12. Red flags and emergency escalation
Any of the following is acted on immediately. EMS is activated first for life threats; provider notification and orders follow.
Red flags — act immediately Severe hypoglycemia — confusion, seizure, or unresponsiveness → treat per protocol, give glucagon per order, and activate EMS if the patient cannot safely take oral carbohydrate or does not rapidly improve. Diabetic ketoacidosis or hyperosmolar state — very high glucose with dehydration, Kussmaul or fruity breath, and altered mentation → activate EMS (cross-reference Diabetes overlay). Adrenal crisis — hypotension, profound weakness, and altered mentation in a steroid-dependent patient or after abrupt steroid stop → activate EMS and give hydrocortisone per order. Thyroid storm (high fever, tachycardia or atrial fibrillation, agitation, confusion) or myxedema (hypothermia, bradycardia, obtundation) → activate EMS (cross-reference Neck/Thyroid). A new foot ulcer or new loss of protective sensation → notify; high amputation risk (cross-reference Wounds and Touch/Sensation). A serious insulin dosing error → monitor glucose closely, treat per protocol, and notify the provider. |
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