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Complete Refusal: The patient refuses to be evaluated by EMS entirely. Evaluation with Refusal: The patient allows EMS to perform an evaluation, including vital signs and an assessment, before refusing further care or transport. Partial Refusal: The patient consents to some aspects of care but refuses specific actions, such as C-spine precautions.
On occasion, a patient will also refuse to sign the "informed refusal" document, in which case a witness would have to sign that the informed process and the refusal took place. [1] The pregnant patient represents a specific dilemma in the field of informed refusal as her action may result in harm or death to the fetus.
In patients with type 1 diabetes mellitus, as plasma glucose levels fall, insulin levels do not decrease – they are simply a passive reflection of the absorption of exogenous insulin. Also, glucagon levels do not increase. Therefore, the first and second defenses against hypoglycemia are already lost in established type 1 diabetes mellitus. [2]
However, diabetes does cause higher morbidity, mortality and operative risks with these conditions. [41] Diabetic foot, often due to a combination of sensory neuropathy (numbness or insensitivity) and vascular damage, increases rates of skin ulcers (diabetic foot ulcers) and infection and, in serious cases, necrosis and gangrene. It is why it ...
Diabetic coma was a more significant diagnostic problem before the late 1970s, when glucose meters and rapid blood chemistry analyzers were not available in all hospitals. In modern medical practice, it rarely takes more than a few questions, a quick look, and a glucose meter to determine the cause of unconsciousness in a patient with diabetes.
Due to its original formulation containing large amounts of glucose, the soft drink Lucozade was recommended by diabetes charities in the United Kingdom as an immediate treatment for hypoglycemia; however, as the drink was reformulated to replace much of its glucose content with artificial sweeteners, this is no longer recommended.