UNRESPONSIVE DIABETIC PATIENT A diabetic patient found unresponsive should immediately make you think about hypoglycemia first because it is common, rapidly fatal if untreated, and quickly reversible. Most likely causes (based on typical NREMT logic): 1. Hypoglycemia 2. Seizure 3. Opioid overdose Hypoglycemia is prioritized because diabetic patients frequently experience low blood glucose, and it can cause altered mental status, seizures, or unconsciousness. BEST SOURCE OF INFORMATION ABOUT AN EVENT When determining the best witness to obtain history from, choose the person who was present during the event. Best choice in this scenario:A student in the dorm room. Reason:They likely witnessed the onset of symptoms and can provide the most accurate timeline. Police or family members usually have secondhand information. INSULIN PUMP MANAGEMENT If a diabetic patient using an insulin pump becomes hypoglycemic or altered, the pump may need to be deactivated. Reason:The pump may continue delivering insulin, which could worsen hypoglycemia. Deactivating it prevents further insulin administration until glucose levels are corrected. LEGAL TERM: RES IPSA LOQUITUR Definition:"Res ipsa loquitur" means the thing speaks for itself. This legal doctrine applies when negligence is obvious without needing further explanation. Example:A surgical instrument left inside a patient after surgery. WERNICKE’S ENCEPHALOPATHY Cause:Thiamine (vitamin B1) deficiency, commonly seen in chronic alcohol use. Classic triad: - Confusion - Ataxia - Ophthalmoplegia (abnormal eye movement) Important treatment principle: Give thiamine before glucose in alcoholic patients to prevent worsening neurologic injury. NIMS (NATIONAL INCIDENT MANAGEMENT SYSTEM) The main components include: PreparednessCommunications and information managementResource managementCommand and managementOngoing management and maintenance Students should also understand the Incident Command System (ICS) structure used during large incidents.

HEPATIC ENCEPHALOPATHY vs WERNICKE’S ENCEPHALOPATHY Hepatic Encephalopathy - Cause: Liver failure leading to buildup of ammonia and toxins in the blood. Signs and symptoms: - Altered mental status - Confusion - Jaundice - Ascites Pathophysiology: The liver cannot detoxify ammonia, allowing it to affect brain function. Treatment priorities: - Support airway - Oxygen - Monitor glucose - Transport Wernicke’s Encephalopathy - Cause: Thiamine (vitamin B1) deficiency, most common in chronic alcohol abuse. Classic triad: - Confusion - Ataxia - Ophthalmoplegia (eye movement abnormalities) Important exam point: Give thiamine before glucose when treating suspected alcoholic patients. IMMUNOGLOBULINS / ANTIBODIES Antibodies are proteins produced by B-cells that help identify and neutralize pathogens. Major types include: IgG - Most abundant antibody - Provides long-term immunity IgM - First antibody produced in infection - Indicates recent infection IgA - Found in mucous membranes and secretions IgE - Responsible for allergic reactions and anaphylaxis IgD - Involved in B-cell activation PUPIL SIZE Normal pupil size: approximately 2–3 mm Dilated pupils (greater than 4 mm) may indicate: - Sympathetic stimulation - Drug intoxication (stimulants, anticholinergics) - Brain injury - Hypoxia Constricted pupils (less than 1 mm) may indicate: - Opioid overdose - Organophosphate poisoning - Pontine stroke ACIDOSIS vs ALKALOSIS Acidosis occurs when blood pH is below 7.35. Common causes: - Diabetic ketoacidosis - Renal failure - Lactic acidosis - Respiratory failure Signs include: - Kussmaul respirations - Confusion - Hypotension Alkalosis occurs when blood pH is above 7.45. Common causes: - Hyperventilation - Vomiting - Diuretic use Signs include: - Muscle twitching - Tingling - Tachycardia INCOMPLETE SPINAL CORD INJURY Incomplete spinal cord injury means partial damage to the spinal cord.

ADRENAL / ENDOCRINE EMERGENCIES Addisonian Crisis Addisonian crisis is acute adrenal insufficiency and can lead to severe hypotension and shock. Common signs and symptoms include: - Severe hypotension - Weakness and fatigue - Abdominal pain - Hyponatremia - Hyperkalemia - Dehydration Treatment: - IV fluids - Hydrocortisone Key concept: Without cortisol, the body cannot maintain blood pressure during stress. Myxedema Coma Myxedema coma is a severe complication of hypothyroidism. Common signs and symptoms include: - Hypothermia - Altered mental status - Bradycardia - Hypotension - Cold intolerance - Dry skin Exam clue: A patient with known hypothyroidism who is extremely cold and has altered mental status. RESPIRATORY Bronchodilator Contraindications Bronchodilators such as albuterol stimulate beta receptors to relax airway smooth muscle. Relative contraindication: Beta blockers Reason: Beta blockers block beta receptors and can reduce the effectiveness of bronchodilators. COMMUNICATION / ETHICS Pediatric Cardiac Arrest – Communicating with Parents When informing parents about the death of a child: Important principles: - Be honest - Speak clearly - Avoid medical jargon - Show empathy - Allow time for questions Example statement: “We did everything we could to save your son, but unfortunately he died.” DIABETIC EMERGENCIES DKA vs HHS (HHNS) DKA (Diabetic Ketoacidosis): - Rapid onset - Blood glucose typically above 250 - Ketones present - Fruity breath odor - Kussmaul respirations (deep rapid breathing) - More common in younger patients HHS / HHNS (Hyperosmolar Hyperglycemic State): - Gradual onset - Blood glucose often above 600 - Little or no ketones - No fruity breath - Respirations usually normal - More common in elderly patients GERIATRIC PATIENT MOVEMENT Lifting a Patient from the Floor Best device: Scoop stretcher Reasons: - Minimizes spinal movement - Can be separated and slid under the patient - Ideal for elderly fall patients

Here's a video on today's prep. Hope it helps! Good topics to review before sitting for your exam.

You have just delivered a baby. According to current AHA guidelines, what should the newborn's target oxygen saturation (SpO2) be at 2 minutes after birth?