Endocrine & Hematologic Emergencies Flashcards
(156 cards)
1
Q
A communication system that controls functions inside the body
A
Endocrine system
2
Q
The endocrine system maintains the body’s ___
A
Homeostasis
3
Q
___ secrete messenger hormones
A
Endocrine glands
4
Q
Chemical substances produced by a gland
A
Hormone
5
Q
Hormones travel through the ___ to the end organs, tissues, or cells that they are intended to affect
A
Blood
6
Q
When the hormone arrives, the cell, tissue, or organ ___
A
Receives the message and an action or cellular process takes place
7
Q
Endocrine disorders are caused by ___
A
An internal communication problem
8
Q
Hypersecretion
A
Produce more hormone than is needed
9
Q
Hyposecretion
A
Produce less hormone than is needed
10
Q
Two things the brain needs to survive
A
Glucose and oxygen
11
Q
Necessary for glucose to enter the cells for metabolism
A
Insulin
12
Q
Two hormones produced and stored by the pancreas that play a major role in glucose metabolism
A
- Glucagon
- Insulin
13
Q
The islets of Langerhans in the pancreas is filled with ___
A
Alpha and beta cells
14
Q
The alpha cells in the islets of Langerhans produce ___
A
Glucagon
15
Q
The beta cells in the islets of Langerhans produce ___
A
Insulin
16
Q
In a person without diabetes, the pancreas stores and secretes insulin and glucagon in response to ___
A
The level of glucose in the blood
17
Q
When a person eats, the level of glucose in the blood ___
A
Rises
18
Q
When the level of glucose in the blood rise, the pancreas ___
A
Secretes insulin into the blood
19
Q
When the pancreas secretes insulin into the blood, this allows ___
A
The glucose to enter the body’s cells and be used for energy. Also allow glucose to be stored in the form of glycogen in the liver and skeletal muscles for use at a later time
20
Q
If a hungry person skips a meal, ___
A
A message is sent to the pancreas to secrete glucagon, which stimulates the liver and skeletal muscles to release glycogen and converts it back to glucose to be used as cellular fuel
21
Q
A disorder of glucose metabolism, such that the body has an impaired ability to get glucose into the cells to be used for energy
A
Diabetes mellitus
22
Q
The patient with diabetes has either ___
A
- Impaired insulin production
- Not enough functional receptors on the surface of the cells for the insulin to bind to
23
Q
Three types of diabetes
A
- Diabetes mellitus type 1
- Diabetes mellitus type 2
- Pregnancy-induced gestational diabetes
24
Q
A state in which the blood glucose level is above normal
A
Hyperglycemia
25
A state in which the blood glucose level is below normal
Hypoglycemia
26
Patients with severe ___ are more likely to have a depressed level of consciousness than patients with ___
1. Hypoglycemia
2. Hyperglycemia
27
Altered mental status related to diabetic emergencies can often mimic ___
Alcohol intoxication
28
___ can develop if a person with diabetes takes their medications as prescribed but fails to eat enough food
Hypoglycemia
29
All hypoglycemic patients require prompt treatment with ___
Oral glucose paste (if alert and able to protect airway), or injection of glucose (dextrose) or glucagon by an ALS provider
30
Blood glucose level below 50 mg/dL
Hypoglycemic crisis
31
Blood glucose level between 50 and 80 mg/dL
Hypoglycemia
32
Blood glucose level between 80 and 120 mg/dL
Normal
33
Blood glucose level between 120 and 400 mg/dL
Hyperglycemia
34
Blood glucose level above 400 mg/dL
DKA, HHNS, or symptomatic hyperglycemia
35
Onset of hyperglycemia
Gradual (hours to days)
36
Onset of hypoglycemia
Rapid (within minutes)
37
Skin with hyperglycemia
Warm and dry
38
Skin with hypoglycemia
Pale, cool, and moist
39
Infection rate with hyperglycemia
Common
40
Infection rate with hypoglycemia
Uncommon
41
Thirst with hyperglycemia
Intense
42
Thirst with hypoglycemia
Absent
43
Hunger with hyperglycemia
Present and increasing
44
Hunger with hypoglycemia
Absent
45
Vomiting/abdominal pain with hyperglycemia
Common
46
Vomiting/abdominal pain with hypoglycemia
Uncommon
47
Breathing with hyperglycemia
With DKA there are rapid, deep (Kussmaul) respirations
48
Breathing with hypoglycemia
Normal; may become shallow or ineffective if hypoglycemia is severe and mental status is depressed
49
Odor of breath with hyperglycemia
With DKA there may be a sweet fruity odor
50
Odor of breath with hypoglycemia
