EMT B-3

• Endocrine system


  Communication system that controls functions inside the body
• Endocrine glands


  Secrete messengers called hormones
• Hormones


  Travel through the blood to end organs and deliver the message
• Insulin is the main topic of discussion for this chapter
• What two things do the brain need to survive?

  Glucose and Oxygen
• Insulin


  Necessary for glucose to enter cells

  
• Pancreas


  Produces glucagon and insulin
• Islets of Langerhans


  Small portion of the pancreas filled with alpha cells that produce glucagon and beta cells that produce insulin
• Diabetes Mellitus


  Disorder of glucose metabolism where the body has an impaired ability to metabolize glucose

  
• Type 1 Diabetes


  No insulin produced
• Type 1 Diabetes


  • Onset usually happens from early childhood through the fourth decade of life
  • Patient must obtain insulin from an external source
  • Patients who inject insulin often need to check blood glucose levels up to six times or more a day

  
• Insulin Pump


  • Continuously measures glucose levels and provides an adjustable infusion of insulin
  • Limits the number of times patients have to check their finger stick glucose levels
  • Can malfunction and diabetic emergencies can develop

  
• Type 2 Diabetes


  Caused by resistance to the effects of insulin at the cellular level and usually occurs later in life

  
• Type 2 Diabetes


  • There is an association between obesity and increased resistance to the effects of insulin
  • The pancreas produces more insulin to make up for the increased levels of blood glucose and dysfunction of cellular insulin receptors
  • Insulin resistance can sometimes be improved by exercise and dietary modification

  
• Type 2 Diabetes Treatment

  1. Early stages - diet and exercise

  2. Moderate stage - Oral tablet insulin

  3. Severe Stage - Injectable insulin

  
• The downside of oral insulin is that the patient will sometimes secrete more insulin paired with oral insulin, leading to a hypoglycemic event

  
• Hyperglycemia


  Too high of blood sugar
• Hypoglycemia


  Too low of blood sugar
• Normal blood glucose


  80-120 mg/dL

  
• Hypoglycemia


  Blood glucose of 80 mg/dL or less

  
• Hyperglycemia


  Sustained blood glucose greater than about 120 mg/dL

  
• New-onset patient symptoms of hyperglycemia

  • Polyuria (frequent urination)
  • Polydipsia (increase in fluid consumption)
  • Polyphagia (severe hunger and increased food intake)
  • Weight loss, and excessive appetite
  • Warm, dry skins, fast HR, acetone breath
• Diabetic Ketoacidosis


  Without sugar, the body turns to burning stored sugar (fat), which produces ketones (an acid)
• Kussmaul Respirations


  Rapid and deep breathing, the body's way of trying to get rid of the acid in the blood (in Type 1 DKA)
• Symptomatic Hyperglycemia


  Occurs when blood glucose levels are high, leading to a state of altered mental status resulting from several combined problems

  
• Symptomatic Hyperglycemia


  • In type 1 diabetes, leads to ketoacidosis with dehydration from excessive urination
  • In type 2 diabetes, leads to a nonketotic hyperosmolar state of dehydration
  • Discharge of fluids from all of the body systems and eventually out through the kidneys, leading to fluid imbalance
• Symptomatic Hypoglycemia


  Acute emergency in which a patient's blood glucose level drops and must be corrected swiftly

  
• Symptomatic Hypoglycemia


  • Can occur in patients who inject insulin or use oral medications
  • When insulin levels remain high, glucose is rapidly taken out of the blood
  • If glucose levels fall, there may be an insufficient amount to supply the brain
  • Mental status declines, patient may become aggressive or display unusual behavior, unconsciousness or permanent brain damage can quickly follow

  
• Glucometer


  Used to assess capillary blood glucose levels, measured in milligrams per deciliter (mg/dL)

  
• Normal blood glucose level is 80 to 120 mg/dL, however 120 to 140 mg/dL is not unusual after eating

  
• Differences between hyperglycemia and hypoglycemia

  • Onset (Gradual vs Rapid)
  • Skin (Warm and Dry vs Cool Pale Clammy)
  • Infection (Common vs Uncommon)
  • Thirst (Intense vs Absent)
  • Hunger (Present and increasing vs Absent)
  • Vomiting and ABD Pain (Common vs Uncommon)
  • Breathing (DKA - Kussmaul vs Normal - shallow/slow)
  • Odor of breath (DKA - Fruity vs normal)
  • Blood Pressure (Normal to Low)
  • Pulse (Rapid, weak, thread vs Rapid and weak)
  • Consciousness (Restlessness, slurred speech, Gait, lead to coma vs Irritability, confusion, seizure, coma, Gait)
• Assessment


  1. Altered mental status assessment

  2. Scene Safety

  3. Airway

  4. Breathing

  5. Circulation

  6. History taking
• SAMPLE questions


  • Do you take insulin or pills to lower blood sugar?
  • Do you wear an insulin pump?
  • Have you taken your usual insulin dose (or pills) today?
  • Have you eaten normally today?
  • Have you had any illness, unusual amount of activity, or stress?
  • Look for an emergency medical identification device (ie. wallet card, necklace, or bracelet)

  
• Glucometer can help rule out possible trauma from falling
• Treatment


  • Hyperglycemia must be treated with insulin in hospital setting
  • Hypoglycemia can be treated with oral glucose

  
• Oral glucose


  • Three types: rapidly dissolving gel, large chewable tablets, liquid formulation
  • Contraindications: inability to swallow and unconsciousness, ALOC
• Airway, airway, airway - patient may not have a gag reflex and vomit or tongue may obstruct the airway, carefully monitor airway and place patient in lateral recumbent position
• Hematologic Emergencies


  Sickle cell disease, Hemophilia A, Thrombophilia
• Blood components


  Erythrocytes (RBCs), Leukocytes (WBCs), Platelets, Plasma
• Sickle Cell Disease


  Misshapen RBCs that lead to dysfunction in oxygen binding and unintentional clot formation, can result in hypoxia, pain, and organ damage