Pathophysiology

Question 1

Describe Primary adrenal insufficiency

Answer 1

-Otherwise known as Addisons disease.

-Occurs when adrenal cortical hormones are deficient, and adrenocorticotropic hormones are elevated.

Question 2

What are common symptoms associated with Addisons disease?

Answer 2

Addisons disease patients often present with hyperpigmentation, GI upset/issues, weight loss, postural hypotension, hypoglycaemia, weakness, low serum Na+, hyperkalemia.

They often end up in renal failure.

Question 3

What is Cushing syndrome?

Answer 3

Secondary adrenal insufficiency. Occurs when there is increased glucocorticosteroid use.

Question 4

What are three classic findings of Cushing syndrome?

Answer 4

Moon face, fragile skin, diabetes.

Question 5

Describe an addasonian crisis?

Answer 5

-Acute worsening of Adrenal insufficiency symptoms, occurs in 25% of pt with Hx.

Tx with steroids (hydrocortisone, dexamethasone), large volumes of fluid, treat hypoglycaemia.

Question 6

What is the pancreases responsible for?

Answer 6

Secretion of insurin and glucagon from the islets of langerhans resulting in the regulation of glucose levels.

Question 7

What cells are in charge of glucagon and insulin production?

Answer 7

Glucagon is created by alpha cells
Insulin is created by beta cells.

Question 8

What are the three P’s associated with diabetes

Answer 8

Polyuria (frequent urination), polydipsia (excessive thirst) and polyphasic (excessive hunger)

Question 9

Define Tpe 1 diabetes

Answer 9

Destruction of beta cells resulting in decreased insulin production.

Question 10

Define Type 2 diabetes

Answer 10

Insulin is readily available, however metabolic abnormalities create insulin resistance.

Question 11

Describe DKA

Answer 11

-Occurs when ketone production exceeds cellular use and excretion causing acid buildup.

-Often what leads to IDDM diagnosis

Question 12

Describe Hyperglycemic hyperosmolar syndrome

Answer 12

Not DKA, occurs mostly with NIDDM.

-Excessive blood glucose levels lead to severe dehydration

-Presents with dehydration, DLOC, seizures, stroke like symptoms, polydipsia.

Question 13

What effect dose hypercapnia on the brain, lungs and vessels?

Answer 13

Brain=Increased ICP secondary to vasodilation and increased cerebral blood flow.

Lungs=Pulmonary vasoconstriction

Vessels=Vasodilation

Question 14

What effect does hypocapnia have on brain, vessels?

Answer 14

Brain= vasoconstriction causing decreased cerebral blood flow, decreased ICP.

Vessels=vasoconstriction

Question 15

What effect does hypoxemia have on the brain and vessels?

Answer 15

Hypoxemia causes vasodilation, resulting in increased CBF and ICP.

Question 16

If a post arrest presents with SVT immediately, what should the paramedics course of action be?

Answer 16

Wait 5 minutes to cardiovert SVT as per post arrest checklist CPG.

Question 17

What is a narrow PEA suggestive of?

Answer 17

Mechanical, or RV problem

-Tamponade
-Tension pnx
-mechanical hyperinflation
-PE
-Acute MI or cardiac rupture

Question 18

What is a wide PEA suggestive of?

Answer 18

Metabolic, or LV problem

-Severe HyperK
-Sodium channel blocker too
-Acute MI

Question 19

What is the definition of Hyperkalemia?

Answer 19

HyperK is defined by a serum potassium greater than 5.5mmol/L

Question 20

Other than blood work, what other findings would suggest HyperK?

Answer 20

-Hx of renal impairment/failure
-Dialysis patient, missed apt.
-Potassium sparing diuretics’ (Med Hx)
-Decreased urine output
-Recent Infection
-ECG findings (bradycardia, wide QRS)
-Metabolic acidosis

Question 21

What are 5 classic causes of hyperK?

Answer 21

-Rhabdomyolysis
-Extensive burns
-Renal failure (decreased excretion)
-Metabolic acidosis
-Toxidrome (Betablockade, TCA, CCB, Digoxin, ASA etc)

Question 22

Define Systemic inflammatory response syndrome Criteria

Answer 22

RR over 30
HR over 100
Fever greater than 38 or less than 36
MAP less than 65