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Emergency Medical Technician > Endocrine & Hematologic Emergencies > Flashcards

Endocrine & Hematologic Emergencies Flashcards

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Royal College: Emergency Medicine flashcards USMLE® Step 1 flashcards
1
Q

A communication system that controls functions inside the body

A

Endocrine system

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2
Q

The endocrine system maintains the body’s ___

A

Homeostasis

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3
Q

___ secrete messenger hormones

A

Endocrine glands

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4
Q

Chemical substances produced by a gland

A

Hormone

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5
Q

Hormones travel through the ___ to the end organs, tissues, or cells that they are intended to affect

A

Blood

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6
Q

When the hormone arrives, the cell, tissue, or organ ___

A

Receives the message and an action or cellular process takes place

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7
Q

Endocrine disorders are caused by ___

A

An internal communication problem

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8
Q

Hypersecretion

A

Produce more hormone than is needed

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9
Q

Hyposecretion

A

Produce less hormone than is needed

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10
Q

Two things the brain needs to survive

A

Glucose and oxygen

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11
Q

Necessary for glucose to enter the cells for metabolism

A

Insulin

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12
Q

Two hormones produced and stored by the pancreas that play a major role in glucose metabolism

A
  1. Glucagon
  2. Insulin
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13
Q

The islets of Langerhans in the pancreas is filled with ___

A

Alpha and beta cells

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14
Q

The alpha cells in the islets of Langerhans produce ___

A

Glucagon

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15
Q

The beta cells in the islets of Langerhans produce ___

A

Insulin

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16
Q

In a person without diabetes, the pancreas stores and secretes insulin and glucagon in response to ___

A

The level of glucose in the blood

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17
Q

When a person eats, the level of glucose in the blood ___

A

Rises

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18
Q

When the level of glucose in the blood rise, the pancreas ___

A

Secretes insulin into the blood

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19
Q

When the pancreas secretes insulin into the blood, this allows ___

A

The glucose to enter the body’s cells and be used for energy. Also allow glucose to be stored in the form of glycogen in the liver and skeletal muscles for use at a later time

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20
Q

If a hungry person skips a meal, ___

A

A message is sent to the pancreas to secrete glucagon, which stimulates the liver and skeletal muscles to release glycogen and converts it back to glucose to be used as cellular fuel

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21
Q

A disorder of glucose metabolism, such that the body has an impaired ability to get glucose into the cells to be used for energy

A

Diabetes mellitus

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22
Q

The patient with diabetes has either ___

A
  1. Impaired insulin production
  2. Not enough functional receptors on the surface of the cells for the insulin to bind to
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23
Q

Three types of diabetes

A
  1. Diabetes mellitus type 1
  2. Diabetes mellitus type 2
  3. Pregnancy-induced gestational diabetes
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24
Q

A state in which the blood glucose level is above normal

A

Hyperglycemia

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25
Q

A state in which the blood glucose level is below normal

A

Hypoglycemia

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26
Q

Patients with severe ___ are more likely to have a depressed level of consciousness than patients with ___

A
  1. Hypoglycemia
  2. Hyperglycemia
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27
Q

Altered mental status related to diabetic emergencies can often mimic ___

A

Alcohol intoxication

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28
Q

___ can develop if a person with diabetes takes their medications as prescribed but fails to eat enough food

A

Hypoglycemia

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29
Q

All hypoglycemic patients require prompt treatment with ___

A

Oral glucose paste (if alert and able to protect airway), or injection of glucose (dextrose) or glucagon by an ALS provider

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30
Q

Blood glucose level below 50 mg/dL

A

Hypoglycemic crisis

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31
Q

Blood glucose level between 50 and 80 mg/dL

A

Hypoglycemia

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32
Q

Blood glucose level between 80 and 120 mg/dL

A

Normal

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33
Q

Blood glucose level between 120 and 400 mg/dL

A

Hyperglycemia

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34
Q

Blood glucose level above 400 mg/dL

A

DKA, HHNS, or symptomatic hyperglycemia

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35
Q

Onset of hyperglycemia

A

Gradual (hours to days)

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36
Q

Onset of hypoglycemia

A

Rapid (within minutes)

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37
Q

Skin with hyperglycemia

A

Warm and dry

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38
Q

Skin with hypoglycemia

A

Pale, cool, and moist

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39
Q

Infection rate with hyperglycemia

A

Common

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40
Q

Infection rate with hypoglycemia

A

Uncommon

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41
Q

Thirst with hyperglycemia

A

Intense

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42
Q

Thirst with hypoglycemia

A

Absent

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43
Q

Hunger with hyperglycemia

A

Present and increasing

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44
Q

Hunger with hypoglycemia

A

Absent

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45
Q

Vomiting/abdominal pain with hyperglycemia

A

Common

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46
Q

Vomiting/abdominal pain with hypoglycemia

A

Uncommon

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47
Q

Breathing with hyperglycemia

A

With DKA there are rapid, deep (Kussmaul) respirations

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48
Q

Breathing with hypoglycemia

A

Normal; may become shallow or ineffective if hypoglycemia is severe and mental status is depressed

