Summary of "Chapter 20 Endocrine and Hematologic Emergencies"
Summary of Chapter 20: Endocrine and Hematologic Emergencies
This chapter covers the recognition, pathophysiology, assessment, and management of acute endocrine and hematologic emergencies, focusing primarily on diabetic emergencies, sickle cell crises, and clotting disorders.
Main Ideas and Concepts
Endocrine Emergencies: Diabetes Mellitus
Endocrine System Overview
- The endocrine system regulates body functions via hormones secreted by glands.
- Diabetes mellitus is an internal communication disorder affecting glucose metabolism.
Glucose and Insulin Physiology
- The brain requires glucose and oxygen to function.
- Insulin (produced by pancreatic beta cells) is necessary for glucose to enter cells.
- Glucagon (produced by alpha cells) helps raise blood glucose levels.
Types of Diabetes
- Type 1 Diabetes Autoimmune destruction of beta cells → no insulin production → requires external insulin. Usually diagnosed in childhood.
- Type 2 Diabetes Insulin resistance, often related to obesity; pancreas produces insulin but cells resist it. Can be managed with oral medications, lifestyle changes, or insulin.
Complications of Diabetes
- Hyperglycemia leads to complications such as blindness, cardiovascular disease, kidney failure, dehydration, and diabetic ketoacidosis (DKA).
- Hypoglycemia results from excess insulin or missed meals and can cause altered mental status, seizures, or unconsciousness.
Signs and Symptoms
- Hyperglycemia Polyuria, polydipsia, polyphagia, weight loss, fatigue, fruity breath (acetone), Kussmaul respirations (deep, rapid breathing), dehydration.
- Hypoglycemia Pale, moist skin, diaphoresis, rapid pulse, confusion, aggression, seizure-like activity, possible unconsciousness.
Assessment and Management
- Ensure scene safety and use body substance isolation (BSI).
- Assess airway, breathing, and circulation (ABCs).
- Use glucometer if allowed by protocols.
- Administer oral glucose if the patient is conscious and able to swallow (gel, tablets, juice).
- If unconscious or unable to swallow, do not give oral glucose; advanced providers may administer IV glucose or glucagon.
- Continuous reassessment and prompt transport to hospital.
- Obtain thorough history: insulin use, food intake, illness, activity level, presence of insulin pump.
Differentiation Between Hyperglycemia and Hypoglycemia
- Skin condition (warm/dry vs. pale/moist), breathing pattern, and mental status help differentiate.
- Hyperglycemia onset is slower; hypoglycemia is rapid and reversible with glucose.
Hematologic Emergencies
Blood Components
- Red blood cells (erythrocytes), white blood cells (leukocytes), platelets, and plasma.
Sickle Cell Disease
- Genetic disorder affecting red blood cells → sickle-shaped cells that clog blood vessels, causing pain and organ damage.
- Common in African, Caribbean, and South American populations.
- Complications include anemia, pain crises, stroke, jaundice, splenic dysfunction, and infection risk.
- Patients often misjudged as drug seekers due to severe pain.
- Management includes oxygen, pain control (ALS level), hydration, and transport.
Hemophilia
- Genetic clotting disorder causing inability to form clots properly, leading to prolonged bleeding.
- Mostly affects males.
- Complications include joint damage, intracranial bleeding, and thrombosis due to treatment.
- EMS care focuses on bleeding control, oxygen, and rapid transport.
Thrombophilia
- Increased tendency to form blood clots (thrombosis).
- Risk factors: immobility, recent surgery, long travel.
- Clots can cause deep vein thrombosis (DVT) or pulmonary embolism (PE).
- Prevention includes anticoagulants, compression stockings, and encouraging mobility.
Anemia
- Reduced red blood cell count or hemoglobin → decreased oxygen delivery despite normal pulse oximeter readings.
- EMS should be aware that pulse oximetry may not reflect true tissue oxygenation.
Assessment and Management of Hematologic Emergencies
- Ensure scene safety and use personal protective equipment (PPE).
- Administer oxygen and provide supportive care.
- Manage pain at ALS level.
- Rapid transport and communication with hospital.
- Obtain detailed history including previous crises and treatments.
Methodology / Instructions for EMS Providers
Diabetic Emergencies
- Ensure scene safety (beware of syringes).
- Perform primary assessment (ABCs).
- Assess mental status and skin condition to differentiate hypoglycemia vs. hyperglycemia.
- Use glucometer if allowed; know device-specific ranges.
- If hypoglycemic and conscious, administer oral glucose buccally using a tongue depressor; do not give if unconscious or unable to swallow.
- If unconscious, prepare for airway management and suction; ALS may administer IV glucose or glucagon.
- Reassess frequently and transport promptly.
- Obtain thorough patient history focusing on insulin use, food intake, illness, and devices like insulin pumps.
Hematologic Emergencies
- Use standard precautions and PPE.
- Provide oxygen and supportive care.
- Control bleeding if present (especially in hemophilia).
- Assess for signs of sickle cell crisis (pain, swelling, jaundice) or thrombosis (pain, swelling, respiratory distress).
- Obtain detailed history of previous crises and treatments.
- Rapid transport and communication with receiving facility.
Key Terms and Concepts
- Kussmaul respirations: Deep, rapid breathing seen in DKA.
- Diabetic Ketoacidosis (DKA): Severe hyperglycemia with ketone buildup causing acidosis.
- Polyuria, Polydipsia, Polyphagia: Excessive urination, thirst, and hunger, respectively.
- Hypoglycemia: Low blood sugar, rapid onset, reversible with glucose.
- Hyperglycemia: High blood sugar, slower onset, associated with dehydration and DKA or hyperosmolar states.
- Sickle Cell Crisis: Acute painful episodes caused by sickled red blood cells clogging vessels.
- Hemophilia: Clotting disorder causing bleeding risk.
- Thrombophilia: Increased clotting tendency leading to DVT or PE.
- Anemia: Low red blood cell count causing tissue hypoxia despite normal pulse oximetry.
Speakers / Sources Featured
- The primary speaker is an EMS educator or paramedic instructor delivering a detailed lecture on Chapter 20: Endocrine and Hematologic Emergencies.
- No other distinct speakers or sources are identified; the content appears to be a single narrator providing a comprehensive teaching session.
This summary encapsulates the critical information for EMS providers and healthcare professionals to recognize, assess, and manage endocrine and hematologic emergencies effectively in the prehospital setting.
Category
Educational
