@LooperCat, I've never required the assistance of a paramedic for diabetic reasons - just wondered what the procedure is if paramedics are called to an unresponsive person (but alive!)
We follow the same procedure for any patient - DR ABCDE
D - check scene for danger as we approach, to ourselves, patient, anyone around. Any catastrophic haemorrhage? Deal with that first. Mechanism of injury?
R - response, using AVPU scale. Are they Alert, responding to Voice, Pain or Unresponsive? Check neck for any injury.
A - airway - is it clear? Anything blocking mouth or nose? Teeeth, tongue, vomit (suction this) etc... head tilt/chin lift to open airway. Consider using an airway adjunct to keep it open. Check carotid pulse - if absent, commence life support - (CPR, attach pads for defibrillation and analyse electrical output of heart. Shock if in a shockable rhythm, recommence chest compressions, reasses every two minutes. Insert an airway and give high flow oxygen, one ventilation every 5-6 seconds. . Gain IV access (if the veins have collapsed consider intraosseus access - by drilling into a bone to get a cannula in) and give adrenaline and then consider amiodarone after the third shock.)
Breathing - rate per minute? If >30 or <10, assist ventilation using a bag valve mask and oxygen. Look at depth, evenness and if there is a bilateral rise and fall of the chest - consider pneumothorax. Listen to to lungs with a stethoscope.
C - circulation. Rate, rhythm, character of heartbeat - bounding, thready, regular? Take blood pressure and oxygen saturation. Assess colour of patient - are they a bit blue? Heart rate should be 60-100. Listen to the heart. 12-lead ECG and analysis of the electrical activity of the heart - we can see where a clot may be causing issues in the coronary arteries from this.
D - disability - this would be where we measure blood glucose. No point doing it until the ABCs are sorted. We would check responsiveness of pupils, Glasgow coma scale, that sort of thing. If hypoglycaemic, we’d decide whether to try glucagon or just go straight for IV glucose. That’s delivered as a 10% solution in 100ml/10g boluses to a total of 300ml/30g glucose in total. Reasses BG after 10 minutes. Hopefully they’ll come around, if not...
E - expose and examine - if the patient is still unresponsive, we cut the clothes away (is as dignified a manner as possible, using blankets to cover them) and do a top to toe examination - looking for discolouration, deformation, crepitus, contusion, abrasions, avulsion, penetration, puncture (needle marks between toes for example - could be due to drugs so consider Narcan), bruising, burns, lacerations, tenderness, temperature, swelling and symmetry. We deal with injuries at this point.
Now that all looks very long and laborious but DR are done in a matter of seconds as you approach. You ask anyone present what’s happened, and crack on with securing the airway. We have this stuff so comprehensively hammered into us that you just work as a team, communicate (even if you’ve never worked with these people before) get the stuff done and hopefully get your patient in a better condition than when you found them. ABC is a finely honed and rehearsed procedure - so once the time critical things are sorted, we can start looking at the other reasons for unresponsiveness - drugs, hypo, injury etc. A lot of this problem solving depends on what history we can get - a good look around the room can tell us a lot. Diabetics often have a lot of paraphernalia around, especially T1s! We gather prescriptions/medications and look up potential side effects as well. Then we decide as a crew, and sometimes call control for advice from a grown up, where to take them - A&E, the cath lab for heart attacks, stroke unit etc. All the info we’ve gathered helps us to reach a working diagnosis and then choose the best pathway. Most hypo diabetics can be stabilised and left at home, we wait until they are steadily and reliably over 5mmol before doing that though.
Hope that answers your question? Mx
