to stupor and coma. Blood pressure falls, and the pulserate becomes rapid and weak. Respirations are deep,and a sickly sweet acetone odor is present on thebreath. The skin is warm and dry.NOTE: Diabetic victims are often mistakenlytreated as if intoxicated since the signs andsymptoms presented are similar to those ofalcohol intoxication.The diabetic under treatment tries to balance theuse of insulin against glucose intake to avoid the aboveproblems. The victim or the victim’s family may beable to answer two key questions:1. Has the victim eaten today?2. Has he taken the prescribed insulin?If the answer is yes to the first and no to the secondquestion, the victim is probably in a diabetic coma.Emergency first aid centers around ABC support,administration of oral or intravenous fluids to countershock, and rapid evacuation to a medical officer’ssupervision.Insulin ShockInsulin shock results from too little sugar in theblood (hypoglycemia). This type of shock developswhen a diabetic exercises too much or eats too littleafter taking insulin. Insulin shock is a very seriouscondition because glucose is driven into the cells to bemetabolized, leaving too little glucose in circulation tosupport the brain. Brain damage develops quickly.Signs and symptoms of insulin shock includepale, moist skin;dizziness and headache;strong, rapid pulse; andfainting, seizures, and coma.Treatment is centered on getting glucose into thesystem quickly to prevent brain damage. Placing sugarcubes under the tongue or administering oral liquidglucose are the most beneficial treatments. Transportthe victim to a medical treatment facility as soon aspossible.NOTE: If you are in doubt as to whether thevictim is in insulin shock or a ketoacidoticstate, give them sugar. Brain damage developsvery quickly in insulin shock and must bereversed immediately. If the victim turns outto be ketoacidotic, a condition that progressesslowly, the extra sugar will do no appreciableharm.CEREBROVASCULAR ACCIDENTA cerebrovascular accident, also known as strokeor apoplexy, is caused by an interruption of the arterialblood supply to a portion of the brain. Thisinterruption may be caused by arteriosclerosis or by aclot forming in the brain. Tissue damage and loss offunction result.Onset of a cerebrovascular accident is sudden,with little or no warning. The first signs includeweakness or paralysis on the side of the body oppositethe side of the brain that has been injured. Muscles ofthe face on the affected side may be involved. Thepatient’s level of consciousness varies from alert tounresponsive. Additionally, motor functionsincluding vision and speechon the affected side aredisturbed, and the throat may be paralyzed.Emergency treatment for a cerebrovascularaccident is mainly supportive. Special attention mustbe paid to the victim’s airway, since he may not be ableto keep it clear. Place the victim in a semi-recliningposition or on the paralyzed side.Be prepared to use suction if the victim vomits.Act in a calm, reassuring manner, and keep anyonlookers quiet since the victim may be able tohear what is going on.Administer oxygen to combat cerebral hypoxia.Carefully monitor the victim’s vital signs andkeep a log. Pay special attention to respirations,pulse strength and rate, and the presence orabsence of the bilateral carotid pulse.Transport the victim to a medical treatmentfacility as soon as possible.ANAPHYLACTIC REACTIONThis condition, also called anaphylaxis oranaphylactic shock, is a severe allergic reaction toforeign material. The most frequent causes areprobably penicillin and the toxin from bee stings,although foods, inhalants, and contact substances canalso cause a reaction. Anaphylaxis can happen at anytime, even to people who have taken penicillin manytimes before without experiencing any problems. Thiscondition produces severe shock and cardiopulmonaryfailure of a very rapid onset. Because of the rapidity4-67
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