Chapter 19 Flashcards by Gail I

emergency med care for hematologic disorders is mainly … and …
patients with inadequate breathing/altered mental status:
administer high-flow oxygen at 12-15 L/min via NRB
place in position of comfort
transport rapidly

supportive; symptomatic

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endocrine system is a … system that controls functions inside the body. endocrine glands secrete …
endocrine disorders are caused by an internal communication problem: if a gland is not functioning normally it may produce … or … hormone than needed
a gland may be functioning correctly, but the receiving organ may not be responding

communication; messenger hormones; more; less

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glucose metabolism:
the brain needs glucose and oxygen
… is necessary for glucose to enter cells
the pancreas produces … and …–> stores and secretes these hormones in response to ..

insulin; insulin; glucagon; insulin; blood glucose level

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type 1 diabetes is the most common metabolic disease childhood. new-onset patient symptoms:
…: frequent urination
..: increase in fluid consumption
…: severe hunger and increased food intake
…
…

polyuria;
 polydipsia
polyphagia
weight loss
fatigue

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diabetes mellitus impairs the body’s ability to use glucose for fuel
without treatment, blood glucose levels become too …–> in severe cases, may cause life-threatening illness, or … and ..
complications include …, … disease, and … failure

high; coma; death; blindness; cardiovascular; kidney

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three types of diabetes:
…
…
…

type 1
type 2
gestational diabetes

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treatments for diabetes:
medications and injectable hormones that …blood glucose level–> can create a med emergency for diabetics; …, if unrecognized and untreated, can be life threatening

lower; hypoglycemia

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hyperglycemia can result in … or … and if treatment exceeds a patient’s need, it can cause a life-threatening state of ..

coma; death; hypoglycemia

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hyperglycemia and hypoglycemia can occur with diabetes … and ..
they can be quite similar in presentation:
…
can often mimic …
all hypoglycemic patients require prompt treatment

type 1; type 2; altered mental state; alcohol intoxication

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hypoglycemia can develop if a person takes his/her meds but fails to … or if a person takes too much meds, resulting in low blood glucose levels despite normal …

eat enough; dietary intake

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diabetes type 1:
an … disorder where the immune system produces antibodies against the pancreatic … cells–> missing the pancreatic hormone insulin
onset usually happens from early childhood through the fourth decade of life
patient must obtain insulin from an … source
patients who inject insulin often need to check blood glucose levels up to … times or more a day

autoimmune; beta; external; six

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type 1 cont:
many people with type 1 have an … that continuously measures glucose levels and provides and adjustable infusion of insulin
can malfunction and diabetic emergencies can develop
limits the number of times patients have to check their fingerstick glucose level
always inquire about the presence of these

implanted insulin pump

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type 1 cont:
patient’s blood glucose level is above normal–> kidney’s filtration system becomes overwhelmed and glucose spills into the …
when glucose is unavailable to cells, body turns to … and produces … waste (…); kidneys then cannot maintain … balance and … respirations result

urine; burning fat; acid; ketones; acid-base; kussmaul

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type 1 cont:
if fat metabolism and ketone production continue, … can develop–> may present as generalized illness, plus: …, …, …, …, … or … (if severe)

diabetic ketoacidosis; abdominal pain; body aches; nausea; vomiting; altered mental status; unconsciousness

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DKA can result in death. when a DKA patient has altered mental status, ask family/friends about patient history and presentation and obtain a …–> generaly higher than .. mg/dL

glucose level; 400

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type 2:
caused by … to the effects of insulin at the cellular level:
an association between obesity and increased resistance to the effects of insulin
pancreas produces more insulin to make up for the increased levels of blood glucose and dysfunction of …
insulin resistance can sometimes be improved by … and … modification

resistance; cellular insulin receptors; exercise; dietary

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type 2 cont:
.. medications used to treat this; some increase … and pose a high risk of hypoglycemic reaction; some stimulate … for insulin; others decrease the effects of … and decrease the release of glucose stored in the liver
injectable medications and insulin are also used

oral; secretion of insulin; receptors; glucagon

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type 2 cont: 
often diagnosed at a yearly medical exam from complaints related to high blood glucose levels, including: 
recurrent ..
change in ..
numbness in the ...

