Transcript bledsoe_pcpp4_ch04_lecture - McLaren

Paramedic Care: Principles & Practice
Fourth Edition
Volume 4: Medicine
CHAPTER
4
Endocrinology
Multimedia Directory
Slide 26
Slide 51
Endocrine System Video
Diabetes Animation
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Standard
• Medicine (Endocrine Disorders)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Competency
• Integrates assessment findings with
principles of epidemiology and
pathophysiology to formulate a field
impression and implement a
comprehensive treatment/disposition
plan for a patient with a medical
complaint.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Introduction
• Endocrine systems closely linked to
nervous system.
• Controls body through specialized
chemical messengers called hormones.
• Fundamental structural units are
endocrine glands.
• Each endocrine gland produces one or
more hormones.
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Paramedic Care: Principles & Practice, 4th Ed.
Introduction
• Endocrine glands are ductless.
• They secrete hormones directly into
capillaries to circulate in blood.
• Majority of glands are exocrine glands,
which release their chemical products
through ducts.
• Exocrine glands have localized effects,
whereas endocrine glands have
widespread effects.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Introduction
• Hormones released by endocrine glands
act on distant tissues and exert very
specific effects on target tissues.
• Some hormones, such as insulin, have
many target organs; others have few
target organs.
• Through release of hormones,
endocrine system plays important role
in regulating body function.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Introduction
• Homeostasis: natural tendency of body
to maintain appropriate internal
environment in the face of changing
external conditions.
• Metabolism: cellular processes that
produce the energy and molecules
needed for growth or repair.
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Anatomy and Physiology
• Eight major endocrine glands:
– Hypothalamus
– Pituitary gland
– Thyroid gland
– Parathyroid glands
– Thymus
– Pancreas
– Adrenal glands
– Gonads
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
The major glands of the endocrine system.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Body tissues that have endocrine
function:
– Kidneys
– Heart
– Placenta
– Parts of digestive tract
©2013 Pearson Education, Inc.
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Anatomy and Physiology
• Hypothalamus
– Located deep within cerebrum of brain.
– Hypothalamic cells act both as nerve
cells, or neurons, and as gland cells.
– As neurons, hypothalamic cells receive
messages from autonomic nervous
system; detect internal conditions.
– As gland cells, they produce and release
hormones.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Hypothalamus: Hormones
– Growth hormone releasing hormone
(GHRH)
– Growth hormone inhibiting hormone
(GHIH)
– Corticotropin releasing hormone (CRH)
– Thyrotropin releasing hormone (TRH)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Hypothalamus: Hormones
– Gonadotropin releasing hormone
(GnRH)
– Prolactin releasing hormone (PRH)
– Prolactin inhibiting hormone (PIH)
©2013 Pearson Education, Inc.
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Anatomy and Physiology
• Hypothalamus
– Many hormonal activities driven not by
one hormone, but by two hormones
with opposing effects.
 Example: GHRH stimulates secretion of
growth hormone; GHIH suppresses
secretion of growth hormone.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Pituitary Gland
– Size of a pea; divided into posterior and
anterior pituitary lobes.
– Posterior pituitary gland responds to
nerve impulses from hypothalamus.
– Anterior pituitary gland responds to
hypothalamic hormones.
– Its hormones have direct impact on
endocrine glands throughout body.
©2013 Pearson Education, Inc.
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Anatomy and Physiology
• Pituitary Gland
– Posterior pituitary two hormones:
 Antidiuretic hormone (ADH)
(vasopressin): causes retention of body
water.
 Oxytocin: causes uterine contraction and
lactation.
 Increased ADH secretion in early shock
states; dehydration or hemorrhage.
©2013 Pearson Education, Inc.
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Anatomy and Physiology
• Pituitary Gland
– Diabetes insipidus: disorder marked by
large volumes of urine; caused by
inadequate ADH secretion relative to
blood volume.
– Oxytocin: natural form of drug Pitocin;
stimulates uterine contraction and
lactation in women.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Five anterior pituitary hormones affect
target glands:
– Adrenocorticotropic hormone (ACTH):
targets adrenal cortexes.
– Thyroid-stimulating hormone (TSH):
targets thyroid.
– Follicle-stimulating hormone (FSH):
targets gonads, or sex organs.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Five anterior pituitary hormones affect
target glands:
– Luteinizing hormone (LH): targets
gonads.
– Prolactin (PRL): targets mammary
glands of women.
• Sixth hormone has broader effect:
– Growth hormone (GH): targets almost
all body cells.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Thyroid Gland
– Its two lobes located in neck anterior to
and just below cartilage of larynx.
– Thyroid produces three hormones:
 Thyroxine (T4): stimulates cell
metabolism.
 Triiodothyronine (T3): stimulates cell
metabolism.
 Calcitonin: lowers blood calcium levels.
©2013 Pearson Education, Inc.
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Anatomy and Physiology
• Thyroid Gland
– Gland composed of tiny hollow sacs
called follicles; filled with thick fluid
called colloid.
– Releases hormones to increase general
rate of cell metabolism.
