Week 6 Flashcards
Type 1 Diabetes
- IDDM (Insulin Dependent Diabetes Mellitus)
- Lack of insulin production due to an autoimmune disorder targeting β cells in the pancreas.
- Commonly diagnosed in children (early onset)
- Medications: Humalog, Novalog, Novalin, Lantis
Type 2 Diabetes
- NIDDM (Non-Insulin Dependent Diabetes Mellitus)
- Body isn’t sensitive to insulin (“wack” regulation or built up tolerance)
- Commonly found later in life due to poor lifestyle choices
- Medications: Metformin/Glucophage
Gestational Diabetes
Occurs during pregnancy (changes in how cells use glucose)
• Tends to lead to hyperglycemia
• Risk factor: Developing type 2 after childbirth.
• Treatment: Birth
Role of Insulin/What produces it?
- insulin is the key that allows for the uptake of glucose by cells
- decreases BGL
- increases glucose within cells
- produced by pancreas, specifically beta cells ( a type of islet cell)
Role of Glucagon/What produces it?
- Breaks down glycogen stores
(sugar stores) in the liver into the blood - Increases BGL when glucose within cells are low
- produced by the alpha cells, found in the islets of Langerhans, in the pancreas
Definition: DKA
- diabetic ketoacidosis
- Body starts breaking down ketones (a type of sugar), which increases blood acidity because increased
generation of CO2 - usually associated with hyperglycemia
Definition: Insulin Shock
- the body shutting down because low BGL
- associated with hypoglycemia; taking too much insulin
Defintion: Diabetic Coma
- occurs when BGL of patient is so low or so high, they can no longer function normally, and become AMS
Definition: Diabetic Neuropathy
- a type of nerve damage that can occur if you have diabetes
- High blood sugar (glucose) can injure nerves throughout your body.
3 P’s of diabetes
- Polyphagia: Excessive hunger
• Polydipsia: Excessive thirst
• Polyuria: Excessive/frequent urination - associated with hyperglycemia
Oral Glucose
Indications: BGL < 60 mg/dL, AMS, history of diabetes
Contraindications: head/facial trauma, unable to swallow, unable to follow directions
Route: buccal
Mechanism: increases BGL
Dose: 1 tube oral glucose; max three tubes
Consider: sugary drinks
4 components of blood
- plasma and proteins
- erythrocytes
- leukocytes
- megakaryocytes
What is sickle cell anemia? Why is it a concern to us? How does the patient present? What are our treatments?
- genetic condition that causes the hemoglobin to form globular S-Hemoglobin that affects the shape of the
hemoglobin protein and the RBC - this is a concern for us because it means patient is not able to move oxygen adequately throughout the body
- S/Sx: swelling, LOC, fatigue, headache/dizziness, jaundice, intense pain in areas with fine capillaries
- Our treatments: High flow O2, rapid transport
Hemophilia
- reduced ability for blood to clot
Thrombophilia
- increased tendency to clot
What is a behavioral emergency?
- when someone behaves in a way
that is not within the social norm or in a way that is
not acceptable to friends and family - Can pose a risk to themselves or others
6 causes of AMS
- hypoxia
- drugs/alcohol
- post-seizure
- head injury
- exacerbated mental illness/disorder
- infection
When should you restrain? How? How many people should you have?
- restrain when pt is a danger to themselves, you, your crew, bystanders, other providers, etc
- use only force necessary, tie to stretcher (not the moveable parts), tie one arm up, one arm down, feet apart, check CMS every five minutes, take not of mileage
- should have atleats 3 people
Major Depressive Disorder
- episodes of decreased mood, willingness to do things
- comes in episodes that vary in length and severity
Bipolar Disorder
- episodes of elevated mood and irritability
- could lead to someone being rash, displaying psychotic features
- an episode could last for days
- 2 types: 1 = manic ep; 2 = only hypomanic ep
Generalized Anxiety Disorder
- anxiety that comes with intense worry, discomfort with uncertainty
- comorbid with depression; has many similar symptoms
Schizophrenia
- disorder linked to positive (hallucinations, delusions) and negative effects (empathy) and disorganized speech and mood
- pt. can have auditory, visual, or even olfactory delusions
Phobias
- intense fear of specific object or experience that is not explainable/ordinary/justifiable
Obsessive Compulsive Disorder
- pt. has obsessions, compulsions, or both
- need to satisfy compulsions and obsessions
Ensuring crew’s safety
- approach patients slowly
- ensure patient has no type of weapon in their hand
- call PD as a precaution if patient seems to be violent
Concerns for patient/Consent
- concerned about possible suicide attempt
- she cant refuse treatment as she is a threat to herself (involuntary consent)
3 questions to ask suicidal patient?
