13d • Paramedic Talk
Today's MUST know to pass the national
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):
- Hypoglycemia
- Seizure
- 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.
RAPID BREATHING WITH NUMBNESS IN HANDS AND AROUND MOUTH
Cause:Hyperventilation leading to hypocarbia (low CO₂ levels).
Low CO₂ causes cerebral vasoconstriction and changes in calcium ion balance, leading to symptoms such as:
- Tingling in hands
- Tingling around mouth
- Dizziness
- Anxiety
This is commonly seen in panic attacks or hyperventilation syndrome.
DIPLOPIA
Diplopia means double vision.
It can occur in conditions such as:
- Stroke (especially posterior circulation strokes)
- Cranial nerve palsy
- Brain injury
- Multiple sclerosis
If diplopia appears with other neurological deficits, suspect a neurological emergency.
PULMONARY EMBOLISM RECOGNITION
Common exam presentation:
- Sudden shortness of breath
- Clear lung sounds
- Pain with inspiration (pleuritic chest pain)
- Low oxygen saturation
- Tachycardia
These findings are classic for pulmonary embolism.
Remember: lungs are often clear because the problem is with blood flow, not airflow.
INTRAMUSCULAR INJECTION SITES
Common IM injection sites include:
Deltoid muscleVastus lateralis muscleRectus femoris muscleVentrogluteal muscle
These are the safest and most commonly tested sites.
NERVE AGENTS
Examples of nerve agents include:
SarinVXTabunSoman
Lewisite is actually a blister agent, not a nerve agent.
Therefore, the correct nerve agents in that question were likely Sarin and another nerve agent such as VX.
FUNCTION OF INSULIN
Insulin allows glucose to move from the bloodstream into cells where it can be used for energy.
Key concept:
Insulin lowers blood glucose by facilitating glucose uptake into cells.
Without insulin, glucose remains in the bloodstream, leading to hyperglycemia.
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Today's MUST know to pass the national
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Calling ALL future EMTs & Paramedics. Let's PASS the National Registry on the FIRST attempt.
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