CARPA Standard Treatment Manual · 2017. 10. 13. · CARPA Standard Treatment Manual a clinical...
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94 Low blood glucose (hypoglycaemia) When BGL low enough to cause symptoms and signs. • Person with usually high BGL may have symptoms with higher BGL, eg 5–6mmol/L • For newborn — see If low blood glucose (WBM p74) If decreased level of consciousness, behaving oddly, serious infecon, serious overdose, fit — always test BGL� Many causes, eg alcohol, oral glucose control medicines, aspirin, beta-blockers, insulin, toxins. Signs and symptoms of low blood glucose • Person may ◦ Be sweaty, pale, clammy, taking deep breaths ◦ Be hungry, weak, red, dizzy, have the shakes ◦ Be drowsy, confused, tearful, behave differently, appear 'drunk' ◦ Be aggressive, suspicious, potenally dangerous ◦ Have fits (p60), lose consciousness • Newborns and infants may have ◦ Poor tone (floppiness), weak cry, poor feeding, breathing problems (stopping breathing [apnoea], cyanosis), tremor, seizures Ask • If on any medicines — have they taken them, could they have taken someone else's • If child — could they have taken medicines or alcohol • Have they eaten that day, what (any carbohydrate foods) • Any voming and/or diarrhoea • Unwell recently, eg sepsis, fever and chills, cough, urinary problems Check • Temp, pulse, BP, RR, O2 sats • BGL. If less than 4mmol/L — treat • Coma scale score (p78) • Do they have right medicines — check boles/packets, dose aid If person unconscious — Life support – DRS ABC D (p2). Low blood glucose — treatment needed when BGL less than 4mmol/L. 95 Low blood glucose (hypoglycaemia) Emergencies and assessments Do If person conscious and can eat and drink • Give simple (fast acng) sugar/glucose (equal to 15g carbohydrate), eg 200ml diluted cordial, 6 jelly beans, 60ml of 75g OGTT mix, 90ml of glucose drink, 2–3 teaspoons of sugar • Medical consult • Check BGL aſter 10 minutes ◦ If BGL less than 4mmol/L — give more simple sugar/glucose ◦ If BGL 4 mmol/L or more — give long lasng (slow release) carbohydrate (starch), eg 4 dry biscuits/crackers, 1½ Weetbix, 1–2 slices bread or damper, 1 piece of fruit, 1 cup of milk • See Follow-up (below) If person unconscious or unable to eat or drink • See Life support – DRS ABC D (p2) • Medical consult as soon as possible, but don't delay treatment • If any chance they are long term or regular heavy drinker of alcohol (grog) — give thiamine IV 300mg before glucose and daily for another 2 days • Give glucagon IM ◦ Child 5 years and under — 0.5mg ◦ Child over 5 years or adult — 1mg • If glucagon not available OR no response to glucagon aſter 5 minutes — put in IV cannula (CPM p85) and give ◦ Child under 10 years — 10% glucose 5ml/kg at 2mls per minute ▪ If 10% glucose not available — dilute 1 part 50% glucose with 4 parts water for injecon, give 5ml/kg at 2ml per minute ◦ Child 10 years and over and adult — 50% glucose 50ml • When regains consciousness ◦ If BGL less than 4mmol/L — give simple sugar/glucose ◦ If BGL 4mmol/L or more — give long lasng carbohydrate • See Follow-up (below) Follow-up • Check BGL again 30 minutes aſter last test ◦ If BGL less than 4mmol/L — repeat treatment • Check BGL hourly — unl BGL more than 5mmol/L on 2 tests in a row ◦ Will take longer if ▪ Kidney failure, liver failure, sepsis not ruled out. Medical consult ▪ Taken blood glucose lowering medicine — takes long me to wear off. Medical consult CARPA Standard Treatment Manual a clinical manual for primary health care practitioners Grounded in evidence based practice and practicalities of remote context. Unique to remote context. ‘For the user by the user’ – user input at all stages of development. Brief, easy-to-read ‘cookbook’ style. Guides diagnosis and treatment. Remote Primary Health Care Manuals suite • CARPA Standard Treatment Manual • Minymaku Kutju Tjukurpa—Women’s Business Manual • Clinical Procedures Manual for Remote and Rural Practice • Medicines Book for Aboriginal and Torres Strait Islander Health Practitioners and Health Workers Freely available online at http://www.remotephcmanuals.com.au/home.html Developed CARPA Inc. May 2017 [email protected] Conditions common or clinically significant in remote practice Supports a cycle of care incorporating collaborative practice Colour coded topics for easy navigation Provides standardised and coordinated clinical care Guides supply or administration of medicines within legislative parameters Not intended to replace clinical judgement, expertise or appropriate referral Promotes patient recall and follow up Pictorial navigation tool Used by health professionals, including Aboriginal and Torres Strait Islander health practitioners and workers, doctors and nurses Short directives guide clinical care Coloured text boxes high light important or life saving information Focus on what makes a difference to clinic practice and health outcomes Standard Treatment Manual features: easily understood simple language standardised layout
Transcript of CARPA Standard Treatment Manual · 2017. 10. 13. · CARPA Standard Treatment Manual a clinical...