- Is there anyone you can talk to about personal issues?
- Have you though about hurting yourself before?
- Do you find yourself lacking the will to do things on a daily basis?
- How would you describe your mood most days?
2 organs that are part of lymphatic system
- spleen
- liver
Histamine’s Role
- Histamine is the main compound involved in an anaphylactic reaction
- Effects: vasodilations, wheezing/stridor lung sounds, angoredema/edema, urticaria
Nosocomial Infection
- infections picked up in hospital environment
- population at risk: providers, immunocompromised patients, and patients who are in such an environment frequently
What should you do when you see localized welling?
- take off jewelry the could impose on the swelling
2. remove allergen by swiping it off
Definition: urticaria
- hives that form on the body
Definition: Angioedema
- swelling of the tongue
Definition: allergic reaction
- Exaggerated immune response to something that usually is nonpathogenic.
Epinephrine Protocol
indications: obvious signs of anaphylaxis, hypotension or severe respiratory distress, prescribed an epi-pen
contraindications: none in emergent situations
mechanism: sympathomimetic
route: intramuscular
dose: .3 mg for adults; .15 mg for peds; max dose = 1
Side Effects: reflect sympathetic nervous system
What is anaphylaxis
- Serious life-threatening hypersensitive
systemic allergic reaction that compromises
two or more body systems.
Symptoms of both Allergic reaction and anaphylaxis
- Swelling • Nausea/Vomitting • Abdominal pain • Dizziness - wheezing
Symptoms unique to anaphylaxis
- Hypotension***
• Tachycardia
• Urticaria (hives)
• Angioedema (swelling of the tongue)
Define: Addiction
- the psychological desire to take drugs despite recognizing negative
consequences
Define: Tolerance
- Need for more after long-term use to achieve an effect
Define: Agonist
- something that INCREASES function at postsynaptic cell
Define: Physical Dependence
- The physical need for a drug to function normally
Define: Idiosyncrasy
- Basically an uncommon side effect or reaction
Define: Potentiation
- Achieving a greater effect than the sum of the drugs
Define: Antagonist
- something that DECREASES or BLOCKS function
Define: Enteral
- Passing through the epithelium of the GI tract
4 routes of medication administration
- enteral - oral, buccal
- parenteral - IV, IM, I0, Subcutaneous
- absorbed - buccal, nasal, inhalation, transdermal
Severe Alcohol Withdrawal
- leads to delirium tremens
- characterized by Nausea/Vomiting, Tremors, Disorientation, Hallucinations, Seizure Activity, and Tachycardia/Hypertension
- Our concerns: seizure activity; electrolyte imbalance can lead to cardiovascular collapse
6 rights of medication administration
- Dose
- Drug
- Documentation
- Time
- Patient
- Route
Depressant
- Decrease CNS Activity
- alcohol
Stimulant
- Increase CNS Activity, Stimulate Sympathetic Nervous
System - cocaine
Narcan Protocol
Indications: suspected opioid overdose, AMS, RR<10
Contraindications: none
Route: Intranasal via atomizer
Mechanism: opiate receptor antagonists
Dose: 2 mg in adults, 1 mg in peds; half dose in each nostril; max dose of 2
Side Effects: vomiting, withdrawal symptoms, aggression, delirium
Name 2 opiates
- fentanyl
- heroin
4 signs of opiate overdose
- low respirations, AMS, hallucinations, tremors,
What is an opioid? Why is it a concern?
- opium derived drugs that numb pain and sensation
- very easy to overdose on it; mixed with other drugs so people will consume without knowing as well
What drug class does Tylenol belong to? Risk of overdose?
- acetaminophen
- liver toxicity, jaundice, confusion, bleeding
Name an anticoagulant. What do they do and why are they prescribed?
- Heparin, Warfarin, Xarelto
- Target soluble blood proteins like Thrombin and Fibrin
- prescribed to prevent blood clots (DVT, PE)
Situation
- cholinergic agents
- affected by an organophosphates
- symptoms:
- Salivation
- Lacrimation
- Urination
- Defecation
- GI Discomfort
- Emesis
- Miosis
- remove patient from scene ASAP
CPEP
- Comprehensive Psychiatric Emergency Program
