Hypoglycaemia in a child at a school carnival

Patient Information

Dispatch: You are called to a patient (Liam Carter, 8-year-old male) who has come to the First Aid Post during a school carnival. His teacher reports he is acting strangely and complaining of feeling shaky.
Patient: Liam Carter — 8yr (26kg)
Incident History: Pt is an 8-year-old known diabetic who has been participating in the school carnival. Teacher states he missed his morning snack and has been running races for the past hour. Now appears pale, shaky and confused.
Emergency Contact: Sarah Carter (Mother) — 0412 384 917

Initial Rapid Assessment

Response: Voice
Airway: Patent. Nil airway obstruction. Nil airway swelling or stridor.
Breathing: Adequate. RR slightly elevated. No increased work of breathing. Nil audible wheeze or crackles.
Circulation: Radial pulse rapid and weak. Skin pale and diaphoretic. Nil bleeding.
Disability: GCS 13 (E3V4M6). Confused. Not orientated to time or place. Knows his own name.
Exposure: Nil visible injuries. Pale, sweaty appearance. No rash. Medic-Alert bracelet on left wrist indicating Type 1 Diabetes.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	97% (RA)	Nil	24	118	90/60	2s	13	4 4 ++	36.8	2.3 mmol/L	0
10 mins	98% (RA)	Nil	18	96	100/65	<2s	15	4 4 ++	36.8	5.8 mmol/L	0

History Taking

Treatment Response

Diagnosis

This patient is suffering from hypoglycaemia (BGL 2.3 mmol/L) secondary to increased physical exertion and a missed snack in a known Type 1 Diabetic child.

Facilitator Triggers — if trainees miss a critical step

! (If BGL is not checked within the first 3 minutes of assessment, the patient becomes increasingly confused — GCS drops to 11 — and begins to tremble more visibly. Facilitator prompts: 'Liam isn't making sense anymore and his teacher is very worried.')
! (If glucose gel is not administered after BGL result is obtained, patient becomes drowsy at the 5-minute mark — GCS 10 — and is no longer able to safely ingest oral carbohydrates. Facilitator prompts: 'Liam's eyes are drooping and he's not responding to your questions.')
! (If post-treatment BGL is not reassessed at 10 minutes, facilitator prompts: 'His teacher asks if he is getting better — how do you know?')

Treatment Objectives

1 Ensure scene safety and don appropriate PPE.
2 Perform Primary Survey — confirm airway patent, breathing adequate, circulation present.
3 Note Medic-Alert bracelet indicating Type 1 Diabetes.
4 Perform blood glucose level (BGL) test — result: 2.3 mmol/L (hypoglycaemia confirmed: BGL < 4 mmol/L).
5 Assess GCS — GCS 13, patient is confused but responsive to voice. Oral administration is NOT yet safe for GCS <15; reassess closely.
6 Note: GCS is 13 — patient cannot safely self-administer or independently ingest glucose. Administer Glucose Oral Gel 15g (entire contents of one tube) in small amounts into the buccal (cheek) mucosa as per paediatric instructions, titrating to effect.
7 Administer Glucose Oral Gel 15g buccally — administered in small amounts, titrating to effect. Indication: BGL 2.3 mmol/L with altered GCS in known diabetic child.
8 Position patient seated or semi-recumbent — do NOT leave unattended.
9 Consider oxygen therapy if SpO2 drops below 94% — currently 97% on room air, not indicated at this time.
10 Perform Vital Sign Survey — record full observations including GCS, BGL, SpO2, HR, RR, BP, CRT.
11 Reassess GCS and BGL at 10 minutes — expected BGL improvement to approximately 5.8 mmol/L; GCS should improve to 15.
12 Once GCS is 15/15 and patient is alert, provide a complex carbohydrate follow-up snack (e.g. a sandwich or crackers) to prevent delayed hypoglycaemia. Advise teacher and contact parent.
13 Contact emergency contact (mother — Sarah Carter, 0412 384 917) to inform her of the episode and management.
14 Encourage transport to hospital for further assessment and review by medical team, even if patient has recovered.
15 Continue to monitor patient persistently while awaiting parent/ambulance arrival. Repeat BGL every 10 minutes.
16 Scenario ends on arrival of ambulance and IMISTAMBO handover.
17 Attention to hand hygiene will be given throughout the scenario.

Clinical references: Hypoglycaemia · Blood Glucose Monitor · Glucose Oral Gel · Primary Survey · Glasgow Coma Scale (GCS) · Pulse Oximetry

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