Hypoglycaemia - Acute Management - Abcde
Hypoglycaemia - Acute Management - Abcde
Hypoglycaemia - Acute Management - Abcde
Emergency Medicine
This guide has been created to assist students in preparing for emergency simulation
sessions as part of their training. It is not intended to be relied upon for patient care.
Clinical features of
hypoglycaemia
Hypoglycaemia can present in a variety of different ways. It is a diagnosis that can be
easily missed if you don’t consider it as the cause for your patient’s symptoms.
Reference ranges
Autonomic:
Sweating
Palpitations
Tremor
Hunger
Neuroglycopenic:
Confusion
Drowsiness
Odd behaviour
Speech difficulty
Incoordination
General malaise:
Nausea
Headache
These symptoms can have an insidious onset. It is always possible that the patient is
also suffering from another condition (e.g. a UTI), which can present with similar
symptoms. Consider hypoglycaemia in anyone presenting with these symptoms but
especially those with risk factors.
Any patient with an altered level of consciousness should have hypoglycaemia ruled
out.
Tips before you begin
Treat all problems as you find them
Re-assess regularly and after every intervention to see if your management is effective
Make use of the team around you to delegate tasks where appropriate
All critically unwell patients should have continuous monitoring equipment attached for
accurate observations including:
Blood pressure
3-lead ECG
Oxygen saturations
Heart rate
Respiratory rate
Communicate how often you would like these observations to be relayed to you
Call for help early using an appropriate SBARR handover structure (check out the
guide here)
You need to both request investigations and review results as they become available
You don’t have to memorise everything off by heart, ask
for guidelines and algorithms that are relevant (i.e. hypoglycaemia protocols)
If you would like medications or fluids, these will need to be prescribed
Don’t forget to document everything you have found and done in the patient notes!
Initial steps
You are likely to be called to see this patient either:
Inspection
If you are assessing the patient outside of the hospital setting (e.g. pre-hospital
care) you need to assess for danger before approaching the patient:
A collapsed casualty may be under the influence of drugs or alcohol and could be violent
when roused, so be aware of this.
If you see that multiple people have collapsed, be aware of the possibility of chemical,
biological, radiological and nuclear causes (e.g. carbon monoxide poisoning). The “Rule of
Three” is sometimes used to help decide on how to approach in this situation:
If there is 1 collapsed casualty, proceed as normal
If there are 2 collapsed casualties, with no obvious explanation (e.g. road traffic
collision), approach with extreme caution (call 999 before you approach)
If there are 3 or more collapsed casualties, with no obvious explanation, do not
approach and call 999, requesting specialist support
Once you reach the patient, perform a quick general inspection to get a sense of
how unwell they are:
If the patient is unconscious, check for a pulse and check that the patient is breathing.
If the patient is unconscious or unresponsive and not breathing start the basic
life support (BLS) algorithm as per resuscitation guidelines. Call 2222 for help!
Interaction
Introduce yourself to the patient even if they appear unconscious as they may still be
able to hear you.
If the patient is able to answer questions- ask them how they are feeling.
Preparation
Patient notes
Drug charts including diabetes charts!
Observations charts
Airway
Assessment
Assess the patient’s ability to speak, listen to the patient’s breathing for added
sounds and inspect the mouth.
The presence of stridor (a high pitched inspiratory noise) indicates upper airway
obstruction. In post-op bleeding, this might indicate that your patient’s consciousness level is
impaired enough to compromise airway patency (the brain is being hypoperfused).
Intervention
If you think your patient has a compromised airway you need help. Put out a crash call
immediately as you require urgent anaesthetic input to secure the airway. You can
perform some simple airway manoeuvers in the meantime.
Breathing
Assessment
Respiratory rate:
Examination
Auscultate both lungs:
Reduced air entry bilaterally suggests significant airway compromise and the need for
critical care input.
Investigations
Chest x-ray
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