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49
Q

Odor of breath with hyperglycemia

A

With DKA there may be a sweet fruity odor

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50
Q

Odor of breath with hypoglycemia

A

Normal

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51
Q

BP with hyperglycemia

A

Normal to low

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52
Q

BP with hypoglycemia

A

Normal to low

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53
Q

Pulse with hyperglycemia

A

Rapid, weak, and thready

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54
Q

Pulse with hypoglycemia

A

Rapid, weak

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55
Q

Consciousness with hyperglycemia

A

Restlessness, possibly progressing to coma; abnormal or slurred speech; unsteady gait

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56
Q

Consciousness with hypoglycemia

A

Irritability, confusion, seizure, or coma; unsteady gait

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57
Q

Response to treatment with hyperglycemia

A

Gradual, within 6 to 12 hours following medical treatment

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58
Q

Response to treatment with hypoglycemia

A

Immediate improvement after administration of glucose

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59
Q

An autoimmune disorder in which the individual’s immune system produces antibodies against the pancreatic beta cells

A

Type 1 diabetes

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60
Q

Always ask about an ___ in patients with type 1 diabetes

A

Insulin pump

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61
Q

A patient with new-onset type 1 diabetes will have these symptoms related to eating and drinking

A
  1. Polyuria
  2. Polydipsia
  3. Polyphagia
  4. Weight loss
  5. Fatigue
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62
Q

More frequent urination

A

Polyuria

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63
Q

Why does type 1 diabetes cause polyuria

A

Excess glucose in the blood overwhelms the kidney’s filtration and glucose spills into the urine. This causes more water to be pulled out of the bloodstream into the urine

64
Q

An increase in fluid consumption

A

Polydipsia

65
Q

Polydipsia can lead to ___

A

Severe electrolyte abnormalities

66
Q

Why does type 1 diabetes lead to polydipsia

A

Polyuria leads to dehydration and increased thirst

67
Q

Increased food intake

A

Polyphagia

68
Q

When the body burns fat instead of glucose, ___ is produced

A

Acid waste

69
Q

The acids produced from burning fat instead of glucose

A

Ketones

70
Q

What causes Kussmaul respirations with type 1 diabetes?

A

The ketone levels in the blood increase and spill into the urine with the excess glucose. When the kidneys are saturated with glucose and ketones they do not work properly to maintain the acid-base balance in the body. The body responds with a backup system by breathing faster and deeper to release more acid via CO2 in the lungs

71
Q

If fat metabolism and ketone production continue, ___ can develop in patients with diabetes

A

Diabetic ketoacidosis (DKA)

72
Q

DKA

A

Diabetic ketoacidosis

73
Q

DKA may present as ___

A

Generalized illness accompanied by:
1. Abdominal pain
2. Body aches
3. Nausea
4. Vomiting
5. Altered mental status or unconsciousness (if severe)

74
Q

Caused by a resistance to the effects of insulin at the cellular level

A

Type 2 diabetes

75
Q

Obesity predisposes patients to ___ diabetes

A

Type 2

76
Q

The blood glucose levels begin to rise and do not respond when the pancreas secretes insulin

A

Insulin resistance

77
Q

Test to estimate the average blood glucose level over time taken at the doctor several times a year

A

A1C

78
Q

Occurs when blood glucose levels are very high

A

Symptomatic hyperglycemia

79
Q

Early signs and symptoms of symptomatic hyperglycemia

A
  1. Frequent urination
  2. Increased thirst
  3. Blurred vision
  4. Fatigue
80
Q

If the high blood glucose levels go untreated, the patient may present with ___

A
  1. A fruity odor on the breath
  2. Nausea and vomiting
  3. Shortness of breath
  4. Dry mouth
  5. Weakness
  6. Altered mental status
81
Q

Type 1 diabetes hyperglycemia leads to ketoacidosis and dehydration from ___

A

Excessive urination

82
Q

Type 2 diabetes hyperglycemia leads to a state of dehydration due to ___

A

The discharge of fluids through all body systems and eventually out through the kidneys

83
Q

Type 2 diabetes hyperglycemia induced dehydration leads to ___

A

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)

