Endocrine and Hematologic Emergencies

Chapter 20

• good sample and opqrst

Some Anatomy

• Glands secrete messenger hormones

  • Hormones affect everything

• Endocrine disorders are caused by an internal communication problem

• The pancreas produces glucagon and insulin

  • islets of langerhans have alpha and beta cells

    • Alpha cells produce Glucagon

    • Beta produce Insulin

Glucose Metabolism

• brain needs it and o2

• insulin is necessary for glucose to enter the cells

• Without enough insulin, cells do not get fed

Symptoms:

• Hyperglycemia (Type 1)

  • 3 Ps

    • Polyuria: Pee a lot

    • Polydipsia: Drink a lot

    • Polyphagia: Eat a lot

    • Weight loss (Patients that experience weight loss without any reason and still eat a ton could be in the area of hyperglycemia)

    • Fatigue

    • Patient Breathes faster and deeper (Kussmaul respirations)

      • Patient becomes acidotic (Co2 build up)

  • Diabetic Ketoacidosis(DKA)

    • Abdominal pain

    • Body aches

    • Nausea

    • Vomiting

    • Altered mental status or unconsciousness

    • Rapid and Deep breathing

  • HHNS

• Hypoglycemia (Type 2)

  • All patients with hypoglycemia need immediate attention

    • Patient can stop breathing pretty fast

  • Common complaints:

    • Recurrent infection

    • Change in vision

    • Numbness in the feet

  • Mental status of the patient declines

  • Patient may become aggressive or display unusual behavior

  • Unconsciousness and permanent brain damage can quickly follow

Symptomatic

• Normal to shallow or rapid respiration

• Pale, moist skin

• Diaphoresis

• Dizziness, headache

• Rapid pulse

• Normal to low BP

• Alterend MS/ Rapid changes in MS

• Anxious or Combative

• Seizures, fainting, coma

• Weakness on one side of body

  • A stoke can actually happen due to low BS levels

Illnesses

• Diabetes mellitus impairs the body’s ability to use glucose as fuel

  • blood glucose can get to high

• Type 1:

  • Hyperglycemia

    • immune system produces antibodies against beta cells (impacts insulin), it destroys the pancreas ability to produce insulin

      • Onset occurs until 40yrs

      • these patients can’t survive around insulin, and need to get it from an external source, such as injections or an insulin pump, to maintain their blood glucose levels.

      • These patients have an implanted device that continuously monitors blood glucose levels and delivers insulin as needed.

        • They have about 5 minutes after taking insulin in the morning to get food otherwise they will pass out

          • Check the fridge for medications with an unconscious patient, specifically hemolin, hemoglob, glyceride, etc.

          • Ask the patient if they have diabetes if they are missing any limbs

          • Ask if they have an insulin pump

          • Check there finger fo caluses from prior pricking of the finger

• Diabetic Ketoacidosis (DKA)

  • If the patient is vomiting to the point they continuously vomit bile ask if they are diabetic

    • Patients vomiting because the body is trying to remove all the sugar

    • Obtain a blood glucose level, if it is above 400 or “HI” thats bad, if your glucometer says hello its baddddd

• After a long time of having hyperglycimia

  • Wounds that don’t heal

  • Numbness

  • Blindness

  • Renal Failure

  • Gastric motility problems

    • In higher blood sugar, the skin is dryyyyyyy and your constipated

Type 2:

• Caused by resistance to the effects of insulin

  • Obesity predisposes patient to type 2 diabetes

    • Meaning, they have been gaining a lot of weight - ASK ABOUT THIS!

  • Pancreas produces more insulin

  • Oral medication- glyceride, glucophage, etc.

• leads to

  • nonketotic hyperosmolar state of dehydration

Common causes:

• Correct dose of insulin with change in routine

• More insulin then needed

• Correct dose of insulin without eating enough

• Correct dose of insulin and the patient developed an acute illness

Medications:

• Oral Glucose

  • On tongue depressor, in cheek.

    • No gag reflex, etc.

• Patients with diabetes use medications with needles, so empty out their bags by turning them upside down, don’t put your hand in there

Assessment:

• You can smell a fruity/sweet smell is a sign of possible diabetic ketoacidosis (DKA)

• Dry, warm skin = Hyperglycemia

• Moist, pale and skin = Hypoglycemia

Hematologic

• sickle cell

• hemophilia

• thrombophilia

• Anemia

Pulmonary embolism: clot in lungs

heat attack: clot in heart

stroke: clot in brain

Sickle Cell

• Inherited

• Sickle cells have a short life span leading to more waste in the blood. Blood is commonly thicker

• Symptoms

  • Swelling, pain, etc.

• Complications

  • Anemia

  • Gallstones

  • Jaundice (looking yellow, impacts the liver due to gallstones blocking the liver)

  • Splenic Dysfunction (pain in the upper left quadrant)

  • Vascular occlusion with ischemia

    • Acute chest syndrome

    • stroke

    • joint necrosis (pain in joints)

    • pain crises (Horrible pain)

      • Oxygen and prompt transport

    • acute and chronic organ dysfunction/failure

    • retinal hemorrhage (popped blood vessels in the eye)

    • increased risk of infection

Symptoms Sickle Cell Crisis:

• Swelling of fingers

• Priapism

  • Trauma

• Jaundice

  • Liver issue

Hemophilia

• Hemophilia A impacts mostly men

  • joint problems that may require replacement

  • bleeding in brain

  • thrombosis due to treatment

• Decreased ability to clot

Thrombophilia

• Decreased ability to maintain smooth blood flow

• Can clog or block

• patients generally take blood thinners

  • DVT (Deep vein thrombosis)

    • Common in patients that sit a lot or have had recent injury

      • Helps: Compression stocking/Blood thinners

      • Treatment; Anticoagulation therapy

Anemia

• abnormally low number of RBCs

• Blood is unable to deliver adequate amounts of oxygen to tissues

  • Pulse ox may indicate an adequate saturation even though the tissue are hypoxic, always treat the patient not the monitor

    • Lay them done, keep comfortable, and keep them warm. (anemic, thinner, menstrual cycle is common)

Patients who have a diabetic emergency and can rna, if they ar not at there house what do they need to do to get home?

• They must find someone else to drive him, he cant do it himself