Endocrine Emergencies

Dr. Samah Mohammed 2015 -2016

EMS LECTURE (7)

Out lines 1. Introduction.

2. Definition of endocrine disorder.

3. Function of Endocrine system.

4. Mechanisms of Hormonal Regulation.

5. Structure of Endocrine System.

6. Components of the Endocrine System.

7. Endocrine emergencies.

8. Patient assessment ( primary, secondary and

reassessment).

Introduction

• The endocrine system influences almost every

cell, organ, and function of the body.

– Disorders often display a broad range of signs

and symptoms.

– Assess thoroughly and treat immediately

to prevent life threats.

Function of Endocrine system

1. Regulates body functions.

2. Maintains homeostasis.

3. Network of glands that produce and secretes hormones.

4. Important regulator of growth and development. Endocrine glands:- are endocrine glands, exocrine

glands.

A. Endocrine glands (inside) or ductless– Secretes directly into bloodstream.

B. Exocrine glands (outside)– Secrete substances into ducts.

Mechanisms of Hormonal Regulation

• Why are hormones needed?– Chemical messages from one body part to cells in

other parts of body– Communication needed to coordinate whole body.–Maintaining homeostasis

• How we maintain homeostasis1. Nervous system• nerve signals control body functions.

2. Endocrine system• hormones• chemical signals control body functions.

Structure Of Endocrine System

Glands

Hormones

bloodstream

Consists of:

to

Target tissues

Secrete

Components of the Endocrine System

Common Gland

1. Hypothalamus

2. Pineal gland

3. Pituitary

4. Thyroid

5. Parathyroid

6. Adrenal

7. Pancreas

8. Gonads: Ovaries

9. & Testes

Components of the Endocrine System

1. Hypothalamus

A. Small region of the brain.

B. Helps control body functions and emotions (Temp).

C. Links endocrine and nervous systems.

2. Pineal glandLocated in the superior and posterior to the pituitary gland.Secretes melatonin hormones affect sleep.

3. Pituitary gland

a. Located at the base of the brain.

b. Two lobes: anterior and posterior.

c. Anterior release (Growth hormone , Prolactin,………ect)

d. Posterior release (oxytocin ………..ect).

Components of the Endocrine System

4.Thyroid gland

A. Secretes thyroxine• Stimulates energy production in cells.

B. Secretes calcitonin• Helps maintain calcium and phosphate levels in the blood.

5. Parathyroid glands

C. Help regulate calcium.

D. Secrete PTH when blood calcium is low.

6.Thymus gland

E. Helps identify and destroy foreign body.

F. Also part of the immune system (production of T and B cells

from white blood cells.

Components of the Endocrine System

7. Adrenal glands– A pair of glands, each one located on top of a kidney.– Both gland produce different hormones.• Adrenal cortex as (Aldosterone, sex hormones)• Adrenal medulla as(Epinephrine known as

adrenaline in stress)

8. Gonads–Main source of sex hormones• Testes in men as testosterone.• Ovaries in women as estrogen.

Components of the Endocrine System

9. Pancreas

Located slightly behind the stomach, maintain blood glucose levels.– has both endocrine and exocrine functions.– Exocrine secretes several key digestive enzymes.– Endocrine functions of the pancreas include 3 types of cells:

( Islets of Langerhans)• Alpha cells secrete glucagon. • Beta cells secrete insulin. • Delta cells secrete somatostatin.

– When blood glucose level falls, glucagon is secreted.– When blood glucose level rises, insulin is secreted.– produce somatostatin, which inhibits both glucagon and insulin.

Emergences DisordersEndocrine disorders includes:-

1. Diabetes Mellitus

2. Gestational Diabetes

3. Adrenal Insufficiency

4. Adrenal Gland Tumor

5. Cushing Syndrome

6. Hypothyroidism and Hyperthyroidism

Endocrine Emergencies• Endocrine disorders are caused by:

A. Hyper secretion of a gland.

B. Insufficient secretion of a gland.• Glucose metabolic disturbance– Caused by dysfunction of the pancreas

• Most endocrine emergencies result in:

A. Disturbance of the ABCs.

B. Improper fluid balance.

C. Deteriorating mental status.

D. Abnormal vital signs and blood glucose levels.

Diabetes Mellitus

Diabetes Mellitus (DM):defined as is a chronic

condition that is characterized by raised blood glucose

levels (Hyperglycemia).

Characterized by (Polyuria, Polydipsia )

Major classifications:-

1. Type 1 Diabetes

2. Type 2 Diabetes

3. Gestational Diabetes

Type 1 Diabetes Mellitus

Type 1 Diabetes (T1DM)

primary insulin deficiency resulting from beta-cell

destruction….. usually caused by an autoimmune process. Usually diagnosed in children and young adults. Previously known as “juvenile diabetes”. Insulin is a hormone made from beta cells inside of the

pancreas. beta cells release insulin in order to help the body use or

store the blood glucose it gets from foods. In this type of diabetes, the body does not produce

insulin.

Type 1 Diabetes Mellitus

• Insulin is required in order for the body to properly use sugar,

in the form of glucose.

• Sugar is the basic fuel for the cells in the body.

• Insulin’s role is to take the sugar from the blood and

carry it into cells where it can be used to provide energy for

the body to work.

• Causes: Genetic, Environmental, Abnormalities in immune

regulation, Viral infections.

Conditions that can arise from Type 1 DM

1. Hypoglycemia defined as : A condition due to low blood glucose.

Symptoms: • Dizziness, Sweating, Hunger, Headache, Pale skin

color, behavior changes, Seizure, Irritability, rapid pulse.

Treatment:

The quickest way to raise your blood glucose and treat

hypoglycemia is with some form of sugar.