84
Q

HHNS

A

Hyperosmolar hyperglycemic nonketotic syndrome

85
Q

Secondary consequences of prolonged hyperglycemia

A
  1. Wounds that do not heal
  2. Numbness in the hands and feet
  3. Blindness
  4. Renal failure
  5. Gastric motility problems
86
Q

When blood glucose levels are not controlled in diabetes type 2, ___ can develop

A

HHNS

87
Q

HHNS can present similarly to the ___ seen in patients with type 1 diabetes

A

DKA

88
Q

The onset of HHNS is commonly associated with ___

A

A profound infection or illness

89
Q

Key signs and symptoms of HHNS

A
  1. Hyperglycemia
  2. Altered mental status, drowsiness, lethargy
  3. Severe dehydration, thirst, dark urine
  4. Visual or sensory deficits
  5. Partial paralysis or muscle weakness
  6. Seizures
90
Q

Very concentrated blood as a result of relative dehydration

A

Hyperosmolarity

91
Q

In HHNS the patient cannot drink enough fluids to keep up with the ___

A

Exceedingly high glucose levels in the blood

92
Q

As HHNS progresses, the urine becomes ___

A

Rather dark and concentrated

93
Q

An acute emergency in which a patient’s blood glucose level drops and must be corrected swiftly

A

Symptomatic hypoglycemia

94
Q

Hypoglycemia develops much more ___ than hyperglycemia

A

Quickly

95
Q

Common patient or caregiver causes of the development of low blood glucose levels

A
  1. Correct dose of insulin with a change in routine
  2. More insulin than necessary
  3. A correct dose of insulin without the patient eating enough
  4. Correct does of insulin and and acute illness developed in the patient
96
Q

Signs and symptoms of hypoglycemia

A
  1. Normal to shallow or rapid respirations
  2. Pale, moist, skin
  3. Diaphoresis
  4. Dizziness, headache
  5. Rapid pulse
  6. Normal to low blood pressure
  7. Altered mental status (aggressive, confused, lethargic, or unusual behavior)
  8. Anxious or combative behavior
  9. Seizure, fainting, coma
  10. Weakness on one side of body (may mimic stroke)
  11. Rapid changes in mental status
97
Q

You must have a high index of suspicion for a ___ when you encounter a child who has an altered mental status or depressed LOC

A

Low glucose level

98
Q

If the patient has eaten but has not taken insulin, it is more likely that ___ is developing

A

Hyperglycemia

99
Q

If the patient has taken insulin but has not eaten, the problem is more likely to be ___

A

Hypoglycemia

100
Q

Questions to ask a patient known to have diabetes

A
  1. Do you take insulin or any pills that lower your blood sugar?
  2. Do you wear an insulin pump and is it working properly?
  3. Have you taken your usual dose of insulin or pills today?
  4. Have you eaten normally today?
  5. Have you had any illness, unusual amount of activity, or stress?
101
Q

When you suspect a diabetes-related problem, the secondary assessment should focus on the patient’s ___

A

Mental status and ability to swallow, and protect the airway

102
Q

With a diabetic patient, obtain a ___ to track the patient’s neurologic status

A

Glasgow Coma Scale Score

103
Q

The blood glucose level in neonates should be ___

A

Above 70 mg/dL

104
Q

Base your administration of glucose on ___

A

Serial glucose readings

105
Q

If a glucometer is not available, a ___ indicates that you need to provide more glucose

A

Deteriorating LOC

106
Q

If the patient is hypoglycemic, conscious, and able to swallow without the risk of aspiration, ___

A

Encourage them to take glucose tablets. If not available, household sources of glucose may be used

107
Q

If the patient is hypoglycemic and unconscious or unable to swallow without the risk of aspiration, ___

A

The patient will need IV glucose, or IM or IN glucagon (most EMTs are not able to give)

108
Q

A patient with symptomatic hypoglycemia needs ___

A

Glucose immediately

109
Q

A patient with symptomatic hyperglycemia needs ___

A

Insulin and IV fluid therapy, prompt transport to the hospital

110
Q

When in doubt if the patient is in symptomatic hyperglycemia or symptomatic hypoglycemia, most protocols will err on the side of ___

A

Giving glucose

111
Q

Most common type of oral glucose preparation for EMS providers

A

Rapidly dissolving gel

112
Q

Three types of oral glucose preparations available commercially

A
  1. Rapidly dissolving gel
  2. Large chewable tablet
  3. Liquid formulation
113
Q

You should administer ___ to any patient with a decreased LOC who has a history of diabetes

A

Glucose gel

114
Q

Contraindications for oral glucose

A

Inability to swallow and unconsciousness

115
Q

How to administer glucose gel

A
  1. Obtain an online or offline order
  2. Open the pouch
  3. Squeeze the glucose under the tongue or into the buccal space
  4. Have the patient swallow
116
Q

