Endocrine & Hematologic Emergencies Flashcards Preview

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Flashcards in Endocrine & Hematologic Emergencies Deck (53)
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1
Q

How does the body manage high glucose levels?

A

Islet of Langerhans secrete insulin to increase cell membrane permeability and mediates transport of glucose across membranes into cells. Glucose is converted into energy via glycolysis.

2
Q

How does the body manage low glucose levels?

A

Alpha cells in islets of Langerhans releases glucagon. Glucagon raised the blood sugar and brings the body’s energy back to normal stimulating the liver to convert stored glycogen to glucose through glycogenolysis.

3
Q

What is metabolized when glycogen levels are depleted?

A

Fats, proteins, and other noncarbonate sources

4
Q

Alpha cells in islets of Langerhans

A

glucagon

5
Q

Beta cells in islets of Langerhans

A

insulin

6
Q

Delta cells in islets of Langerhans

A

somatostatin

7
Q

Major effects of hypothyroidism

A

Cardiovascular : slow pulse, reduces CO
Metabolic : decreased metabolism, cold skin, weight gain
Neuromuscular : weakness, sluggish reflexes
Mental, emotional : sluggish, personality placid
GI : constipated
General somatic : cold, dry skin

8
Q

Major effects of hyperthyroidism

A

Cardiovascular : rapid pulse, increased CO
Metabolic : increased metabolism; skin hot and flushed, weight loss
Neuromuscular : tremor, hyperactive reflexes
Mental, emotional : restlessness, irritability, emotional lability
GI : diarrhea
General somatic : warm, moist skin

9
Q

s/s thyroid storm

A

s/s of hyperthyroidism including fever, severe tachycardia, n/v, AMS, and possibly heart failure

10
Q

Thyroid storm

A

Caused my excessive levels of circulating thyroid hormone called thyrotoxicosis.

11
Q

3 p’s of DM

A

polyphagia - increased appetite
polydipsia - increased thirst
polyuria - excessive urination

12
Q

What is microangiopathy?

A

Microscopic deterioration of the vessel walls. It causes swelling of the basement membrane cells restricting blood flow to organs and tissues causing ischemia.

13
Q

Why can’t insulin be ingested orally?

A

The digestive process with render it inactive.

14
Q

Normal, prediabetic, and type 2 A1c levels.

A

Normal - less than 5.7%
Prediabetes - 5.7% to 6.4%
DMII - greater than 6.4%

15
Q

Risk factors of prediabetes and DMII

A

Older than 45
Overweight
Fmhx DM
African American, Hispanic/Latino, American Indian, Pacific Islander, and some Asian American
Gestational diabetes or given birth to baby over 9 lbs
Physically active fewer than 3x/week

16
Q

Two hormones produced by the placenta, ____ and ____, results in insulin resistance.

A

Progesterone and estrogen

17
Q

Management of gestational diabetes.

A

Diet modification, exercise, and blood glucose testing.

18
Q

Gestational diabetes is usually diagnosed at ____ weeks of gestation and peaks in ____ trimester.

A

28; third

19
Q

Which nervous system depends entirely on glucose for energy?

A

Central nervous system

20
Q

What is the body’s first line of defense again hypoglycemia?

A

Insulin production is reduced in the pancreas and glucagon is increased by alpha cells.

21
Q

When cells are deprived of glucose where does the stress signal go to and what happens?

A

Sympathetic nervous system.

Causes a release of catecholamines - epi and norepi - by adrenal gland.

22
Q

What is the body’s second line of defense against hypoglycemia?

A

Cortisol is released to increase blood glucose levels to interact insulin’s action.

23
Q

Two actions of type 2 dm medications.

A

Stimulate body’s ability to secrete insulin.

Improve insulin’s actions.

24
Q

Hypoglycemia is caused by :

A
Elevated level of exogenous insulin
Inaccurate dosing
Intentional OD
Mismatch w/ carb and insulin
Increased use of glucose
25
Q

Most common signs of hypoglycemia :

A
BS less than 70
Hunger
Agitation, irritability, combative
AMS or confusion
Nausea
Weakness, dizziness, or fainting
Tachycardia
Cool, clammy skin
Headache
Incoordination
Slurred speech
Dilated pupils
Seizures or coma
26
Q

Hyperglycemic crisis

A

AKA diabetic coma

State of unresponsiveness resulting from problems including DKA, hyperglycemia, and dehydration.

