EMT-B Chapter 19 – Endocrine and Hematologic Emergencies (Multiple)

What is the endocrine system
A complex message and control system that includes a network of glands to maintain hemostasis

__________________ is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can’t produce enough insulin.
Diabetic Ketoacidosis (DKA)

Endocrine Glands
Glands that secrete or release chemicals that are used inside the body

Hormone
A chemical substance produced by a gland that has special regulatory effects on other organs and tissues

Diabetes
A metabolic disorder in which the bodys ability to metabolize simple carbohydrates(Glucose) is impaired.

S/S of Hyperglycemia and Definition
Blood glucose is higher than normal
BGL Above 120
Thirst=Intense
Hunger=Absent
Vomitting=Common
Breathing=Kusmaul (rapid and deep)
Breath=Sweet/Fruity
Blood pressure=normal to low
Pulse=Weak, rapid and thready
restlessness, possibly progressing to coma; abnormal or slurred speech;unsteady gait.

Response to treatment is gradual withing 6-12 hours

S/s of Hypoglycemia and Definition
Blood glucose is below normal
BGL Below 80

Thirst=IAbsent
Hunger=Intense
Vomitting=uncommon
Breathing=Normal or rapid
Breath=Normal
Blood pressure=Normal to low
Pulse=Weak and rapid
Irritability, confusion, seizure, or coma; unsteady gait

Response to treatment is immidieate.

What does the history look like with a Hyperglycemic patient.
Food Intake-Excessive
Insulin Dosage-Insufficient
Onset-Gradual(Days)
Skin-PWD
Infection-Common

What does the history look like with a Hypoglycemic patient.
Food Intake-Insufficient
Insulin Dosage-Excesive
Onset-rapid within minutes
Skin-PCC
Infection-UNcommon

The central problem in any type of diabetes is
lack of, or to much insulin

What are the two types of diabetes?
Mellitus and Insipidus

Diabetes Mellitus
Two types… 1 and 2
Diabetes Mellitus means “Sweet” Diabetes. This refers to the presence of glucose (sugar) in the urine.

Type 1 Diabetes
Patients do not produce insulin
They daily injections to control their blood glucose
Usually develops during childhood
More likely to have metabolic problems and organ damage, such as blindness, heart disease, kidney failure and nerve disorders.

Type 2 Diabetes
Usually appears later in life
Produces inadequate amounts of insulin or they may produce a normal amount it just doesnt function effectivley
Can be reveresed with a lifestyle change.

Diabetes Insipidus
Rare
Involves excessive urination
Here the missing hormone is one that regulates urinary fluid reabsorption.

Glucose
On of the basic sugars; it is the primary fuel , in conjuction with oxygen for cellular metabolism.

Insulin
A hormone produced by islets of Langerhans (Endocrine gland located throughout the pancreas) that enables glucose in the blood to enter cells; used in synthetic form to treat and control diabetes mellitus.

Polyuria
Frequent, plentiful urination

Polydipsia
Frequently drinking to satisfy taste

Polyphagia
Excessive Eating

acidosis
to much acids in the body

Diabetic Ketoacidosis (DKA) – Signs and Symptoms
weakness and nausea
Kussmaul respiration
weak and rapid pulse
sweet breath/fruity (two-day old drunk breath)
can progress to coma and death
blood sugar 400 or above
All we can do is drive the truck fast

Kussmaul respirations
Rapid and Deep respirations

Can we as EMTs give insulin?
No

what are the three P’s of diabetes
Polyuria, Polydipsia and Polyphagia

Why do diabetics get thirsty and drink more fluids?
To dilute the high blood sugar.

When glucose is unavailable the body turns to fat. Why is that bad?
Using fat results in a build up of ketones and fatty acids in the blood tissue that makes your body even more off in ph levels

Ketones
Ketones are produced when the body burns fat for energy or fuel. They are also produced when you lose weight or if there is not enough insulin to help your body use sugar for energy.

Without enough insulin, glucose builds up in the blood. Since the body is unable to use glucose for energy, it breaks down fat instead.

Fatty Acids
Fatty acids are the building blocks of the fat in our bodies and in the food we eat.

During digestion, the body breaks down fats into fatty acids, which can then be absorbed into the blood.

Fatty acid molecules are usually joined together in groups of three, forming a molecule called a triglyceride.

(HHNC) Hyperosmolar hyperglycemic nonketotic coma
More often caused by type 2
no sweet smelling breath
Excessive urination results in dehydration
Slower, more gradual onset
800 or above
it will say HI on a glucometer
Could be in a coma

Hyperglycemic crisis (Diabetic Coma)
Blood glucose is too high

A state of unconsciousness resulting from several problems, including ketoacidosis, hyperglycemia and dehydration resulting from excessive urination

A lot more critical. If untreated can result in death.
You have to bring it down slowly. If you drop it down to fast it could result in severe brain swelling

Needs ALS

Hypoglycemic Crisis (Insulin Shock)
Insufficient glucose in the blood.
to much insulin.
May have vomited after a meal or just engaged in rigorous physical acitivity

treat with oral glucose
should have a set of vitals before and after glucose.

