Overview
This lecture covers endocrine and hematologic emergencies, focusing on diabetes (type 1, type 2, gestational), sickle cell disease, clotting disorders, and related pre-hospital assessment and treatment.
Endocrine System and Glucose Metabolism
- The endocrine system controls body functions by releasing hormones from glands into the blood.
- Endocrine disorders come from problems in hormone production (hypersecretion/hyposecretion) or the target organ's response.
- The pancreas produces insulin (from beta cells) and glucagon (from alpha cells) to control blood glucose.
- Insulin is needed for glucose entry into cells; lack of insulin causes high blood glucose.
Diabetes Mellitus
- Diabetes mellitus is a disorder of glucose metabolism leading to high blood glucose.
- Type 1 diabetes: autoimmune destruction of beta cells; patients require external insulin.
- Type 2 diabetes: insulin resistance at the cellular level, often related to obesity; managed with diet, exercise, oral meds, or insulin.
- Gestational diabetes occurs during pregnancy.
- Diabetic emergencies include hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose).
Diabetic Emergencies: Presentation & Assessment
- Hypoglycemia: rapid onset, altered mental status, shallow/rapid breathing, pale/clammy skin, rapid pulse, seizures, and possible coma.
- Hyperglycemia: slow onset, dry/warm skin, deep/rapid (Kussmaul) respirations, fruity breath, dehydration, and possible DKA or HHS.
- Assess with scene safety, history (OPQRST, SAMPLE), blood glucose testing, and monitoring ABCs.
Prehospital Treatment of Diabetic Emergencies
- For conscious, hypoglycemic patients who can swallow: oral glucose or sugary drinks.
- For unconscious or risk of aspiration: rapid transport and advanced care (IV glucose, IM/IN glucagon).
- Always reassess mental status, ABCs, and blood glucose.
Hematologic Emergencies
- Blood consists of erythrocytes (RBCs), leukocytes (WBCs), platelets, and plasma.
- Sickle cell disease: inherited, causes misshapen RBCs, resulting in anemia, pain crises, and organ dysfunction.
- Hemophilia A: decreased clotting factors, mostly in males, leads to dangerous bleeding.
- Thrombophilia: increased blood clot risk, may be inherited or acquired.
- Deep vein thrombosis (DVT): clots in deep veins, risk of pulmonary embolism; managed with anticoagulants.
Patient Assessment for Hematologic Disorders
- Ensure scene safety, wear PPE, and consider trauma.
- Primary assessment (ABCs), provide high-flow oxygen for respiratory distress.
- Gather history of present illness, prior crises, and sample history.
- Focused secondary assessment, monitor vital signs and oxygen saturation.
Key Terms & Definitions
- Hypersecretion — Excess hormone production.
- Hyposecretion — Deficient hormone production.
- Insulin — Hormone that allows glucose into cells.
- Diabetic Ketoacidosis (DKA) — Life-threatening complication from fat metabolism in type 1 diabetes.
- Hyperosmolar Hyperglycemic Syndrome (HHS) — Severe dehydration and high glucose in type 2 diabetes.
- Sickle Cell Disease — Inherited RBC disorder causing misshapen RBCs and many complications.
- Hemophilia — Genetic disorder causing impaired clotting.
- Thrombophilia — Increased tendency to form abnormal blood clots.
- Deep Vein Thrombosis (DVT) — Blood clot in a deep vein, especially in the legs.
Action Items / Next Steps
- Review and memorize signs and symptoms of hyper/hypoglycemia.
- Practice blood glucose assessment and use of glucometer.
- Study local protocols for oral glucose administration.
- Read textbook sections on hematologic emergencies and review case studies.