– Calcitonin lowers blood calcium levels by
increasing uptake of calcium by bones;
inhibiting breakdown of bone tissue.
©2013 Pearson Education, Inc.
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Anatomy and Physiology
• Parathyroid Glands
– Four small glands located on posterior
lateral surfaces of thyroid.
– Secrete: parathyroid hormone (PTH):
increases blood calcium levels.
– PTH is antagonist of calcitonin; balance
of PTH and calcitonin determines level
of blood calcium.
©2013 Pearson Education, Inc.
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Anatomy and Physiology
• Thymus Gland
– In mediastinum just behind sternum.
– During childhood, it secretes:
 Thymosin: promotes maturation of T
lymphocytes responsible for cellmediated immunity.
 T of T lymphocyte stands for thymus.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Pancreas
– Located in upper retroperitoneum
behind stomach.
– Composed of both endocrine and
exocrine tissues.
– Exocrine tissues secrete digestive
enzymes.
– Endocrine tissue found in pancreas are
known as islets of Langerhans.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine System Video
Click here to view a video on the topic of the endocrine system.
Back to Directory
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Pancreas
– Endocrine cells in islets of Langerhans:
alpha (α), beta (β), delta (Δ).
– Each produces and secretes different
hormone.
– Two hormones essential for homeostasis
of blood glucose:
 Glucagon: increases blood glucose.
 Insulin: decreases blood glucose.
©2013 Pearson Education, Inc.
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The internal anatomy of the pancreas.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Pancreas
– Alpha cells produce hormone glucagon.
– Glycogenolysis: glucagon stimulates
breakdown of glycogen.
– Gluconeogenesis: glucose from
nonsugar sources.
– Both processes contribute to
homeostasis, raising blood glucose
level.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Pancreas
– Beta cells produce hormone insulin.
– Insulin antagonist of glucagon:
 Lowers blood glucose level.
 Promotes energy storage by increasing
synthesis of glycogen, protein, fat.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Pancreas
– Delta cells produce somatostatin.
 Inhibits secretion of glucagon and insulin.
 Retards nutrient absorption from
intestines.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Adrenal Glands
– Paired adrenal glands located on
superior surface of kidneys.
– Adrenal medulla; cells behave both as
nerve cells and gland cells.
 Secretes catecholamine hormones
epinephrine (adrenalin; norepinephrine).
©2013 Pearson Education, Inc.
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Anatomy and Physiology
• Adrenal Glands
– Adrenal cortex consists of endocrine
tissue; secretes steroidal hormones.
 Glucocorticoids: increase blood glucose
level.
 Mineralocorticoids: contribute to salt and
fluid balance.
 Androgenic hormones: same effects as
those secreted by gonads.
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Anatomy and Physiology
• Gonads
– Ovaries produce eggs; testes produce
sperm cells.
– Responsible for sexual maturation of
puberty and subsequent reproduction.
– Ovaries (female gonads): paired organs
about size of almond; located in pelvis
on either side of uterus.
 Produce: estrogen and progesterone.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Gonads
– Estrogen: development and
maintenance of secondary female
sexual characteristics.
 Plays role in egg development; protects
against heart disease.
– Progesterone: implantation of fertilized
egg and maintenance of uterine lining
throughout pregnancy.
©2013 Pearson Education, Inc.
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Anatomy and Physiology
• Gonads
– Male gonads (testes): located outside
abdominal cavity in scrotum.
– Hormone testosterone: development
and maintenance of secondary male
sexual characteristics; development of
sperm.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Anatomy and Physiology
• Pineal Gland
– Located in roof of thalamus in brain.
– Releases hormone melatonin in
response to changes in light.
 Melatonin may affect person's mood.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Diabetes mellitus: inadequate insulin
activity.
– Insulin critical to maintaining normal
blood glucose levels.
– Insulin enables body to store energy as
glycogen, protein, fat.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Anabolism: building processes within a
cell.
– Catabolism: breakdown processes
within cell.
– Anabolic activity uses energy.
– Catabolic activity produces energy.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– In order for anabolic pathways to
proceed, insulin must exert stimulatory
effects.
 There must be sufficient insulin
circulating in bloodstream to satisfy
cellular needs.
 Insulin must be able to bind to body cells
so that adequate levels of stimulation
occur.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Sometimes body cannot use glucose as
primary energy source.
– In diabetes, occurs when insufficient
insulin activity exists for blood glucose
to be taken in and used by cells.
– Body slowly switches from glucose to fat
as primary energy source.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Ketone bodies: acetoacetic acid,
acetone, β-hydroxybutyric acid.
– Ketosis: catabolic state; emergency
condition called diabetic ketoacidosis, or
diabetic coma.
– Blood glucose level lower than baseline
(less than 80 mg/dL) reflects
hypoglycemia (low blood sugar).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Blood glucose level higher than
expected (greater than 140 mg/dL)
reflects hyperglycemia (high blood
sugar).
– Kidneys: water, glucose, useful
materials reabsorbed; waste products
not reabsorbed become part of urine,
excreted from body.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Glucose loss in urine can lead to
dehydration.