When should you check vitals in a hypoglycemic patient
Before and after you administer oral glucose

Where do you administer oral glucose
between the gum and cheek

What is the poem for remembering what the skin tells you about hyper and hypoglycemia patients
Hot and dry, sugar is high
Cool and clammy, needs some candy

Altered mental status is what priority?
High priority

What questions should you ask? When establishing an accurate history.
Did you take anything to lower your blood sugar?
Have you eaten normally today ?
Are you insulin dependent?

Can EMT-B use a glucometer
Yes

How do you take a proper glucose reading
Swab it
Dry IT
Poke it
Wipe It
Test It

Should you wear gloves when adminstering oral glucose
Yes

Should you check a blood sugar on anybody with AMS
Yes

Hematology
The study and prevention of blood related disorders

Red Blood Cells
The blood cells that carry oxygen. Red cells contain hemoglobin and it is the hemoglobin which permits them to transport oxygen

Plasma
The colorless fluid part of blood.

Platlets
Platelets, also called thrombocytes are a component of blood whose function is to stop bleeding by clumping and clotting blood vessel injuries.

White Blood Cells
White blood cells (WBCs), also called leukocytes or leucocytes, are the cells of the immune system that are involved in protecting the body

Sickle Cell Disease
Sick red blood cells
only live for 16 days
could cause hypoxia
rupture of blood vessels for spleen
S shaped red blood cell

Leukocytes
a colorless cell that circulates in the blood and body fluids and is involved in counteracting foreign substances and disease; a white (blood) cell.

Erythrocytes
Red blood cells (RBCs), also called erythrocytes, are the most common type of blood cell and the principal means of delivering oxygen (O2) to the body tissues.

Hemoglobin
Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body’s tissues and returns carbon dioxide from the tissues back to the lungs

Vaso-occlusive crisis
Blood flow to organs is restrcted

aplastic crisis
worsening of baseline amenia
(lack of circulation red blood cells in the body)

Hemolytic Crisis
an acute, accelerated drop in hemoglobin level

Splenic sequestraion
acute enlargment of the spleen

Thrombophilia
Thrombophilia is a condition where the blood has an increased tendency to form clots. Blood clots can cause problems such as deep vein thrombosis (DVT) or pulmonary embolism.

Can you live without a spleen
Yes

S/s of Sickle Cell
Periodic episodes of pain, called crises, are a major symptom of sickle cell anemia

Complications of Sickle cell
Gall Stones
Jaundice
Avascular Necrosis
Splenic Infections
Osteomyelitis
Opiate tolerance
Leg Ulcers
Retinopathy
Chronic Pain
Pulmonary Hyertension
Chronic renal Failure

Why do sickle cell patients have a tolerance to opiates
Because it’s so painful they take drugs for it which leads to a tolerance

Hemophilia
can’t form blood clots
aka you bleed a lot

Two types A and B

S/s of Hemophilia
Nosebleeds.
Bruising, especially a large, lumpy bruise.
Bleeding for no known reason.
Blood in the urine or stool.
Bleeding that does not stop after getting a cut, having a tooth out, getting an injury to the mouth or having surgery.
Bleeding that does not stop after circumcision.

What are normal glucose levels
80-120 mg/dL

Hormone
Chemical produced by a gland that regulates body organs

Sickle Cell Disease
Inherited disease that affects red blood cells

Type I diabetes
Diabetes that usually starts in childhood; requires insulin

Acidosis
Pathologic condition resulting from the accumulation of acids in the body

Insulin
Hormones that enables glucose to enter the cells

Diabetic coma
State of unconsciousness resulting from several problems, including ketoacidosis, dehydration, and hyperglycemia or insufficient insulin

Polyuria
Excessive urination

Thrombophilia
tendency to develop blood clots

Polyphagia
excessive eating

Hemotology
the study and prevention of blood-related diseases

insulin shock
altered level of consciousness caused by insufficient glucose; hypoglycemia and too much insulin

Glucose
primary fuel, along with oxygen, for cellular metabolism

Kussmaul respirations
deep, rapid breathing

hyperglycemia
extremely high blood glucose level

Diabetes
literal meaning: “A passer through; a siphon;” refers to a metabolic disorder in which the body’s ability to metabolize simple carbs (glucose) is impaired

Polydipsia
excessive thirst persisting for a long period of time

hemophilia
disorder that causes an inability to develop blood clots

Type 2 diabetes
diabetes with onset later in life; may be controlled by diet and oral medication

Patients with which type of diabetes are more likely to have metabolic problems and organ damage?
Type 1

Normal blood glucose levels range from _______ mg/dL
80 to 120

A sickle cell crisis caused by an acute drop in hemoglobin levels in known as an
hemolytic crisis

diabetes is a metabolic disorder in which the hormone _______ is missing or ineffective
insulin

