Diabetic emergencies, patient education, and professional issues

Diabetic emergencies

Diabetes mellitus is caused by a malfunction in the production of insulin in the pancreas or by an inability of the cells to use insulin. Insulin is required on the cellular level so that glucose can be used for energy. Two different diabetic emergencies can occur, one caused by hyperglycemia (high blood glucose levels) and the other by hypoglycemia (low blood glucose levels).

Insulin shock is caused by severe hypoglycemia, which results when a patient with diabetes takes too much insulin, does not eat enough food, or exercises an unusual amount. Signs and symptoms, which have a rapid onset, include tachycardia, profuse sweating (diaphoresis), headache, irritability, vertigo, fatigue, hunger, seizures, and coma. If the patient is conscious and able to swallow safely, provide glucose immediately, preferably in the form of glucose tablets, which have a known, concentrated quantity of glucose; never give anything by mouth to a patient who is unconscious or seizing, since this risks aspiration - call for emergency help instead.

Diabetic coma results from severe hyperglycemia, which develops because the body is not producing enough insulin; the patient eats too much food or is very stressed; or the patient has an infection. The symptoms of impending diabetic coma, which develop more slowly than those of insulin shock, include general malaise, dry mouth, polyuria, polydipsia, nausea, vomiting, SOB, and breath with an acetone (or “fruity”) smell. If the patient or caregiver calling for an appointment reports these symptoms, notify the provider immediately because the patient typically would be admitted to the hospital.

In an emergency situation, if a patient diagnosed with diabetes mellitus shows signs and symptoms of a diabetic emergency, the patient should be given glucose (if conscious and able to swallow safely). The two conditions contrast sharply: insulin shock (hypoglycemia) has a rapid onset and the patient improves quickly after receiving glucose, while diabetic coma (hyperglycemia) develops gradually and a small amount of added glucose will not affect the patient’s condition - he or she must be transported to the hospital regardless.

Patient education

Emergencies can occur anywhere. Patients need to learn how to handle emergency situations both by the example of healthcare workers and through instruction. The medical assistant must remain calm, screen the situation, call for help, and be prepared to administer appropriate first aid. Brochures on home safety can be used to help teach patients methods for preventing accidents in the home.

All patients, even children, should understand how to contact EMS. This is especially important for families with members who have chronic diseases that can be life-threatening, such as heart conditions, severe allergic reactions, diabetes, and asthma. Patients should be encouraged to post important numbers next to the telephone; these include emergency numbers (local EMS and poison control center) and the primary care provider’s number. Families with young children must child proof their homes, taking special care to keep potentially poisonous substances stored where children cannot get into them. Placing “Mr. Yuk” stickers on containers of poisonous substances can be an excellent educational tool for young children.

Medical assistants must remember to keep their American Red Cross or AHA certifications current, and they should take advantage of community workshops to maintain and extend their skills. Also, a list of community safety workshops should be posted in an area where patients can see it, and they should be encouraged to attend. Your participation in emergency care workshops, in addition to encouraging others to participate, may help to save lives.

Legal and ethical issues

The medical assistant works in the healthcare environment as the provider’s agent. Although you are responsible for your own actions, the provider is legally responsible for the care you administer to patients while working in the healthcare facility. You are responsible for knowing the limitations placed on medical assistants in your state and for adhering strictly to your employer’s emergency care policies and procedures. This scope of practice is set by state law and by the provider’s delegation of specific tasks to you - not simply by your employer’s job description. Medical assistants are not qualified to diagnose a patient’s problem, but they are responsible for acting appropriately in a medical emergency.

Most states have enacted Good Samaritan laws to encourage healthcare professionals to provide medical assistance at the scene of an accident without fear of being sued for negligence. These statutes vary greatly, but all have the intent of protecting the caregiver. A provider or other healthcare professional is not legally obligated to provide emergency care at the site of an accident, regardless of the ethical and moral considerations. Legal liability is limited to gross neglect of the victim or willfully causing further injury to the victim. As a caregiver, you are required to act as a reasonable person and cannot be held liable for personal injury resulting from an act of omission. Good Samaritan statutes provide for evaluation of the caregiver’s judgment but are in effect only at the site of an emergency, not at your place of employment.

If you have not been trained in CPR, you cannot be expected to perform the procedure at the emergency site. However, in many states, a healthcare provider with CPR training and skills who is present at the scene can be declared negligent if cardiac arrest occurs and he or she does not administer CPR to the victim.

If the victim is conscious or if a member of his or her immediate family is present, obtain verbal consent to perform emergency care. Consent is implied if the patient is unconscious and no family member is present.

Medical assistants also can play a key role in the community response to natural or human-caused disasters. The medical assistant is cross-trained to perform multiple administrative and clinical duties that would prove very useful in an emergency. These include management of medical records, interacting professionally with patients, performing diagnostic tests, performing phlebotomy and administering medications, assisting with procedures, and administering first aid and CPR as needed. Because of their wide range of skills, medical assistants serve as useful volunteers on local emergency response teams. Investigate agencies and organizations that are committed to emergency preparedness in your community and see how a medical assistant could help these organizations if an emergency arises.

Professional behaviors

In addition to legal responsibilities, you have an ethical responsibility to your patients to provide the highest standard of care. Always act in the best interest of the patient, and never hesitate to ask the provider and/or the office manager for immediate assistance when faced with a medical emergency. Many types of emergencies can be handled in the provider’s office. In an emergency situation, decisions that must be made quickly can determine whether the patient lives. A medical assistant must be prepared to act calmly and efficiently in all emergency situations.

Critical thinking is a crucial part of managing medical emergencies. The ability to ask pertinent questions, consider all available information, and distinguish between relevant and irrelevant patient feedback can make the difference in the immediate management of an emergency situation. Both the provider and the patient rely on the professional medical assistant when he or she is managing potentially serious phone calls and/or caring for a patient with a medical emergency in the healthcare setting.