Chapter 19 Endocrine and Hematologic Emergencies Introduction lendocrine system influences nearly every, organ, and bodily function.

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1 Chapter 19 Endocrine and Hematoogic Emergencies Introduction Endocrine system infuences neary every, organ, and bodiy function. Endocrine disorders can have many signs and symptoms. Hematoogic emergencies Difficut to assess and treat Your actions may save a ife. Endocrine System A compex message and system. Gands secrete messenger hormones. are chemica messengers. System maintains homeostasis Endocrine disorders are caused by an interna communication probem. Anatomy and Physioogy Gucose metaboism The brain needs gucose and oxygen. is necessary for gucose to enter ces. The pancreas produces gucagon and insuin. Stores and secretes insuin and gucagon in response the bood gucose eve Diabetes (1 of 2) Diabetes impairs the body s abiity to use gucose (sugar) for fue. Compications incude bindness, disease, and kidney faiure. Without treatment, bood gucose eves become too high. In severe cases, may cause ife-threatening iness, or coma and death Diabetes (2 of 2) As an EMT, you need to know signs and symptoms of bood gucose 1

2 As an EMT, you need to know signs and symptoms of bood gucose that is: High ( ) Low (hypogycemia) Centra probem in diabetes is ack, or ineffective action, of. Hypergycemia and hypogycemia can occur with diabetes meitus type 1 and type 2. A hypogycemic patients require prompt treatment. Defining Diabetes (1 of 2) Diabetes meitus Metaboic disorder in which the body cannot gucose Usuay due to a ack of insuin. Gucose One of the basic sugars in the body Aong with oxygen, it is a primary fue for ceuar metaboism Defining Diabetes (2 of 2) Insuin produced by the pancreas Enabes gucose to enter the ces Without insuin, ces starve Hormone Chemica substance produced by a gand Has specia effects on other body organs and tissues Diabetes Meitus Type 1 (1 of 5) disorder where the immune system produces antibodies against the pancreatic beta ces Patient does not produce any insuin Insuin injected daiy Onset usuay in chidhood through the fourth decade of ife Patient must obtain insuin from an externa source Diabetes Meitus Type 1 (2 of 5) Many peope with type 1 diabetes have an impanted insuin pump. Continuousy measures gucose eves and provides an 2

3 Many peope with type 1 diabetes have an impanted insuin pump. Continuousy measures gucose eves and provides an infusion of insuin Can mafunction and diabetic emergencies can deveop Aways inquire about the presence of an insuin pump. Diabetes Meitus Type 1 (3 of 5) Most common metaboic disease of chidhood New-onset patient symptoms: Poydipsia Poyphagia Weight oss Fatigue Diabetes Meitus Type 1 (4 of 5) Patient s bood gucose eve is above norma Kidney s fitration system becomes overwhemed and gucose spis into the. Gucose is unavaiabe to ces. Body turns to burning fat. Produces acid waste (ketones) Kidneys cannot maintain acid base baance. Kussmau respirations resut Diabetes Meitus Type 1 (5 of 5) If fat metaboism and ketone production continue, diabetic ketoacidosis (DKA) can deveop. May present as generaized iness DKA can resut in death. Obtain patient s history and presentation. Obtain a gucose eve. Generay higher than mg/dl Diabetes Meitus Type 2 (1 of 3) Caused by resistance to the effects of insuin at the ceuar eve An association between obesity and increased resistance to the 3

4 Caused by resistance to the effects of insuin at the ceuar eve An association between obesity and increased resistance to the effects of insuin Pancreas produces more insuin to make up for the increased eves of bood gucose and dysfunction of ceuar insuin receptors. Insuin can sometimes be improved by exercise and dietary modification. Diabetes Meitus Type 2 (2 of 3) Ora medications used to treat type 2 diabetes Some increase secretion of insuin and pose a high risk of hypogycemic reaction. Some stimuate for insuin. Others decrease the effects of gucagon and decrease the reease of gucose stored in the iver. Injectabe medications and insuin are aso used for type 2 diabetes. Diabetes Meitus Type 2 (3 of 3) Often diagnosed at a yeary medica examination from compaints reated to high bood gucose eves, incuding: Recurrent infection Change in Numbness in the feet Severity of Diabetes Severity of diabetic compications depends on patient s bood gucose eve and when diabetes began. Obesity increases the risk of diabetes. Diabetes compicates every other medica condition and injuries Roe of Gucose and Insuin Gucose is the major source of for the body. Constant suppy of gucose needed for the brain. Insuin acts as the key for gucose to enter ces. Norma gucose (bood sugar) is to mg/dl. Insuin 4

