Chapter 20: Endocrine and Hematologic Emergencies

Overview

• Focus on diabetes, sickle cell disease, clotting disorders, and complications.
• Understand characteristics of type 1 and type 2 diabetes.
• Steps for assessment and pre-hospital treatment of diabetic emergencies.
• Discussion on hematologic emergencies including sickle cell disease, hemophilia, thrombophilia, and deep vein thrombosis.

Endocrine System

• Controls body functions via hormone secretion.
• Hormones travel through blood affecting organs, tissues, and cells.
• Disorders arise from communication issues (e.g., hypersecretion or hyposecretion).

Glucose Metabolism

• Brain requires glucose and oxygen.
• Insulin allows glucose to enter cells.
• Pancreas produces glucagon and insulin.

Diabetes Mellitus

Type 1 Diabetes

• Autoimmune destruction of insulin-producing cells.
• Requires external insulin source.
• Common in childhood to young adulthood.
• Symptoms: polyuria, polydipsia, polyphagia, weight loss, fatigue.

Type 2 Diabetes

• Resistance to insulin effects at a cellular level, often related to obesity.
• Managed with medications, diet, and exercise.
• Symptoms: recurrent infections, vision changes, numbness.

Diabetic Emergencies

• Hypoglycemia: Low blood sugar, potentially life-threatening.
• Hyperglycemia: High blood sugar, can lead to diabetic ketoacidosis (DKA).
• Assessment: Check glucose levels; symptoms may mimic alcohol intoxication.

Hematologic Disorders

Sickle Cell Disease

• Inherited, affects red blood cells’ shape, leading to clots.
• Complications: anemia, gallstones, spleen dysfunction, increased infection risk.

Hemophilia

• Rare, mostly affects males.
• Decreased ability to clot after injury.
• Treatments include medications to replace clotting factors.

Thrombophilia and DVT

• Blood clots more easily; risk factors include sedentary lifestyle and surgeries.
• Treatment for DVT includes anticoagulation therapy.

Anemia

• Low red blood cell count; can result from various causes.
• Affects oxygen delivery to tissues; may cause hypoxia.

Patient Assessment and Management

Diabetes

• Scene size-up: Look for syringes, insulin pumps, glucose sources.
• Primary assessment: Check airway, breathing, circulation, and transport needs.
• Secondary assessment: Focus on mental status and glucose levels.

Hematologic Disorders

• Ensure scene safety and assess for signs like swelling or jaundice.
• Monitor vital signs and oxygen levels.

Emergency Care

• Diabetic patient: Administer oral glucose if conscious and able to swallow.
• Sickle cell or hemophilia crisis: Provide high-flow oxygen, position of comfort, rapid transport.

Key Takeaways

• Diabetic ketoacidosis presents with rapid, deep breathing.
• Hypoglycemia requires swift correction with glucose.
• Ensure proper documentation and understanding of patient history in emergencies.