infection; vision; feet

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symptomatic hyperglycemia: occurs when blood glucose levels are high
patient is in a state of … resulting from several combined problems:
- in type 1 diabetes, leads to … with … from excessive urination
- in type 2 diabetes, leads to a … state of dehydration due to the discharge of fluids from all of the body systems and eventually out through the kidneys, leading to fluid imbalance

altered mental status; ketoacidosis; dehydration; nonketotic hyperosmolar

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symptomatic hyperglycemia cont: 
…: when blood glucose levels are not controlled in type 2 
signs and symptoms include: 
hyperglycemia
altered mental status, drowsiness, lethargy, 
severe dehydration, thirst, dark urine
visual/sensory deficits
partial paralysis/muscle weakness
seizures

hyperosmolar hyperglycemic nonketotic syndrome

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symptomatic hyperglycemia cont:
higher glucose levels in the blood cause the excretion of glucose in the urine–> patient increases … intake, which causes polyuria
patient cannot drink enough fluid to keep up with the exceedingly high blood glucose and urine becomes … and ..
patient may become unconscious or have seizure activity due to severe dehydration

fluid; dark; concentrated

symptomatic hypoglycemia:
acute emergency where a patient’s blood glucose drops and must be swiftly corrected: can occur in patients who … or use … meds
when insulin levels remain high, glucose is rapidly taken out of the blood; if glucose levels fall, there may be an insufficient amount to ..

inject insulin; oral; supply the brain

symptomatic hypoglycemia cont:
.. declines–> patients may become aggressive/display unusual behavior
… or … can quickly follow
hypoglycemia develops much more quickly than hyperglycemia

mental status; unconsciousness; permanent brain damage

hypoglycemia is quickly reversed by giving the patient

glucose

scene safety: | patients with diabetes may use ..

syringes

airway and breathing: patients showing signs of inadequate breathing, a pulse ox level less than or equal to 94% or altered mental status should receive ..

high-flow oxygen

hyperglycemic patients may have .., … kussmaul respirations and …, … breath hypoglycemic patients will have normal or … to … respirations

rapid; deep; sweet; fruity; shallow; rapid

``` circulatory status: hyperglycemia: .., … skin hypoglycemia: …, … skin symptomatic hypoglycemia: …, … pulse transport promptly patients with altered mental status and impaired ability to swallow ```

dry; warm; moist; pale rapid; weak

SAMPLE history: ask the patient: do you take … or pills to … blood sugar? do you wear an ..? have you taken your usual … (or pills) today? have you … normally today? have you had any illness, unusual amount of activity or stress? look for emergency med identification devices

insulin; lower; insulin pump; insulin dose; eaten;

secondary assess: | when you suspect a diabetes related problem, focus on …, ability to …, and ability to …--> obtain a … score

mental status; swallow; protect airway; Glasgow Coma Scale

secondary assess--vitals: hypoglycemia: respirations are .. to .., pulse is .. and .. and skin is typically … and … with a … blood pressure hyperglycemia: respirations may be … and …; pulse may be …, …, and …; and skin may be … and … with a … blood pressure

normal; rapid; weak; rapid; pale; clammy; low; deep; rapid; rapid; weak; thread; warm; dry; normal

secondary assess: portable glucometer: know the upper and lower ranges at which your glucometer functions normal nonfasting adult and child blood glucose level range: … to … mg/dL; neonates should be above … mg/dL

80; 120; 70

reassessment: for hypoglycemic, conscious patients who can swallow: encourage patient to take … or drink .. containing sugar administer gel preparation/sugar drink provide rapid transport base administration of glucose on serial glucometer readings/deteriorating level of consciousness

glucose tablets; juice

for unconscious, hypoglycemic patients, or patients with risk of aspiration: … or Im or IN … is needed, which EMTs can't give if in doubt whether that patient has hyper/hypo glycemia, err on side of giving glucose

IV; glucagon

if unable to test for a blood glucose value: perform a thorough assessment, contact the hospital to help sort out the signs and symptoms coordinate communication and documentation: patients who refuse transport bc their symptoms improve after taking oral glucose may require even more ..

.thorough documentation

three types of oral glucose: rapidly dissolving … large .. … formulation

gel; chewable tablets; liquid

oral glucose: contraindications: inability to … and … wear gloves follow protocols

swallow; unconsciousness

seizures should be considered very serious … is a possible cause may indicate potentially life-threatening condition management: clear airway place patient on his/her ..if there is no possibility of cervical trauma don't place anything in patient's mouth have … equipment ready if patient is cyanotic/breathing inadequately, provide ox/ventilations

hypoglycemia; side; suctioning

presentation of hypoglycemia: altered mental status-- may be caused by other conditions may be caused by complications of diabetes-- … or … use mnemonic AEIOU-TIPS--> always suspect and check for low blood glucose in a patient with altered mental status

hypoglycemia; ketoacidosis

misdiagnosis of neurologic dysfunction: symptoms mistaken for … a patient with diabetes confined by police is at risk look for medic tags perform blood glucose test at scene if allowed … and .. can coexist in a patient

intoxication; diabetes; alcoholism