Normal
51
BP with hyperglycemia
Normal to low
52
BP with hypoglycemia
Normal to low
53
Pulse with hyperglycemia
Rapid, weak, and thready
54
Pulse with hypoglycemia
Rapid, weak
55
Consciousness with hyperglycemia
Restlessness, possibly progressing to coma; abnormal or slurred speech; unsteady gait
56
Consciousness with hypoglycemia
Irritability, confusion, seizure, or coma; unsteady gait
57
Response to treatment with hyperglycemia
Gradual, within 6 to 12 hours following medical treatment
58
Response to treatment with hypoglycemia
Immediate improvement after administration of glucose
59
An autoimmune disorder in which the individual's immune system produces antibodies against the pancreatic beta cells
Type 1 diabetes
60
Always ask about an ___ in patients with type 1 diabetes
Insulin pump
61
A patient with new-onset type 1 diabetes will have these symptoms related to eating and drinking
1. Polyuria
2. Polydipsia
3. Polyphagia
4. Weight loss
5. Fatigue
62
More frequent urination
Polyuria
63
Why does type 1 diabetes cause polyuria
Excess glucose in the blood overwhelms the kidney's filtration and glucose spills into the urine. This causes more water to be pulled out of the bloodstream into the urine
64
An increase in fluid consumption
Polydipsia
65
Polydipsia can lead to ___
Severe electrolyte abnormalities
66
Why does type 1 diabetes lead to polydipsia
Polyuria leads to dehydration and increased thirst
67
Increased food intake
Polyphagia
68
When the body burns fat instead of glucose, ___ is produced
Acid waste
69
The acids produced from burning fat instead of glucose
Ketones
70
What causes Kussmaul respirations with type 1 diabetes?
The ketone levels in the blood increase and spill into the urine with the excess glucose. When the kidneys are saturated with glucose and ketones they do not work properly to maintain the acid-base balance in the body. The body responds with a backup system by breathing faster and deeper to release more acid via CO2 in the lungs
71
If fat metabolism and ketone production continue, ___ can develop in patients with diabetes
Diabetic ketoacidosis (DKA)
72
DKA
Diabetic ketoacidosis
73
DKA may present as ___
Generalized illness accompanied by:
1. Abdominal pain
2. Body aches
3. Nausea
4. Vomiting
5. Altered mental status or unconsciousness (if severe)
74
Caused by a resistance to the effects of insulin at the cellular level
Type 2 diabetes
75
Obesity predisposes patients to ___ diabetes
Type 2
76
The blood glucose levels begin to rise and do not respond when the pancreas secretes insulin
Insulin resistance
77
Test to estimate the average blood glucose level over time taken at the doctor several times a year
A1C
78
Occurs when blood glucose levels are very high
Symptomatic hyperglycemia
79
Early signs and symptoms of symptomatic hyperglycemia
1. Frequent urination
2. Increased thirst
3. Blurred vision
4. Fatigue
80
If the high blood glucose levels go untreated, the patient may present with ___
1. A fruity odor on the breath
2. Nausea and vomiting
3. Shortness of breath
4. Dry mouth
5. Weakness
6. Altered mental status
81
Type 1 diabetes hyperglycemia leads to ketoacidosis and dehydration from ___
Excessive urination
82
Type 2 diabetes hyperglycemia leads to a state of dehydration due to ___
The discharge of fluids through all body systems and eventually out through the kidneys
83
Type 2 diabetes hyperglycemia induced dehydration leads to ___
Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
84
HHNS
Hyperosmolar hyperglycemic nonketotic syndrome
85
Secondary consequences of prolonged hyperglycemia
1. Wounds that do not heal
2. Numbness in the hands and feet
3. Blindness
4. Renal failure
5. Gastric motility problems
86
When blood glucose levels are not controlled in diabetes type 2, ___ can develop
HHNS
87
HHNS can present similarly to the ___ seen in patients with type 1 diabetes
DKA
88
The onset of HHNS is commonly associated with ___
A profound infection or illness
89
Key signs and symptoms of HHNS
1. Hyperglycemia
2. Altered mental status, drowsiness, lethargy
3. Severe dehydration, thirst, dark urine
4. Visual or sensory deficits
5. Partial paralysis or muscle weakness
6. Seizures
90
Very concentrated blood as a result of relative dehydration
Hyperosmolarity
91
In HHNS the patient cannot drink enough fluids to keep up with the ___
Exceedingly high glucose levels in the blood
