Hypoglycaemia

Mid complexity — Central Nervous System

Goals

  1. Recognise a compromised airway due to reduced consciousness using the ABCDE method.
  2. Describe the treatment for hypoglycaemia and apply it.
  3. Recognise and describe hypoglycaemia.

Anamnese

  • Name: Mr de Lange
  • Age: 67 years
  • Family: Married
  • Occupation: Carpenter
  • Cultural: Not known

AMPLE

A: Unknown

M: Aspirin, metformin, gliclazide, insulin glargine

P: Renal impairment, myocardial infarction, type II diabetes

L: Last night

E: Abdominal complaints for 3 days, now fasting for abdominal ultrasound

SBAR

S: Mr de Lange is admitted to your ward for observation of abdominal complaints. He is being kept fasting for a planned abdominal ultrasound. Your colleague is now asking you to check on him because he does not appear to be responding normally.

B: Mr de Lange is 67 years old and has a history of renal impairment, myocardial infarction and type II diabetes.

A: See ABCDE

R: Please assess the patient using ABCDE and apply interventions where necessary.

Situation at the start of scenario

A: Compromised airway, snoring breathing.

B: RR 12 breaths/min, normal depth, symmetrical thoracic excursions, normal jugular veins, normal breath sounds, saturation 89%.

C: Normal colour, CRT 2 sec, HR 105 bpm, strong regular pulse, skin lukewarm and clammy, BP 145/80.

D: Voice on AVPU, glucose 1.1, pupils PEARL.

E: Temp 36.9°C, no oedema. Urine output: spontaneous 200 ml 3 hours ago.

Situation at the end of scenario

A: Compromised airway, snoring breathing.

B: RR 12 breaths/min, normal depth, symmetrical thoracic excursions, normal jugular veins, normal breath sounds, saturation 85%.

C: Ashen colour, CRT 2 sec, HR 91 bpm, strong regular pulse, skin lukewarm and clammy, BP 132/80.

D: Pain on AVPU, glucose 1.0, pupils PEARL.

E: Temp 36.4°C, no oedema.

Recommendations

  • Recheck glucose level