【优质】Work package Treatment Pathway and care guidelines for Diabetic.docVIP

Treatment Pathway and care guidelines for Diabetic Ketoacidosis and Hyperglycaemic Hyperosmolar State Diagnostic Tool / Criteria For diagnostic criteria see Management of Diabetic Ketoacidosis and Hyperglycaemic Hyperosmolar State (DKA and HHS) guidelines (already submitted). Community treatment and referral pathway First aid guidelines for GP, patient will need admission if: Blood sugar greater than 14, despite treatment adjustments Ketones equal to or greater than 2 Any signs and symptoms of DKA / HHS Refer to medical team on call and admit to acute medical admission ward for assessment. First aid guidelines for ambulance crew / paramedics Follow medical emergencies guideline Ensure airway maintained Ensure high flow O2 therapy Obtain IV access, and commence rehydration using sodium chloride intravenous 0.9%, 250mls rapidly (up to 20ml/kg in children) and then reassess vital signs, preferably on route to hospital If vital signs and perfusion improve, slow down infusion “to keep vein open” rate If no improvement, give a further 250mls and reassess, repeating process to maximum 2 litres of fluid (40ml/kg in children). Provide hospital alert message / information call and transport to nearest receiving hospital for urgent hospital treatment. Acute DKA and HHS pathway Follow Management of Diabetic Ketoacidosis and Hyperglycaemic Hyperosmolar State (DKA and HHS) guidelines (already submitted). For prescription and treatment in ward areas see Guideline for the management of blood sugars in Hyperglycaemic emergencies in adults with Diabetes (Diabetic ketoacidosis (DKA) and Hyperglycaemic Hyperosmolar State (HHS)) (already submitted). In practice this form is colour coded to yellow, ICP should follow this. Discharge procedure Before discharge patient should be seen by Diabetes Specialist Nurse for education regarding sick day rules. Follow up appointment with Diabetologist Referral to community DSN for ongoing support and contact advice. Prevention and self mana