``` presentation of hypoglycemia: relationship to airway management: may not have a … …/… may obstruct airway carefully monitor airway place patient in .. positon make sure suction is available ```

gag reflex vomit/tongue lateral recumbent

hematologic emergencies for prehospital enviro: … … ...

sickle cell hemophilia A thrombophilia

sickle cell: inherited disorder that affects red blood cells predominantly in people of African, Caribbean and South American ancestry people with sickle cell have … that lead to dysfunction in oxygen binding and … formation--> clots may result in a blockage known as … and can result in hypoxia pain and organ damage

misshapen RBCs; unintentional clot formation; vasoocclusive crisis

``` sickle cell disease contd: sickled cells have short life span results in more cellular waste products and contributing to … of the blood --> maintaining hydration is important complications include: … … … … dysfunction … with .. ```

``` sludging; anemia gallstones jaundice splenic vascular occlusion w/ ischemia ```

hemophilia A affects mostly … have a decreased ability to create a … after an injury, which can be life threatening patients typically have .. replacement infusions (which help the blood clot) close on hand

males; clot; intravenous factor VIII

thrombophilia: disorder in the body's ability to maintain he … of blood through the venous and arterial systems concentration of particular elements in the blood creates … or … issues general term for many conditions that result in blood clotting more … than normal clots can spontaneously develop

smooth flow; clogging; blockage; easily

deep vein thrombosis: common med problem in … patients and in patients who have had recent injury/surgery methods designed to prevent clot formation include: … meds … stockings …

sedentary; blood-thinning compression mechanical devices

DVT: treatment: … therapy, oral meds typically administered for at least 3 months after diagnosis a clot from the DVT can travel from the patient's lower extremity to the lung, causing a ..

anticoagulation; pulmonary embolus

sickle cell crisis patients may have .. respirations or sigsn of ..

increased; pneumonia

sickle cell crisis patients will have … heart rate to force sickled cells through smaller vessels for suspected hemophilia patients be alert for signs of acute blood loss; note bleeding of unknown origin and be alert for signs of..., due to blood loss

increased; hypoxia

for pot4ential blood disorders ask about:" is pain .. in single location or felt throughout body? …? nausea, vomiting, or abdominal cramping? … pain or shortness of breath?

isolated; visual disturbances; chest

``` secondary assess for blood disorders: focus on .. at which cells congregate normal sickle cell crisis vitals: … to … respirations .., … pulse …, … skin … blood pressure ```

``` major joints; normal; rapid weak; rapid pale; clammy; low ```