Chapter 20: Endocrine and Hematologic Emergencies

Overview

• Focuses on understanding endocrine and hematologic emergencies
• Key conditions: Diabetes (Type 1 & 2), Sickle Cell Disease, Clotting Disorders, and related complications
• Pre-hospital assessment and treatment strategies for diabetic emergencies
• Discussion of hematologic emergencies including Sickle Cell Disease, Hemophilia, Thrombophilia, and Deep Vein Thrombosis (DVT)

Endocrine System

• Function: Controls body functions through hormone secretion
• Endocrine Disorders: Result from communication problems within the body
  • Hypersecretion: Excess hormone production
  • Hyposecretion: Insufficient hormone production
  • Receptor Issues: Target organs not responding to hormones

Glucose Metabolism

• Brain requires glucose and oxygen to function
• Insulin: Key for glucose entry into cells
• Pancreas: Produces insulin and glucagon
  • Alpha Cells: Produce glucagon
  • Beta Cells: Produce insulin

Diabetes Mellitus

• Type 1 Diabetes: Autoimmune destruction of beta cells, requires external insulin
• Type 2 Diabetes: Insulin resistance, managed with medications and lifestyle changes
• Gestational Diabetes: Occurs during pregnancy

Complications of Diabetes

• Hypoglycemia: Low blood sugar, life-threatening if untreated
  • Signs: Altered mental status, rapid pulse, pale skin
• Hyperglycemia: High blood sugar, can lead to DKA or HHNS
  • Symptoms: Thirst, frequent urination, nausea, fruity breath

Diabetic Emergencies

• Diabetic Ketoacidosis (DKA): Life-threatening, needs rapid recognition and treatment
• Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS): High blood sugar without ketosis, leads to severe dehydration

Hematologic Emergencies

• Components of Blood: Red blood cells, white blood cells, platelets, plasma
• Sickle Cell Disease: Genetic disorder causing misshapen red blood cells
  • Leads to pain crises and increased infection risk
  • Symptoms: Anemia, gallstones, spleen dysfunction

Clotting Disorders

• Hemophilia: Decreased ability to clot, risk of life-threatening bleeding
• Thrombophilia: Blood clots more easily than normal, risk for DVT and pulmonary embolisms

Deep Vein Thrombosis (DVT)

• Common in sedentary individuals or post-surgery
• Treatment: Anticoagulation therapy, compression stockings

Patient Assessment

• Scene Size-up: Look for indications of diabetic supplies
• Primary Assessment: Check ABCs, level of consciousness, and transport decision
• History Taking: Gather information on insulin use, dietary intake, and recent activity
• Secondary Assessment: Focus on neurological status and vital signs

Emergency Care

• For Diabetic Emergencies:

  • Administer glucose for hypoglycemia if patient is conscious
  • Rapid transport for unresponsive patients
  • Monitor and manage airway, breathing, and circulation

• For Hematologic Emergencies:

  • Provide supportive care: oxygen, comfort, and rapid transport

Review Questions

• Address topics like glucose utilization impairment in Type 1 diabetes, causes of hypoglycemic crisis, and the importance of maintaining proper glucose levels.