If the patient’s mental status, vital signs, and blood glucose level become normal after administering glucose, encourage the patient to ___

A

Eat a meal or snack containing carbohydrates and protein

117
Q

Mnemonic to remember conditions that can lead to an altered mental status

A

AEIOU-TIPS

118
Q

AEIOU-TIPS

A

-Alcohol
-Epilepsy, endocrine, electrolytes
-Insulin
-Opiates and other drugs
-Uremia
-Trauma, temperature
-Infection
-Poisoning, psychogenic causes
-Shock, stroke, seizure, space-occupying lesion, subarachnoid hemorrhage

119
Q

The study of blood-related diseases

A

Hematology

120
Q

Four components of blood

A
  1. Erythrocytes (red blood cells)
  2. Leukocytes (white blood cells)
  3. Platelets
  4. Plasma
121
Q

RBCs

A

Red blood cells

122
Q

WBCs

A

White blood cells

123
Q

RBCs make up how much of the total blood volume?

A

42% to 47%

124
Q

RBCs contain a protein called ___

A

Hemoglobin

125
Q

The hemoglobin carries ___ of the oxygen in the blood and some of the CO2

A

97%

126
Q

WBCs make up ___ of the total blood cell volume

A

0.1% to 0.2%

127
Q

WBCs collect ___ and provide for their ___

A
  1. Dead cells
  2. Correct disposal
128
Q

Platelets make up ___of the blood cell volume

A

4% to 7%

129
Q

An inherited blood disorder that affects the RBCs

A

Sickle cell disease

130
Q

Sickle disease is also called ___

A

Hemoglobin S disease

131
Q

Serves as the transportation medium for all blood component as well as proteins and minerals

A

Plasma

132
Q

The sickle cell protects individuals from contracting ___

A

Malaria

133
Q

Sickle cell disease is common among people of ___ ancestry

A

African, Caribbean, and South American

134
Q

The sickle cell shape leads to dysfunction in ___

A

Oxygen binding and unintentional clot formation

135
Q

The inintentional clots from sickle cells may result in a blockage called ___

A

Vasoocclusive crisis

136
Q

Lifespan of normal RBCs

A

110 to 120 days

137
Q

Sickle cells shorter lifespan leads to ___

A

More cellular waste products in the blood, contributing to sludging of the blood

138
Q

Maintaining ___ is important to patients with sickle cell disease

A

Hydration

139
Q

Complications associated with sickle cell disease

A
  1. Anemia
  2. Gallstones
  3. Jaundice
  4. Splenic dysfunction
  5. Vascular occlusion with ischemia
140
Q

Hemophilia mostly affects ___

A

Males

141
Q

Males inherit hemophilia from their ___

A

Mother, but only if the mother’s father has hemophilia and their mother is also a carrier

142
Q

Decreased ability to create a clot after an injury

A

Hemophilia

143
Q

In a healthy person a clot will begin to form ___

A

Within 13 seconds for a small cut and not longer than about 7 minutes for a more serious injury

144
Q

Common complications of hemophilia A

A
  1. Long-term joint problems
  2. Bleeding in the brain
  3. Thrombosis due to treatment
145
Q

A disorder in the body’s ability to maintain the viscosity and smooth flow of blood through the venous and arterial systems

A

Thrombophilia

146
Q

The concentration of particular elements in the blood creates what amounts to clogging or blockage issues

A

Thrombophilia

147
Q

General term for many different conditions that result in blood clotting more easily than normal

A

Thrombophilia

148
Q

DVT

A

Deep vein thrombosis

149
Q

DVT is a common medical problem in ___

A

Sedentary patients and an patients who have had recent injury or surgery

150
Q

DVT is a particularly worrisome risk for patients who have had ___

A

Joint replacement surgery

151
Q

If DVT develops in an individual, ___ may be administered

A

Anticoagulation therapy may be administered

152
Q

An abnormally low number of RBCs

A

Anemia

153
Q

Each hemoglobin molecule can carry how much oxygen?

A

4 molecules

154
Q

Anemia may be the result of ___

A
  1. Chronic or acute bleeding
  2. Deficiency in certain vitamins or minerals
  3. Underlying disease process
155
Q

Hypoxia from anemia

A

Hypoxemia hypoxia

156
Q

Additional questions to ask a patient with known sickle cell disease

A
  1. Have you had a crisis before?
  2. When was the last time you had a crisis?
  3. How did your last crisis resolve?
  4. Have you had any illness, unusual amount of activity, or stress lately?

Emergency Medical Technician (100 decks)

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