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Personal cabinetPrehospital management of type 1 diabetes mellitus: a critical analysis of common diagnostic and therapeutic errata
Бібліографічний опис статті:
Asimionese Vitalii. Prehospital management of type 1 diabetes mellitus: a critical analysis of common diagnostic and therapeutic errata//Наука онлайн: Міжнародний електронний науковий журнал - 2026. - №4. - https://nauka-online.com/publications/medicine/2026/4/02-51/
Анотація: (English) The subject of the present research is the specificity of the prehospital management of acute life-threatening conditions of diabetic ketoacidosis (DKA) and severe neuroglycopenia in patients with type 1 diabetes mellitus (T1DM) within the framework of the American emergency medical services (EMS) system. The clinical situation is analyzed wherein the provision of urgent care under conditions of information deficit and severe time constraints becomes a catalyst for severe iatrogenic complications. In focus are the cognitive biases of providers, the phenomenon of diagnostic obfuscation and systemic contradictions between the complex transcellular biochemistry of endocrine crises and the rigid architecture of field operational algorithms. The objective of the work consists in conducting a comprehensive, pathophysiologically substantiated critical analysis of the most common diagnostic and therapeutic errors committed by emergency medical crews. The research seeks to deconstruct the mechanisms of iatrogenesis occurrence to substantiate the necessity for the profound humanization and conceptual optimization of local EMS protocols. To realize the set objective, an integrative critical review design was applied, combining elements of the retrospective analysis of clinical guidelines and the assessment of epidemiological metrics. Leading medical repositories (PubMed, Cochrane Library, Scopus) served as the information base, encompassing specialized publications for the 2010-2024 period. The research synthesizes current consensuses of US associations (ADA, NAEMSP, ACEP) and representative data of the National Emergency Medical Services Information System (NEMSIS). The extracted data array was subjected to thematic content analysis with the stratification of identified deviations into three fundamental categories: diagnostic distortions, osmotic catastrophes of fluid resuscitation and pharmacotherapeutic incidents. The research results convincingly demonstrate that the high frequency of complications in patients with T1DM is a logical consequence of systemic algorithmic dissonance rather than the individual incompetence of medical professionals. To break the vicious cycle of iatrogenesis, the mandatory integration of expanded screening (POCT) into the basic triage protocol, the categorical rejection of the prehospital application of exogenous insulin and the transition to a restrictive, physiologically calibrated tactic of infusion therapy and the gentle alleviation of hypoglycemia (D10W) are critically necessary. The global transformation of prehospital endocrinology requires the abandonment of the rigid “cookbook medicine” concept in favor of adaptive guidelines returning to paramedics the right to scientifically substantiated clinical judgment.