92
As HHNS progresses, the urine becomes ___
Rather dark and concentrated
93
An acute emergency in which a patient's blood glucose level drops and must be corrected swiftly
Symptomatic hypoglycemia
94
Hypoglycemia develops much more ___ than hyperglycemia
Quickly
95
Common patient or caregiver causes of the development of low blood glucose levels
1. Correct dose of insulin with a change in routine
2. More insulin than necessary
3. A correct dose of insulin without the patient eating enough
4. Correct does of insulin and and acute illness developed in the patient
96
Signs and symptoms of hypoglycemia
1. Normal to shallow or rapid respirations
2. Pale, moist, skin
3. Diaphoresis
4. Dizziness, headache
5. Rapid pulse
6. Normal to low blood pressure
7. Altered mental status (aggressive, confused, lethargic, or unusual behavior)
8. Anxious or combative behavior
9. Seizure, fainting, coma
10. Weakness on one side of body (may mimic stroke)
11. Rapid changes in mental status
97
You must have a high index of suspicion for a ___ when you encounter a child who has an altered mental status or depressed LOC
Low glucose level
98
If the patient has eaten but has not taken insulin, it is more likely that ___ is developing
Hyperglycemia
99
If the patient has taken insulin but has not eaten, the problem is more likely to be ___
Hypoglycemia
100
Questions to ask a patient known to have diabetes
1. Do you take insulin or any pills that lower your blood sugar?
2. Do you wear an insulin pump and is it working properly?
3. Have you taken your usual dose of insulin or pills today?
4. Have you eaten normally today?
5. Have you had any illness, unusual amount of activity, or stress?
101
When you suspect a diabetes-related problem, the secondary assessment should focus on the patient's ___
Mental status and ability to swallow, and protect the airway
102
With a diabetic patient, obtain a ___ to track the patient's neurologic status
Glasgow Coma Scale Score
103
The blood glucose level in neonates should be ___
Above 70 mg/dL
104
Base your administration of glucose on ___
Serial glucose readings
105
If a glucometer is not available, a ___ indicates that you need to provide more glucose
Deteriorating LOC
106
If the patient is hypoglycemic, conscious, and able to swallow without the risk of aspiration, ___
Encourage them to take glucose tablets. If not available, household sources of glucose may be used
107
If the patient is hypoglycemic and unconscious or unable to swallow without the risk of aspiration, ___
The patient will need IV glucose, or IM or IN glucagon (most EMTs are not able to give)
108
A patient with symptomatic hypoglycemia needs ___
Glucose immediately
109
A patient with symptomatic hyperglycemia needs ___
Insulin and IV fluid therapy, prompt transport to the hospital
110
When in doubt if the patient is in symptomatic hyperglycemia or symptomatic hypoglycemia, most protocols will err on the side of ___
Giving glucose
111
Most common type of oral glucose preparation for EMS providers
Rapidly dissolving gel
112
Three types of oral glucose preparations available commercially
1. Rapidly dissolving gel
2. Large chewable tablet
3. Liquid formulation
113
You should administer ___ to any patient with a decreased LOC who has a history of diabetes
Glucose gel
114
Contraindications for oral glucose
Inability to swallow and unconsciousness
115
How to administer glucose gel
1. Obtain an online or offline order
2. Open the pouch
3. Squeeze the glucose under the tongue or into the buccal space
4. Have the patient swallow
116
If the patient's mental status, vital signs, and blood glucose level become normal after administering glucose, encourage the patient to ___
Eat a meal or snack containing carbohydrates and protein
117
Mnemonic to remember conditions that can lead to an altered mental status
AEIOU-TIPS
118
AEIOU-TIPS
-Alcohol
-Epilepsy, endocrine, electrolytes
-Insulin
-Opiates and other drugs
-Uremia
-Trauma, temperature
-Infection
-Poisoning, psychogenic causes
-Shock, stroke, seizure, space-occupying lesion, subarachnoid hemorrhage
119
The study of blood-related diseases
Hematology
120
Four components of blood
1. Erythrocytes (red blood cells)
2. Leukocytes (white blood cells)
3. Platelets
4. Plasma
121
RBCs
Red blood cells
122
WBCs
White blood cells
123
RBCs make up how much of the total blood volume?