27
Q

Hyperglycemia can be caused by :

A
Excessive food intake
Insufficient insulin dosages
Infection or illness
Injury
Surgery
Emotional stress
28
Q

Hyperosmolar hyperglycemic syndrome (HHS)

A

blood glucose level greater than 600

29
Q

s/s of simple hyperglycemia

A
blurred vision
polyuria
polydipsia
polyphagia
orthostatic syncope
frequent infections
skin ulcerations
30
Q

Treatment of simple hyperglyemia

A

Supportive care and transport

31
Q

The body loses excessive amounts of ___, ____, and ___, in the urine during hyperglycemia resulting in dehydration and metabolic acidosis.

A

Sodium, potassium and phosphates

32
Q

s/s advanced hyperglycemia

A
3 p's
n/v
tachycardia
Kussmaul respirations
Warm, dry skin and dry mucous membranes
Fruity odor on breath
Abd pain
Orthostatic hypotension
Supine hypotension
Fatigue
AMS
Weight loss
Hypocapnia
33
Q

s/s hypoglycemia

A
Onset : rapid
Skin : pale, moist
Breathing : normal or rapid
BP : low
Pulse : rapid, weak
LOC : irritability, confusion, seizure, coma
Response to treatment : immediately after administration
Intense hunger
34
Q

s/s HHS

A
Skin : warm and dry
Breathing : tachypneic
Odor of breath : none
BP : hypotensive
Pulse : rapid, weak
LOC : restless to coma
Response to treatment : gradual ; 6-12 hours
35
Q

HHS/HONK typically characterized by

A

hyperglycemia, hyperosmolarity, and absence of substantial ketosis

36
Q

Difference between HHS/HONK and DKA

A

HHS/HONK : > 600. Usually secondary illness resulting in reduced fluid intake. Lack ketoacidosis. Takes weeks to develop.

DKA : > 250. Metabolic ketoacidosis present. Occurs in a few hours.

37
Q

Pertinent additional SAMPLE questions for DM emergencies.

A

Last meal and insulin dose
Visual changes, headaches, dizziness, or bleeding
Changes in bowel or eating habits
Tingling, numbness, or swelling in extremities

38
Q

What should be the main focus in the secondary assessment for DM emergencies?

A

Mental status - GCS
Ability to swallow
Protect the airway

39
Q

Dosage of IV dextrose for adults, peds, neonates/infants.

A

Adults : 12.5 to 25 mg of D50 (or local protocol)
Children > 1 : 0/5 to 1 g/kg per dose of D25 or D10 slow IV push.
Neonates/infants : 200 to 500 mg/kg of D10 via IV push. (D50 2 mL into syringe and 8 mL of normal saline)

40
Q

Dosage of Glucagon.

A

Adult : 1MG IM. May be repeated in 7-10 minutes.

Pediatric : 0.5 mg or 20 to 30 mcg/kg IM who weigh less than 20 kg.

41
Q

Management of hyperglycemia and DKA

A
Maintain airway and administer oxygen
Prepare for vomiting
Consider ALS 
IV access
Administer 20-mL/kg bolus of isotonic crystalloid solution for sign of dehydration or hypotension
42
Q

What is the prehospital treatment goal for hyperglycemia and DKA?

A

Goals are to rehydrate and correct electrolytes and acid-base abnormalities.

43
Q

Management of HHS/HONK

A

Airway management
Consider c-spine w. possible mechanism of high-energy injury
Obtain blood glucose level
IV access
500 mL bolus of 0.9% normal saline
(Give fluid sparingly w/ hx of heart failure or renal insufficiency)

44
Q

Bone marrow is found in:

A

long bones, pelvis, skull, and vertebrae.

45
Q

Potential complications of sickle cell disease:

A
CVA
Gallstones
Jaundice
Osteonecrosis
Splenic infections
Osteomyelitis
Opiate tolerance
Leg ulcers
Chronic pain 
Pulmonary hypertension
Chronic renal failure
46
Q

Vaso-occlusive crisus

A

Blood flow to an organ is restricted causing pain, ischemia, and organ damage.

47
Q

Acute chest syndrome

A

vaso-occlusive crisis associated with pneumonia

48
Q

Aplastic crisis

A

Worsening of baseline anemia causing tachycardia, pallor, and fatigue

49
Q

Hemolytic crisis

A

Acute accelerated drop in Hgb. Caused by RBCs breaking down faster than a normal rate.

50
Q

Splenic sequestration crisis

A

Painful, acute enlargements of the pain causing the abdomen to become hard and bloated.

51
Q

Suspicion of leukopenia

A

Infection and fever

52
Q

s/s anemia

A

Fatigue
Lethargy
Dyspnea
Pale skin

53
Q

Suspicion of low platelet count

A

Cutaneous bleeding (petechiae) and bleeding from mucous membranes.