Transcript Endorcrine Emergencies - Madison County Emergency Medical

ENDOCRINE
EMERGENCIES
ANDREW SCORDATO EMS-I
SCENARIO
• 18 YO unresponsive found in the bathroom. Father
states Pt. is a known diabetic. No Hx of drug abuse.
• V/S
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BP-88/60
HR-86
RR-16
BS-116
Skin-pale, warm and dry/has a bronze hue
• HX-Addison Disease and Diabetes, NKA and MEDS?
• As you continue to assess him he becomes agitated
and violent
• What is going on with your Patient?
ENDOCRINE EMERGENCIES
• 3 major Disorders
• Pancreas
• Thyroid
• Adrenals
• Endocrine emergencies often produce a wide
variety of signs and symptoms
• Deficient/Excess hormone production/action
• Diabetes one of the most common disease in North
America
• ADA-25.8 million Americans
ENDOCRINE SYSTEM
• HYPOTHALAMUS
• PITUITARY
• ANTERIOR
• POSTERIOR
• THYROID
• PARATHYROID
• THYMUS
• PANCREASE
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ISLETS OF LANGERHANS
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ALPHA
BETA
DELTA
• ADRENALS
• MEDULA
• CORTEX
• GONADS
• ESTROGEN
• TESTOSTERONE
ENDOCRINE
HYPOTHALAMUS/PITUITARY
• Hypothalamus
• Cerebrum
• Junction
• Pituitary
• Master Gland
• Size of a pea
• Two parts
• Posterior
• Oxytocin-lactation and contraction
• ADH-Vasopressin, regulation of water
• Anterior
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TSH-act on the thyroid
GH-Growth hormone
ACTH-regulates the adrenals
FSH-follicle stimulating hormone
PITUITARY
THYMUS/THYROID
• Thymus
• Thymosin
• Thyroid
• Anterior portion of the neck
• Two lobes connected by isthmus
• Three hormones
• Thyroxine-T4
• Triiodothyronnine-T3
• Calcitonin
THYROID
PANCREAS
• Located behind the stomach
• Islets of Langerhans
• Alpha-glucagon
• Beta-insulin
• Delta-Somatostatin
• Glucagon
• Gylcogenolysis
• Breakdown of glycogen to glucose
• Gluconeogenesis
• Conversion of protein and fat to glucose
PANCREAS
GLYCOGENOYLSIS
Glucose
decrease
Alpha cells
secrete
glucagon
Glucagon
stimulates
breakdown of
Glycogen.
Glucose is
released into
blood
•Glycogen
is the
stored
form of
Glucose
GONADS AND ADRENALS
• Gonads
• Estrogen
• Testosterone
• Adrenals
• Kidneys on top
• Medulla
• Norepinephrine
• epinephrine
• Cortex
• Glucotroids-cotrisol
• Mineraltroids-aldosterone
• Androgenic-secondary sex characteristics
ADRENALS
ENDOCRINE VIDEO
• http://www.youtube.com/watch?v=f_Z1zsR9lFM
DISORDERS OF THE PANCREAS
• Diabetes Mellitus
• Insulin
• Inadequate
• Bind
• Type I
• Low production of insulin (IDDM)
• Less common more serious
• Hyperglycemia
• Polydipsia (thirst)
• Polyuria (urination)
• Polyphagia (appetite)
DIABETES
• Type II (NIDDM)
• Marked decline and marked response from cells to insulin in
blood stream
• Obese more at risk
• More common
• DKA <HHNK
• DKA (Diabetic Ketoacidosis)
• Insulin deficiency and increased glucagon activity
• Common causes=Not taking insulin, Stress
• Signs and SX=Kussmaul resp, Fruity odor, fever, decreased
loc, signs of dehydration
• Tx-ABC,fluid
DIABETES
• HHNK (hyperglycemic hyperosmolar nonketotic
coma)
• Insulin and Glucagon: Sustained Hyperglycemia, marked
dehydration
• DKA++/Mortality higher
• Signs and SX-slower than DKA over days, Increased thirst
urination, orthostatic hypotension, dehydration.