Emergency care of a patient with hemophilia includes all of the following:
rapid transport, bleeding control, ventilations if needed

The accumulation of ketones and fatty acids in blood tissue can lead to a dangerous condition in diabetic patients known as: around 400 mg/dL
diabetic ketoacidosis

The term for excessive eating as a result of cellular “hunger” is
polyphagia

Insulin is produced by the”
pancreas

Factors that may contribute to diabetic coma include:
infection, alcohol consumption, insufficient insulin (too much glucose)

The only organ that does not require insulin to allow glucose to enter its cell is the:
brain

The sweet or fruity odor on the breath of a diabetic patient is caused by ________ in the blood
ketones

It is uncommon to encounter ________ patients with thrombophilia
pediatric

Oral diabetic medication include
micronase, glucotrol, diabinese

__________ is one of the basic sugars in the body
dextrose (glucose)

___________ is the hormone that is normally produced by the pancreas that enable glucose to enter the cell
insulin

The term for excessive urination is
polyuria

When fat is used as an immediate energy source, _______ and fatty acids are formed as waste products
ketones

An African American patients complaining of severe, generalized pain may have undiagnosed
sickle cell disease

The onset of hypoglycemia can occur within
minutes

Without _________, or with very low levels, brain cells rapidly suffer permanent damage
glucose

___________ are a potentially life-threatening complication of insulin shock
Seizures

Blood glucose levels are measured in
milligrams per deciliter

Diabetic coma may develop as a result of
too little insulin

always suspect hypoglycemia in any patient with
an altered mental status

the most important step in caring for the unresponsive diabetic patients is to
open the airway

determination of diabetic coma or insulin shock should
be based upon your knowledge of the signs and symptoms of each condition

When obtaining the medical history of a patient experiencing a sickle cell crisis, you should
ask the patient if he has been compliant with his medications

contraindications for the use of oral glucose include
unconsciousness

when reassessing the diabetic patient after administration of oral glucose, watch for
airway problems, seizures, sudden loss of consciousness

Signs and symptoms associated with hypoglycemia include
anxious or combative behavior

the patient in insulin shock is experiencing
hypoglycemia

signs of dehydration include
sunken eyes

hospital intervention for hemophilia may include
blood transfusions, analgesics for pain, IV therapy

Causes of insulin shock include
taking too much insulin, vigorous exercise without sufficient glucose intake, nausea, vomiting and anorexia; hypoglycemia

insulin shock can develop more often and more severely in children than in adults due to their
high activity level and failure to maintain a strict schedule of eating

Because diabetic coma is a complex metabolic condition that usually develops over time and involves all the tissues of the body, correcting this condition may
take many hours in a hospital setting

A patient in insulin shock or a diabetic coma may appear to be
intoxicated

A patient in insulin shock needs ________ immediately, and a patient in a diabetic coma needs ________ and IV fluid therapy
sugar; insulin

Golfer collapsed, skin pale, cool, diaphoretic providing incoherent answers. Type 2 diabetic meaning:
developed diabetes later in life, produced inadequate amounts of insulin, takes noninsulin-type oral medications

His blood glucose level is 65 mg/dL. You:
suspect hypoglycemia and proceed to give oral glucose

The patient loses consciousness and a second blood glucose level reads 48mg/dL. You should:
call for an ALS units, ensure a patient airway, provide high-flow oxygen

Because of his low blood glucose level and rapid respirations, you suspect:
insulin shock/hypoglycemia

Because the patient is unconscious and his blood glucose level is 48mg/dL, how should the glucose be delivered
NOT BY: placing between check and gum, on back or tip of tongue NO oral glucose intake

Respirations are 28 breaths/min, her pulse is 110 beats/min, and her blood pressure is 94/52 mm Hg. How should you intervene for her?
Provide high-flow oxygen

aplastic crisis
a condition in which the body stops producing red blood cells; typically caused by infection

Hyperglycemia crisis symptoms
Kussmaul respirations (rapid, deep respirations), dehydration (dry, warm, “tenting skin” and sunken eyes), sweet or fruity acetone odor in breath caused by unusual waste products in the blood (ketones), rapid thready pulse weak; normal or slightly low blood pressure; varying degrees of unresponsiveness; weakness, nausea, vomiting, polyuria, polydipsia (excessive thirst), polyphagia

Hypoglycemia crisis symptoms
normal to shallow or rapid respirations; pale, moist skin; diaphoresis (sweating); dizziness, headache; rapid pulse; normal to low blood pressure; altered mental status (aggressive, confused, lethargic, or unusual behavior); anxious or combative behavior; hunger; seizures, fainting coma; weakness on one side of body (may mimic stroke); rapid changes in mental status

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Diabetes A group of diseases characterized by hyperglycemia caused by defects in insulin secretion, insulin action, or both Functions of Insulin Transports and metabolizes glucose for energy, Stimulates storage of glucose in the liver and muscle as glycogen, Signals the …

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