5 Cassic Symptoms of Uncontroed Diabetes (3 Ps) Poyuria: frequent, pentifu Poydipsia: frequent drinking to satisfy continuous thirst Poyphagia: excessive eating Energy Sources The body uses gucose as a principa energy source When gucose is not avaiabe, the body turns to other sources is most abundant. Using fat for energy resuts in buidup of ketones and fatty acids in bood and tissue. Symptomatic Hypergycemia (1 of 4) Occurs when bood gucose eves are high Patient is in a state of atered menta status resuting from severa combined probems. In type 1 diabetes, eads to with dehydration from excessive urination In type 2 diabetes, eads to a nonketotic hyperosmoar state of dehydration Symptomatic Hypergycemia (2 of 4) Hyperosmoar hypergycemic nonketotic syndrome (HHNS) When bood gucose eves are not controed in diabetes meitus type Symptomatic Hypergycemia (3 of 4) HHNS key signs and symptoms i. Hypergycemia ii. Atered menta status, drowsiness, ethargy iii. Severe, thirst, dark urine iv. Visua or sensory deficits v. Partia paraysis or musce weakness 5

6 iv. Visua or sensory deficits v. Partia paraysis or musce weakness vi. Seizures Symptomatic Hypergycemia (4 of 4) Higher gucose eves in the bood cause the excretion of gucose in the urine. Patient increases fuid intake. Patient cannot drink enough fuid to keep up with the exceedingy high gucose eves in the bood. Urine becomes and concentrated. Patient may become unconscious or have seizure activity due to severe dehydration. Symptomatic Hypogycemia (1 of 3) Acute emergency where a patient s bood gucose eve and must be corrected swifty Can occur in patients who inject insuin or use ora medications When insuin eves remain high, gucose is rapidy taken out of the bood. If gucose eves fa, there may be an insufficient amount to suppy the brain. Symptomatic Hypogycemia (2 of 3) Menta status decines. Patient may become aggressive or dispay unusua behavior. Unconsciousness or permanent brain damage can quicky foow. Hypogycemia deveops much more than hypergycemia. Signs and symptoms of hypogycemia Patient needs intravenous (IV) gucose or intramuscuar (IM) or intranasa (IN) gucagon (beyond EMT competencies). 6

7 Symptomatic Hypogycemia (3 of 3) Hypogycemia is quicky reversed by giving the patient gucose. Hypergycemic Emergencies Diabetic Ketoacidosis (DKA) (1 of 2) Decrease in insuin eves. Most common in type 1 diabetes cannot enter ces. Gucose accumuates in the bood. Body PH decreases Poyuria Poydipsia Diabetic Ketoacidosis (DKA) (2 of 2) diuresis Dehydration Shock Ces metaboize fat, produce ketones as waste Retention of by kidneys which eads to cardiac arrhythmias Hyperosmoar Hypergycemic Nonketotic Syndrome (HHNS) More often caused by type 2 diabetes, more gradua onset than DKA No sweet-smeing breath Other S/S same as DKA Excessive urination resuts in dehydration. Hypergycemic Crisis (Diabetic Coma) (1 of 3) A state of unconsciousness resuting from: Hypergycemia Dehydration Excess bood gucose 7

8 Excess bood gucose Hypergycemic Crisis (Diabetic Coma) (2 of 3) Can occur in diabetic patients: Not under medica treatment Who have taken insufficient insuin Who have markedy Under stress due to infection, iness, overexertion, fatigue, or acoho Hypergycemic Crisis (Diabetic Coma) (3 of 3) If untreated, can resut in Treatment may take hours in a we-controed hospita setting. Suspect for a unconscious patients of unknown etioogy Diabetic Coma S/S of DKA Air hunger (Kussmau Respirations) Dehydration Sweet, breath odor Rapid, weak puse Norma or sighty ow bood pressure Varying degrees of unresponsiveness Gradua onset--over severa hours or days Skin is norma Management of DKA High fow oxygen Obtain bood gucose eve if authorized Transport Hypogycemic Emergencies Insuin Shock (Hypogycemic Crisis) Insuin Shock (Hypogycemic Crisis) Three causes of Insuin Shock insuin taking insuin but not eating adequatey 8

9 insuin taking insuin but not eating adequatey over exercising Decreased bood sugar Brain is deprived of sugar S/S of Insuin Shock Norma or rapid breathing Pae, skin Sweating Dizziness, headache Rapid puse Norma or sighty eevated B/P Aggressive or confused behavior Hunger Fainting, seizure, or coma Weakness on one side of the body Speech Care for Insuin Shock Oxygen Obtain sugar eve if authorized Give sugar if (Instant Gucose) Contact ALS backup if unconscious or severe atered LOC Rapid Transport True emergency Diabetic Conditions Diabetes and Acoho Abuse Patients may appear. Suspect hypogycemia with any atered menta status. Be aert to the simiarity in symptoms of acute acoho intoxication and diabetic emergencies. Diabetics may drink acoho and become intoxicated Emergency Medica Care (1 of 2) Ask a patient with known diabetes: Do you take insuin or any pis to ower bood sugar? 9