• Tx-ABC’s and Fluid
• Hypoglycemia
• Causes-takes too much insulin, eats to little to match or
overexerts
• Sign and SX-ALOC, Low BS, “fight or flight”, SZR
• Tx-ABC, Glutose or D50,D25,D10
INSULIN
• Names-Humulin, Novolin
• Actions-combines with insulin receptor on the cell
allow glucose entry into the cell
• Indications-low insulin production, DKA,
• Not currently given in the field
ORAL GLUCOSE
• Names-Glutose
• Actions-raises blood glucose concentration
• Indications-Hypoglycemia, ALOC, SZR with BS<60
• Dosage-1-2 tubes concentration varies
• Contraindications-Inability to control airway
D10,D25,D50
• Names-dextrose
• Actions-Supplemental glucose
• Indications-hypoglycemia
• Dosage-pediatric/adult
• Contraindications-Possible brain injury. Do not delay
if sugar is low
GLUCAGON
• Names-Glucagen
• Actions-protein secreted by the pancreas.
Breakdown of glycogen to glucose. Inhibits the
synthesis of glycogen from glucose
• Indications-hypoglycemia
• Dosage-1mg IM
• Contraindications-hypersensitivity
GLUCAGON AND THE ALCOHOLIC
• Several Reasons
• Alcohol may interfere with the process of glycogenesis
• Glucagon is only effective if there are sufficient stores of
glycogen.
• In chronic alcoholism, however, liver glycogen stores may
become depleted secondary to malnutrition (or a reduced
supply of substrate)
IM, SUB-Q INJECTION
DISORDERS OF THE THYROID
• Hypothyroidism
• Inadaquate thyroid hormone in blood
• Low metabolic state
• Myxedema-thickening of connective tissue
• Signs/SX-fatigue (attributed to aging), cold intolerance,
decreased mental function with increased weight.
Myxedema-puffy face, thinned hair, enlarged tongue and
pale cold skin, doughy
• Tx-ABC, IV (limit fluids)/Coma-intubation and vent assist.
HYPERTHYROID
• Graves Disease
• Genetic
• Autoimmune
• Signs and SX=Agitation, weight loss despite increased appetite,
weakness, cardiac changes (afib)
• Not a medical emergency in itself?
• Thyrotoxic crisis (thyroid storm)
Caused by Graves
Fatal within 48 hours
Physiologic stress-trauma, infection
Signs and Sx-high fever, delirium, coma, tachycardia, Hypotn,
vomiting and diarrhea
• Tx-Oxygenation, fluid, and monitoring
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HYPO/HYPER
THYROID
DISORDERS OF THE ADRENALS
• Cushing Syndrome
• To much adrenocortical activity
• Middle aged Women>Men
• Long term exposure to glucorticoids numerous changes
• Insulin/handling of fat/diabetes/sodium retention/Htn
• Signs and Sx-weight gain (moon face), buffalo hump,
thinning skin, bruise easily, facial hair (women) mood swings.
• Tx-Monitor treat signs and symptoms
ADDISON’S DISEASE
• Addison’s Disease
To little adrenocortical activity
Cortisol destruction/probably autoimmune
Water and electrolyte disturbances
Can lead to Renal Failure
Therapy with steroids
Signs and Sx-Sudden changes in behavior, Weakness,
fatigue, decreased appetite and weight loss.
Hyperpigmentation (bronze) to skin, vomiting, diarrhea,
hypotension, dysthymias are common
• Tx-ABC, fluids, and 12 –lead to monitor for dysthymias
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ADDISON CRISIS
• Addison Crisis-metabolic failure
• Infection
• Trauma
• Stop taking meds
• Acute Problems
• S/Sx-Severe Vomiting/Diarrhea leading to hypotension,
syncopal episodes, confusion & Psychosis, slurred speech
agitation, combativeness, SZR.
ADDISON’S
SCENARIO CONTINUED
• What disease is effecting our patient.
• What can we do for this patient
• What do we want to assess
THE END