Ok, just so you won't panic, this article is not going to be a big clinical lecture. There are professionals out there who can cover these topics atlength and with much greater accuracy than I can.

I do however want to discuss these two topics and how they affect us as EMS professionals in the field.

A big percentage of our patients as EMS providers are elderly. In fact on a national level approximately 34% of emergency medical calls (3.4 million responses) involve patients over the age of 60. Many of these patients have diabetes and/or dementia. This along with their increased risk of cardiac episodes and CVA's make it more and more difficult to tell the difference between these conditions.

As providers we must take these patients both seriously and professionally which will help us make the best clinical judgment in the field as we can.

One of the most troubling is when a patient has both diabetes and dementia and the call is for a change in mental status. It is very important to get a complete history leading up to the event such as last meal, medication administration , and if the change is sudden or gradual.

Knowing whether the patient ate a proper meal for their condition or whether the change was gradual can be key indicators of the event. Another great diagnostic tool is using a glucometer to check sugar levels. Unfortunately not all EMS systems allow them to be used in the field. While you may use the patients tester if available, there is no guarantee that it is calibrated correctly and whether it is giving you a proper reading.

This is why we must use all our resources to tell the difference between a hypoglycemic event, increase in dementia or possibly a CVA. Noting signs and symptoms such as skin color, temperature, blood pressure, neurological examination and EKG's can also help us in our diagnosis.

In addition if you feel that the event is not one related to diabetes and feel it is more due to the patients dementia it is important to note that patients who, because of a cardiac episode or a stroke, may appear to be suffering from dementia. Many geriatric patients may appear confused because of their disease, not because they are old.

For us as EMS providers, our resources are limited without a CT-Scan and complete blood work ups etc. Therefore our treatment at times is based more on protocols and the need to do something rather than just stand by. Most standing protocols allow the administration of Dextrose via IV for altered mental status patients. The concern however is if the patient is having a CVA that it can do more harm than good.

This is why you must take a good history and know the signs and symptoms of these illnesses. Doing this will help you treat the patient appropriately.

As always, I stress the basics in all that is EMS. If you stick with the basics of patient history and signs and symptoms you will avoid critical mistakes. This way when you enlist more advanced techniques and procedures you can be confident that you are treating correctly. Especially since you covered the basic skills that are always necessary as an EMS provider

Jim Hoffman is a contributor to EMS Solutions.
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