10 Ask a patient with known diabetes: Do you take insuin or any pis to ower bood sugar? Have you taken your usua dose of (or pis) today? Have you eaten normay today? Have you had any iness, unusua amount of activity, or stress today? Emergency Medica Care (2 of 2) Perform initia assessment. Obtain baseine vita signs and SAMPLE history. Check for emergency medica identification symbo. Aways do a fu, carefu assessment. Ask patient or famiy about ast mea or insuin dose. administer anything by mouth to an unconscious patient. DKA vs. Insuin Shock Pt eaten but has not taken insuin? -DKA Pt taken insuin and has exercised profusey? -Insuin shock Pt accidentay took two doses of insuin? -Insuin shock Pt has been sick and vomiting atey and has been taking insuin? -Insuin Shock DKA vs. Insuin Shock Pt has taken insuin and has been eating normay? -????? Pt has not been eating and has not taken insuin? -????? When in doubt, GIVE SUGAR!! Administering Gucose (1 of 4) Names: Gutose Insta-Gucose Dose equas grams (one tube) Gucose shoud not be given to a diabetic patient with a decreased 10

11 Dose equas grams (one tube) Gucose shoud not be given to a diabetic patient with a decreased eve of consciousness. Administering Gucose (2 of 4) DO NOT give gucose to a patient with the inabiity to or unconscious. Give between cheek and gums Administering Gucose (3 of 4) Make sure the tube is intact and has not. Squeeze a generous amount onto a bite stick. Administering Gucose (4 of 4) Open the patient s mouth. Pace the bite stick on the mucous membranes between the cheek and the with the ge side next to the cheek. Repeat if needed Compications of Diabetes Heart disease disturbances Rena faiure Stroke Ucers Infections of the feet and toes Seizures Atered menta status Seizures Consider as the cause. Use appropriate BLS measures for airway management. Obtain bood gucose eve if authorized Ca for ALS backup for IV administration of gucose Provide prompt transport. Geriatric Needs Patient may have undiagnosed diabetes. Certain symptoms suggest poory controed or uncontroed diabetes. 11

12 Patient may have undiagnosed diabetes. Certain symptoms suggest poory controed or uncontroed diabetes. Nonheaing wounds Bindness Rena faiure Obtain a history. Check bood gucose eve if authorized Bood Gucose Monitors Test strips Norma range mg/dl There are numerous different gucometers. You must become famiiar with the one used on your service. Hematoogic Emergencies Hematoogy is the study and prevention of bood-reated diseases. Bood is the fuid of ife. Understanding it heps understand disorders. Bood Made up of ces and. Red bood ces contain hemogobin, which carries oxygen to the tissues. White bood ces respond to infection and coect dead ces for their correct disposa. Pateets assist in cot formation. Pasma transports bood ces. Sicke Ce Disease (1 of 2) Inherited disorder, affects bood ces Predominant in African, Caribbean, and South American ancestry Peope with sicke ce disease have misshapen RBCs that ead to dysfunction in binding and unintentiona cot formation. Cots may resut in a bockage known as vaso-occusive crisis. Sicke Ce Disease (2 of 2) May cause hypoxia; sweing or rupture of bood vesses or ; pain and organ damage, and death 12

13 May cause hypoxia; sweing or rupture of bood vesses or ; pain and organ damage, and death Sicke ce disease (cont d) Sicked ces have a short ife span Resuts in more ceuar waste products and contributing to sudging of the bood Compications of Sicke Ce Disease (1 of 2) Cerebra vascuar attack Gastones Jaundice Avascuar necrosis Spenic dysfunction toerance Leg ucers Retinopathy Chronic pain Pumonary hypertension Chronic rena faiure Anemia Compications of Sicke Ce Disease (1 of 2) Sicke ce disease (cont d) Many of these compications are very and potentiay ife threatening. Cotting Disorders Thrombophiia Hemophiia Thrombophiia Tendency to deveop bood Bood-thinning medications used to treat Not common in pediatric patients Risk factors: Recent surgery, impaired mobiity, congestive heart faiure, cancer, 13

14 Risk factors: Recent surgery, impaired mobiity, congestive heart faiure, cancer, respiratory faiure, infectious diseases, over 40 years of age, being overweight/ obesity, smoking, ora contraceptive use Hemophiia (1 of 2) Rare: Ony about 20,000 Americans have the disorder. Congenita; impaired abiity to bood cots Predominant in maes (1 per 5,000 10,000) Hemophiia A most common Patients typicay have intravenous factor VIII repacement infusions (which hep the bood cot) cose at hand. Hemophiia (1 of 2) Signs and symptoms: Spontaneous, acute, chronic beeding beeding (major cause of death) During assessment, seriousy consider injury/iness that can cause beeding. Deep Vein Thrombosis Cotting disorders deep vein thrombosis (DVT) Common medica probem in sedentary patients and in patients who have had recent injury or Methods designed to prevent bood cot formation, incude: Bood-thinning medications Compression stockings Mechanica devices Deep Vein Thrombosis Cotting disorders DVT (cont d) Risk factors Treatment therapy Ora medications typicay administered for at east 3 months after diagnosis of a DVT A cot from the DVT can trave from the patient s ower extremity to the ung, causing a pumonary embous. 14

15 70 the ung, causing a pumonary embous. Emergency Medica Care for Hematoogic Disorders Mainy supportive and symptomatic Patients with inadequate breathing or atered menta status: Administer high-fow O 2 at 12 to 15 L/min. Pace in a position of. Transport rapidy to hospita. 15