94
Low blood glucose (hypoglycaemia)
When BGL low enough to cause symptoms and signs. • Person with usually high BGL may have symptoms with higher BGL, eg
5–6mmol/L • For newborn — see If low blood glucose (WBM p74)
If decreased level of consciousness, behaving oddly, serious infection, serious overdose, fit — always test BGL�Many causes, eg alcohol, oral glucose control medicines, aspirin, beta-blockers, insulin, toxins.
Signs and symptoms of low blood glucose • Person may
◦ Be sweaty, pale, clammy, taking deep breaths ◦ Be hungry, weak, tired, dizzy, have the shakes ◦ Be drowsy, confused, tearful, behave differently, appear 'drunk' ◦ Be aggressive, suspicious, potentially dangerous ◦ Have fits (p60), lose consciousness
• Newborns and infants may have ◦ Poor tone (floppiness), weak cry, poor feeding, breathing problems
(stopping breathing [apnoea], cyanosis), tremor, seizures
Ask • If on any medicines — have they taken them, could they have taken
someone else's • If child — could they have taken medicines or alcohol • Have they eaten that day, what (any carbohydrate foods) • Any vomiting and/or diarrhoea • Unwell recently, eg sepsis, fever and chills, cough, urinary problems
Check • Temp, pulse, BP, RR, O2 sats • BGL. If less than 4mmol/L — treat • Coma scale score (p78) • Do they have right medicines — check bottles/packets, dose aid
If person unconscious — Life support – DRS ABC D (p2).
Low blood glucose — treatment needed when BGL less than 4mmol/L.
95
Low blood glucose (hypoglycaemia)
Emer
genc
ies a
nd a
sses
smen
tsDoIf person conscious and can eat and drink
• Give simple (fast acting) sugar/glucose (equal to 15g carbohydrate), eg200ml diluted cordial, 6 jelly beans, 60ml of 75g OGTT mix, 90ml of glucose drink, 2–3 teaspoons of sugar
• Medical consult • Check BGL after 10 minutes
◦ If BGL less than 4mmol/L — give more simple sugar/glucose ◦ If BGL 4 mmol/L or more — give long lasting (slow release) carbohydrate
(starch), eg 4 dry biscuits/crackers, 1½ Weetbix, 1–2 slices bread or damper, 1 piece of fruit, 1 cup of milk
• See Follow-up (below)
If person unconscious or unable to eat or drink • See Life support – DRS ABC D (p2) • Medical consult as soon as possible, but don't delay treatment • If any chance they are long term or regular heavy drinker of alcohol (grog) —
give thiamine IV 300mg before glucose and daily for another 2 days • Give glucagon IM
◦ Child 5 years and under — 0.5mg ◦ Child over 5 years or adult — 1mg
• If glucagon not available OR no response to glucagon after 5 minutes — putin IV cannula (CPM p85) and give ◦ Child under 10 years — 10% glucose 5ml/kg at 2mls per minute
▪ If 10% glucose not available — dilute 1 part 50% glucose with 4 parts water for injection, give 5ml/kg at 2ml per minute
◦ Child 10 years and over and adult — 50% glucose 50ml • When regains consciousness
◦ If BGL less than 4mmol/L — give simple sugar/glucose ◦ If BGL 4mmol/L or more — give long lasting carbohydrate
• See Follow-up (below)
Follow-up • Check BGL again 30 minutes after last test
◦ If BGL less than 4mmol/L — repeat treatment • Check BGL hourly — until BGL more than 5mmol/L on 2 tests in a row
◦ Will take longer if ▪ Kidney failure, liver failure, sepsis not ruled out. Medical consult ▪ Taken blood glucose lowering medicine — takes long time to wear off.
Medical consult
CARPA Standard Treatment Manuala clinical manual for primary health care practitioners
Grounded in evidence based practice and practicalities of remote context.
Unique to remote context.
‘For the user by the user’ – user input at all stages of development.
Brief, easy-to-read ‘cookbook’ style.
Guides diagnosis and treatment.
Remote Primary Health Care Manuals suite• CARPA Standard Treatment Manual• Minymaku Kutju Tjukurpa—Women’s Business
Manual• Clinical Procedures Manual for Remote and
Rural Practice• Medicines Book for Aboriginal and Torres Strait
Islander Health Practitioners and Health WorkersFreely available online athttp://www.remotephcmanuals.com.au/home.html Developed CARPA Inc. May 2017
Conditions common or clinically significant in remote practice
Supports a cycle of care incorporating collaborative practice
Colour coded topics for easy navigation
Provides standardised and coordinated clinical care
Guides supply or administration of medicines within legislative parameters
Not intended to replace clinical judgement, expertise or appropriate referral
Promotes patient recall and follow up
Pictorial navigation tool
Used by health professionals, including Aboriginal and Torres Strait Islander health practitioners and workers, doctors and nurses
Short directives guide clinical care
Coloured text boxes high light important or life saving information
Focus on what makes a difference to clinic practice and health outcomes
Standard Treatment Manual features: easily understood simple language standardised layout