42% to 47%
124
RBCs contain a protein called ___
Hemoglobin
125
The hemoglobin carries ___ of the oxygen in the blood and some of the CO2
97%
126
WBCs make up ___ of the total blood cell volume
0.1% to 0.2%
127
WBCs collect ___ and provide for their ___
1. Dead cells
2. Correct disposal
128
Platelets make up ___of the blood cell volume
4% to 7%
129
An inherited blood disorder that affects the RBCs
Sickle cell disease
130
Sickle disease is also called ___
Hemoglobin S disease
131
Serves as the transportation medium for all blood component as well as proteins and minerals
Plasma
132
The sickle cell protects individuals from contracting ___
Malaria
133
Sickle cell disease is common among people of ___ ancestry
African, Caribbean, and South American
134
The sickle cell shape leads to dysfunction in ___
Oxygen binding and unintentional clot formation
135
The inintentional clots from sickle cells may result in a blockage called ___
Vasoocclusive crisis
136
Lifespan of normal RBCs
110 to 120 days
137
Sickle cells shorter lifespan leads to ___
More cellular waste products in the blood, contributing to sludging of the blood
138
Maintaining ___ is important to patients with sickle cell disease
Hydration
139
Complications associated with sickle cell disease
1. Anemia
2. Gallstones
3. Jaundice
4. Splenic dysfunction
5. Vascular occlusion with ischemia
140
Hemophilia mostly affects ___
Males
141
Males inherit hemophilia from their ___
Mother, but only if the mother's father has hemophilia and their mother is also a carrier
142
Decreased ability to create a clot after an injury
Hemophilia
143
In a healthy person a clot will begin to form ___
Within 13 seconds for a small cut and not longer than about 7 minutes for a more serious injury
144
Common complications of hemophilia A
1. Long-term joint problems
2. Bleeding in the brain
3. Thrombosis due to treatment
145
A disorder in the body's ability to maintain the viscosity and smooth flow of blood through the venous and arterial systems
Thrombophilia
146
The concentration of particular elements in the blood creates what amounts to clogging or blockage issues
Thrombophilia
147
General term for many different conditions that result in blood clotting more easily than normal
Thrombophilia
148
DVT
Deep vein thrombosis
149
DVT is a common medical problem in ___
Sedentary patients and an patients who have had recent injury or surgery
150
DVT is a particularly worrisome risk for patients who have had ___
Joint replacement surgery
151
If DVT develops in an individual, ___ may be administered
Anticoagulation therapy may be administered
152
An abnormally low number of RBCs
Anemia
153
Each hemoglobin molecule can carry how much oxygen?
4 molecules
154
Anemia may be the result of ___
1. Chronic or acute bleeding
2. Deficiency in certain vitamins or minerals
3. Underlying disease process
155
Hypoxia from anemia
Hypoxemia hypoxia
156
Additional questions to ask a patient with known sickle cell disease
1. Have you had a crisis before?
2. When was the last time you had a crisis?
3. How did your last crisis resolve?
4. Have you had any illness, unusual amount of activity, or stress lately?
