Endocrine & Hematologic Emergencies

Question 1

How does the body manage high glucose levels?

Answer 1

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.

Question 2

How does the body manage low glucose levels?

Answer 2

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.

Question 3

What is metabolized when glycogen levels are depleted?

Answer 3

Fats, proteins, and other noncarbonate sources

Question 4

Alpha cells in islets of Langerhans

Answer 4

glucagon

Question 5

Beta cells in islets of Langerhans

Answer 5

insulin

Question 6

Delta cells in islets of Langerhans

Answer 6

somatostatin

Question 7

Major effects of hypothyroidism

Answer 7

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

Question 8

Major effects of hyperthyroidism

Answer 8

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

Question 9

s/s thyroid storm

Answer 9

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

Question 10

Thyroid storm

Answer 10

Caused my excessive levels of circulating thyroid hormone called thyrotoxicosis.

Question 11

3 p’s of DM

Answer 11

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

Question 12

What is microangiopathy?

Answer 12

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

Question 13

Why can’t insulin be ingested orally?

Answer 13

The digestive process with render it inactive.

Question 14

Normal, prediabetic, and type 2 A1c levels.

Answer 14

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

Question 15

Risk factors of prediabetes and DMII

Answer 15

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

Question 16

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

Answer 16

Progesterone and estrogen

Question 17

Management of gestational diabetes.

Answer 17

Diet modification, exercise, and blood glucose testing.

Question 18

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

Answer 18

28; third

Question 19

Which nervous system depends entirely on glucose for energy?

Answer 19

Central nervous system

Question 20

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

Answer 20

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

Question 21

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

Answer 21

Sympathetic nervous system.

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

Question 22

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

Answer 22

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

Question 23

Two actions of type 2 dm medications.

Answer 23

Stimulate body’s ability to secrete insulin.

Improve insulin’s actions.

Question 24

Hypoglycemia is caused by :

Answer 24

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

Question 25

Most common signs of hypoglycemia :

Answer 25

``` 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 ```

Question 26

Hyperglycemic crisis

Answer 26

AKA diabetic coma | State of unresponsiveness resulting from problems including DKA, hyperglycemia, and dehydration.

Question 27

Hyperglycemia can be caused by :

Answer 27

``` Excessive food intake Insufficient insulin dosages Infection or illness Injury Surgery Emotional stress ```

Question 28

Hyperosmolar hyperglycemic syndrome (HHS)

Answer 28

blood glucose level greater than 600

Question 29

s/s of simple hyperglycemia

Answer 29

``` blurred vision polyuria polydipsia polyphagia orthostatic syncope frequent infections skin ulcerations ```

Question 30

Treatment of simple hyperglyemia

Answer 30

Supportive care and transport

Question 31

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

Answer 31

Sodium, potassium and phosphates

Question 32

s/s advanced hyperglycemia

Answer 32

``` 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 ```

Question 33

s/s hypoglycemia

Answer 33

``` 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 ```

Question 34

s/s HHS

Answer 34

``` 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 ```

Question 35

HHS/HONK typically characterized by

Answer 35

hyperglycemia, hyperosmolarity, and absence of substantial ketosis

Question 36

Difference between HHS/HONK and DKA

Answer 36

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.

Question 37

Pertinent additional SAMPLE questions for DM emergencies.

Answer 37

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

Question 38

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

Answer 38

Mental status - GCS Ability to swallow Protect the airway

Question 39

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

Answer 39

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)

Question 40

Dosage of Glucagon.

Answer 40

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.

Question 41

Management of hyperglycemia and DKA

Answer 41

``` 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 ```

Question 42

What is the prehospital treatment goal for hyperglycemia and DKA?

Answer 42

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

Question 43

Management of HHS/HONK

Answer 43

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)

Question 44

Bone marrow is found in:

Answer 44

long bones, pelvis, skull, and vertebrae.

Question 45

Potential complications of sickle cell disease:

Answer 45

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

Question 46

Vaso-occlusive crisus

Answer 46

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

Question 47

Acute chest syndrome

Answer 47

vaso-occlusive crisis associated with pneumonia

Question 48

Aplastic crisis

Answer 48

Worsening of baseline anemia causing tachycardia, pallor, and fatigue

Question 49

Hemolytic crisis

Answer 49

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

Question 50

Splenic sequestration crisis

Answer 50

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

Question 51

Suspicion of leukopenia

Answer 51

Infection and fever

Question 52

s/s anemia

Answer 52

Fatigue Lethargy Dyspnea Pale skin

Question 53

Suspicion of low platelet count

Answer 53

Cutaneous bleeding (petechiae) and bleeding from mucous membranes.