Chapter 20: Endocrine and Hematologic Emergencies

Introduction

• Endocrine System: Influences nearly every cell, organ, and function in the body. Disorders often present with diverse signs and require thorough assessment and immediate treatment.
• Diabetes Mellitus: Focus on types 1 and 2, pancreas' role in hormone production, and differentiation of hyperglycemia vs. hypoglycemia.
• Hematologic Emergencies: Often missed in patients, but timely diagnosis and treatment can be life-saving.

Endocrine Emergencies

Anatomy and Physiology

• Communication System: Controls internal functions and maintains homeostasis through messenger hormones.
• Disorders: Caused by overproduction or underproduction of hormones, or lack of response from target organs.
• Glucose Metabolism: Insulin allows glucose to enter cells; glucagon stimulates the release of glucose for energy.

Pathophysiology

• Diabetes Statistics: Affects 9.4% of the population in the US; 1.5 million new cases yearly.
• Diabetes Mellitus: Impaired glucose metabolism due to inadequate insulin production or cellular resistance.
• Types of Diabetes:
  • Type 1: Autoimmune destruction of beta cells; requires external insulin.
  • Type 2: Cellular resistance to insulin, often associated with obesity.
  • Gestational Diabetes: Covered in obstetrics.

Treatment

• Medications and Hormones: Lower blood glucose; incorrect use can cause emergencies.

Hyperglycemia vs. Hypoglycemia

• Hyperglycemia: High blood glucose, can cause life-threatening conditions if untreated.
• Hypoglycemia: Low blood glucose, requires prompt treatment.

Diabetes Mellitus Type 1

• Characteristics:
  • Autoimmune disorder.
  • Lack of insulin production.
  • Symptoms: Polyuria, polydipsia, polyphagia, weight loss, and fatigue.
  • Management: Insulin pumps, glucose monitoring.
  • Complications: Diabetic ketoacidosis, ketone production, and metabolic acidosis.

Diabetes Mellitus Type 2

• Characteristics:
  • Insulin resistance.
  • Associated with obesity.
  • Management: Lifestyle changes, oral medications, and sometimes insulin.

Symptomatic Hyperglycemia and Hypoglycemia

• Symptoms and Management:
  • Hyperglycemia: Frequent urination, thirst, blurred vision; can develop into severe dehydration and altered mental status.
  • Hypoglycemia: Rapid onset, requires immediate correction with glucose.

Hematologic Emergencies

Anatomy and Physiology

• Blood Components:
  • Red Blood Cells: Carry oxygen.
  • White Blood Cells: Fight infection.
  • Platelets: Clotting.
  • Plasma: Transport medium.

Pathophysiology

• Sickle Cell Disease: Inherited disorder causing misshapen red blood cells, leading to occlusion and pain.
• Hemophilia: Rare disorder, usually in males, causing impaired clotting.
• Thrombophilia: Increased clotting risk due to various factors.
• Anemia: Low red blood cell count leading to hypoxia.

Patient Assessment and Management

• Scene Safety and Initial Assessment: Evaluate for trauma and primary assessment of consciousness, airway, breathing, and circulation.
• History Taking: Focus on symptoms, medical history, and potential causes of current state.
• Secondary Assessment and Reassessment: Check for additional signs, monitor vital signs, especially glucose levels.
• Emergency Care: Provide oxygen, manage airway, and assess for transport to higher-level care.

Communication and Documentation

• Hospital Communication: Provide complete patient history, assessment findings, and interventions.
• Documentation: Thoroughly document assessment findings and treatment given.

These notes provide a comprehensive overview of the endocrine and hematologic emergencies as discussed in the lecture, focusing on the hormonal and blood disorders, their pathophysiology, and emergency medical care.