A. 3 glucose tablets

B. ½ cup of fruit juice

C. 5-6 pieces of hard candy

Treatment of Hypoglycemia (Cont)

Once you have treated the hypoglycemia, wait 15-20 minutes and check again.

If blood glucose is still low and symptoms have not went away, repeat the treatment.

After you feel better, continue eating your regular meals and snacks as planned to keep blood glucose levels up.

If you pass out from hypoglycemia, people should:

1. NOT inject insulin.

2. NOT give you food or fluids.

3. NOT put their hands in your mouth.

4. Inject glucagon IM or IV.

5. Call for emergency help.

Conditions that can arise from Type 1 DM

2. Hyperglycemia defined as: is term for high blood glucose.

• Can be a serious problem if you don’t treat it.

The Symptoms:• High blood glucose, High levels of sugar in the urine,

Frequent urination, Increased thirst.

Causes:

• Eating more than planned, Exercising less than

planned, Stress as family conflicts.

Treatment of Hypoglycemia

1. Often, you can lower your blood glucose level by

exercising.

2. If blood glucose level is above 240 mg/dl, check your

urine for ketones.

3. If there are ketones present, Do Not Exercise!

Conditions that can arise from Type 1 DM

Ketones defined as: are acids that build up in the blood.

1. They appear in the urine when the body doesn’t have enough insulin.

2. They can poison the body.

3. They are present in high amounts in a condition known as: Ketoacidosis.

• Results from a failure to treat hyperglycemia.• Rarely occurs in individuals with type 2 diabetes• It is a serious condition that can lead to diabetic coma

or death.

KetoacidosisSigns & symptoms:

Thirst, Frequent urination, High blood glucose levels, feeling tired,

Dry skin, Nausea, vomiting, abdominal Pain, and Fruity odor on

breathcauses1. Not getting enough insulin: Maybe you didn’t inject enough insulin than usual because of illness. 2. Not enough food: When people are sick, they often do not feel like eating. High ketonesmay result. 3. An insulin reaction: (low blood glucose). When blood glucose levels fall too low, the body must use fat to getenergy.

Diabetic Ketoacidosis

3. Management

1. Insulin therapy may be delivered at the hospital.

2. Monitor cardiac rhythm.

3. Untreated hyperglycemia will progress to DKA.

• Occurs when certain acids accumulate because

insulin is not available.

Type 2 DM• Type 2 diabetes was previously called non-insulin-

dependent diabetes mellitus. • Pathophsiology: Reduced biological response to insulin

and reduced ability of -cells to secrete insulin in response to hyperglycemia.

Insulinresistance

Genetic, obesity, lifestyle.

Type 2 Type 2 diabetes

IR b-celldysfunction

Type 2 DM• Risk factors & causes: older age, obesity, family history of

diabetes, history of gestational diabetes, impaired glucose

tolerance, physical inactivity.

Signs and Symptoms :

1. Frequent urination

2. Thirst

3. Blurred vision

4. Frequent infections

5. Unresponsiveness

Management:1. Weight loss helps to control the

disease.2. Food intake must be spread

throughout the day.3. Medication/insulin required daily.4. Oral medications are used with

some patients.

Gestational DiabetesGestational diabetes defined as : type of diabetes that occur

in pregnant woman. but usually disappears after pregnancy• The word gestational actually refers to “ during

pregnancy”

Path physiology

A. Form of glucose intolerance during pregnancy.

B. Increases risk of type 2 diabetes.

C. High levels of glucose in the fetus cause increased production of insulin.

D. May result in large babies.

E. Often requires cesarean sections

Gestational DiabetesRisk factors:• Older mothers, especially over the age of 30 years of age• Women with a family history of type 2 diabetes.• Women who are overweight.

3. Management

Eat Well Play Well Stay Well

1. Healthy eating.

2. Physical activity.

3. Monitoring your blood glucose.

4. Medication if needed.

Patient Assessment

1. Scene Size-Up

Address hazards.

Follow standard precautions.

Check the home for medications.

Identify and manage life threats.

2. Primary Assessment

A. Form a general impression.

1. Signs and symptoms depend on affected hormone.

2. Diaphoresis is a sign of disease ( sweating).

B. Airway and breathing.

1. Ensure a patent airway.

2. Investigate abnormal breathing sounds.

3. Administer oxygen if the rate is:• Greater than 24 breaths/min.• Less than 8 breaths/min.

Primary Assessment

C. CirculationAssess skin color, moisture, and temperature.Obtain blood pressure.Administer IV If necessary.

D. Transport decisionMany patients should be transported to a

specialty facility.( EMS)Provide rapid transport to the closest facility if

the patient is unstable. ( ICU)

History Taking• Observe signs and symptoms.–Undiagnosed or poorly managed diabetes

may include:• Polyuria ( produce of abnormally

large volumes of urine)• Polydipsia ( abnormally great thirst)

• Ascertain any allergies to administering medication.

• Document all medications being taken.

3. Secondary Assessment Physical exam:-

a. Observe appearance and position.

b. Exam from head to toes.

c. abnormalities will help determine treatment.

• Goals with comatose patients:a. Determine level of consciousness.

b. Look for the source of coma.

Vital signs:-A. Look for hypertension and bradycardia.

B. Be alert for abnormal respiratory patterns.

C. Look for respiratory distress.

4. Reassessment1. Continually reassess the patient.– Critical patients at least every 5 minutes– Noncritical every 15 minutes

2. Manage ABCs.

3. Obtain blood specimens early in patients with diabetes.– Immediately determine blood glucose level.• Initiate treatment if less than 40 mg/dL. ( insulin shock)• Provide emotional support.

• Recheck vital signs, pupils,