Emt: Endocrine And Hematologic Emergencies

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acidosis

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A phatologic condition that results from the accumulation of acids in the body.

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aplastic crisis

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A condition in which the body stops producing red blood cells; typically caused by infection

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diabetes mellitus

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A metabolic disorder in which the ability to metabolize carbohydrates (sugars) is impaired, usually because of a lack of insulin

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diabetic ketoacidosis (DKA)

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A form of hyperglycemia in uncontrolled diabetes in which certain acids accumulate when insulin is not available.

Ketones will produce a sweet or fruity odor.

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endocrine glands

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

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glucose

Normal range for blood glucose

Trade Names for Glucose

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(aka dextrose) One of the basic sugars; it is the primary fuel,in conjunction with oxygen, for cellular metabolism.

80 to 120 mg/dL

Glucose/InstaGlucose

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hematology

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The study and prevention of blood-related disorders

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hemolytic crisis

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A rapid destruction of red blood cells that occurs faster than the body's ability to create new cells

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hemophilia

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A congenital abnormality in which the body is unable to produce clots,which results in uncontrollable bleeding

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hormone

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A chemical substance prodced by a gland that regulates the activity of organs and tissues.

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hyperglycemia

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(Diabetic Coma) An abnormally high glucose level in the blood.

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hypoglycemic crisis

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(insulin shock) Severe hypoglycemia resulting in changes in mental status

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insulin

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

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Kussmaul respirations

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Deep, rapid breathing; usually ther esult of an accumulation of certain acids when insulin is not available in the body.

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polydipsia

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Excessive thirst that persists for long periods, despite reasonable fluid intake;often the result of excessive urination

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polyphagia

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Excessive eating; in diabetes,the inability to use glucose properly can cause a sense of hunger

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polyuria

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The passage of an unusually large volume of urine in a given period; in diabetes, this can result from the wasting of glucose inthe urine

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sickle cell disease

what are two complications caused by sickle cell disease

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A inherited disease that causes normal, round blood cells to become oblong,or sickle shaped.

sickle cells are poor oxygen carriers and they can become logged in blood vessels and organs.

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splenic sequestration crisis

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An acute, painful enlargement of the spleen caused by sickle cell disease

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thrombophilia

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A Tendency towards the development of blood clots as a result of an abnormality of the system of coagulation.

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thrombosis

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A blood clot, either in the arterial or venous system

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type 1 diabetes

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The type of diabetic disease that typically develops in childhood and requires synthetic insulin for proper treatment and control.

Patients with type 1 diabetes are more likely to have metabolic problems and organ damage, such as bindness, heart disease, kidney failure, and nerve disorders.

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type 2 diabetes

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The type of diabetic disease that typically develops in later life and often can be controlled through diet and oral medications

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vaso-occlusive crisis

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Ischemia and pain caused by sickle shaped red blood cells that obstruct blood flow to a portion of the body.

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3 P's of Uncontrolled Diabetes

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Polyuria, Polydipsia, Polyphagia

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Name the 4 types of sickle cell crises

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1. vaso-occlusive crisis
2. aplastic crisis
3. hemolytic crisis
4. splenic sequestration crisis

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Assessment and Care for Hematologic Disorders

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Primary Assesment
ABC - ***** level of consciousness. High flow oxygen 12 to 15 L/min. Insert airway if indicated. Control bleeding if life threatening.

History - Determine if the patient has been compliant with medication. Ask SAMPLE and OPQRST questions.

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Signs of Dehydration

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Dry, Warm, "tenting" skin and sunken eyes

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Why does insulin shock develop more rapidly and more severely in children?

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High levels of activity cause children to use up glucose more rapidly than adults do.

Children don't always eat on schedule

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Characteristics of Hyperglycemia

(History, GI tract, respiratory system, cardiovascular system, nervous system, treatment response)

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(Diabetic Shock)
History - Excessive food intake, insufficient insulin dosage, gradual onset (hours to days), warm and dry skin, infection common

GI Tract - intense thirst, absent hunger, vomiting common

Respiratory System - Kussmaul respirations, sweet/fruity breath

Cardiovascular System - Normal to Low BP, Rapid, week and thready pulse (fine and scarcely perceptible)

Nervous System - Restlessness, possibly progressing to coma; abnormal or slurred speech; unsteady gait

Response - Gradual, within 6 to 12 hours following medical treatment

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Characteristics of Hypoglycemia

(History, GI tract, respiratory system, cardiovascular system, nervous system, treatment response)

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(Insulin Shock)
History - Insufficient food intake, excessive insulin dosage, rapid (within minutes) onset, pale cool, and moist skin, infection uncommon

GI Tract - Absent Thirst, Intense Hunger, Vomiting Uncommon

Respiratory - Normal or rapid breathing, normal odor of breath

Cardiovascular - Normal to low BP, rapid, weak pulse

Conciousness - Irritability, confusion, seizure, or coma; unsteady gate

Response - Immediately after administration of glucose.

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You are called to a local residence where you find a 22 year old woman supine in bed, unresponsive to your attempts to rouse her. She is cold and clammy with gurgling respirations. Her mother tells you that her only hitory is diabetes, which she hads since she was a small child.

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1. Turn the patient on her side immediately or use suction to clear the airway.
2. Insert an oral or nasal airway and apply high flow oxygen
3. Attempt to obtain a blood glucose level.
4. Transport the patient rapidly because you should never give anything by mouth to an unresponsive patient.
5. Monitor the patient closely.

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You are requested to respond to a local convenience store for an unkown medical problem. Upon arrival you find a young African American man sitting on the curb, clutching his torso and crying. He tells you that he is in severe pain and has a history of sickle cell disease.

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The prehospital management of patients suffering from sickle cell crises will commonly include only comfort care and rapid transportation. You may also treat individual symptoms as they arise as per standard protocol. For example, a sickle cell patient presenting with difficulty breathing should receive oxygen therapy or ventilatory assistance if required