The goal of prehospital treatment is to protect and maintain the airway and treat shock, if present. Every child with this diagnosis should receive supplemental oxygen and have an IV with normal saline started. Administer a bolus of saline (20 ml/kg body weight). A second or third bolus may be necessary, especially where transport times are lengthy. As always, determine the blood sugar, and recheck it if transit times are prolonged. Since nausea and vomiting frequently occur, be prepared to utilize standard maneuvers to prevent aspiration of stomach contents.
The mainstay of treatment is intravenous insulin, usually administered as a continuous infusion. It is a rare region of the country where this is an approved protocol for the prehospital provider. Since in most cases this is not an option, rapid transfer to an appropriate facility is the order of the day.
Caring for pediatric emergency conditions is always stressful for the prehospital provider. The fact that diabetic conditions are fairly common does not reduce this stress level. The key to providing appropriate evaluation and management of the child with a diabetic emergency is to become familiar with the possible presentations you’re likely to encounter. These presenting symptoms may be variable, potentially leading to incorrect diagnoses. Such familiarity will decrease stress and allow the provider to deliver optimum care.
Bernard Beckerman, MD, FACEP, is an associate professor in the Physician Assistant Program at York College-City University of New York, deputy chief for medical affairs for the Plainview Fire Department and a longtime member of EMS World’s editorial advisory board.
John Graffeo, MS, RPA-C, is an associate professor and clinical coordinator in the Physician Assistant Program at York College (CUNY) in Jamaica, NY.