperglycemia – push 2-3 N.saline fast.
2nd I.V. line – NS + 20 units plain insuli slow Sodabicarb 100ml slow I.V, higher antibiotics.
Hospitalise the patient