– Water follows glucose into urine to
cause water loss (osmotic diuresis);
basis of excessive urination
characteristic of untreated diabetes.
– Glycosuria: presence of glucose in
urine; creates sweet urine.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Type I diabetes mellitus: -cell
destruction; very low production of
insulin; in many cases, no insulin at all.
– Commonly called juvenile onset
diabetes because of age at diagnosis.
– Insulin-dependent diabetes mellitus
(IDDM): regular insulin injections to
maintain glucose homeostasis.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Type I less common than type II
diabetes, but more serious.
– Accounts for most diabetes-related
deaths; heredity important factor.
– In untreated type I diabetes, blood
glucose levels rise because cells cannot
take up circulating sugar.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Type I: hyperglycemia of 300 to 500
mg/dL not uncommon.
– Constant thirst (polydipsia), excessive
urination (polyuria), ravenous appetite
(polyphagia), weakness, weight loss.
– Ketosis result of fat catabolism.
– May proceed to frank diabetic
ketoacidosis.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Type II diabetes mellitus
 Moderate decline in insulin production
accompanied by deficient response to
insulin present in body (insulin
resistance).
 Non-insulin-dependent diabetes mellitus
(NIDDM); some type II patients may
require insulin.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Type II diabetes mellitus
 Heredity and obesity play role.
 Far more common than type I diabetes;
80% of cases of diabetes mellitus.
 Untreated type II diabetes presents with
lower level of hyperglycemia and fewer
major signs of metabolic disruption.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Type II diabetes mellitus
 Initial therapy: dietary change, increased
exercise, oral hypoglycemic agents.
 Eventually may require use of insulin.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Diabetes Animation
Click here to view an animation on the topic of diabetes.
Back to Directory
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Diabetic ketoacidosis (diabetic coma):
serious, potentially life-threatening
complication associated with type I
diabetes.
– Profound insulin deficiency coupled with
increased glucagon activity.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– In initial phase of diabetic ketoacidosis,
profound hyperglycemia exists because
of lack of insulin.
– Body cells cannot take in glucose.
– Loss of glucose in urine and loss of
water through osmotic diuresis produce
significant dehydration.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– As body switches to fat-based
metabolism, blood level of ketones
rises.
– In initial phase, signs of diuresis
appear: increased urine production; dry,
warm skin and mucous membranes;
excessive hunger and thirst;
progressive sense of malaise.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– As ketoacidosis develops, major
compensatory mechanism for acidosis
appears: rapid, deep breathing pattern
termed Kussmaul's respirations; helps
expel carbon dioxide.
– Breath: fruity or acetone-like smell.
– Over time, mental function declines and
frank coma may occur.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Assessment and management of
diabetic ketoacidosis: same as any
patient with mental impairment or
unconscious patient.
– Complete assessment of airway,
breathing, circulation; focused history
and physical exam.
– Look for Medic-Alert bracelet and/or
insulin in refrigerator.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Complete rapid test for blood glucose
level; not uncommon for patients with
ketoacidosis to have blood glucose
levels in excess of 500 mg/Dl.
– Maintain ABCs and fluid resuscitation to
counteract dehydration; transport.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Hyperosmolar hyperglycemic state
(HHS), also called hyperglycemic
hyperosmolar nonketotic (HHNK) coma:
serious complication associated with
type II diabetes.
 Sustained hyperglycemia causes osmotic
diuresis to produce dehydration; water
intake inadequate to replace lost fluids.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Mortality rate for HHS coma higher than
for ketoacidosis (40 to 70%).
– Primarily affects elderly.
– Onset slow; increased urination and
increased thirst; becomes lethargic,
confused, or enters frank coma.
– Prehospital management: same as
ketoacidosis.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Hypoglycemia (insulin shock), or low
blood glucose, is medical emergency.
– Patient takes too much insulin, eats too
little to match insulin dose, overexerts
and uses almost all blood glucose.
– Risk: brain cells permanently damaged
or killed due to lack of glucose.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Altered mental status sign of
hypoglycemia; inappropriate anger or
bizarre behavior.
– Diaphoresis and tachycardia;
hypoglycemic seizure or become
comatose.
– Can develop quickly.
– Look for Medic-Alert bracelet.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Pancreas
– Hypoglycemia
 Determine blood glucose level.
 If patient conscious and able to swallow,
complete glucose administration with
orange juice, sugared sodas,
commercially available glucose pastes.
 If patient unconscious, start IV of normal
saline and administer 50 to 100 mL of
50% percent dextrose.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Thyroid Gland
– Hyperthyroidism: presence of excess
thyroid hormones in blood.
– Thyrotoxicosis: prolonged exposure of
body organs to excess thyroid
hormones, with resultant changes in
structure and function (caused by
Graves' disease).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Thyroid Gland
– Hypothyroidism: presence of inadequate
thyroid hormones in blood.
– Myxedema: long-term exposure to
inadequate levels of thyroid hormones;
resultant changes in structure and
function.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Thyroid Gland
– Graves' disease
 Six times more common in women than
men; onset young adulthood.
 Autoimmune origin; excessive amounts
of thyroid hormones.
 Agitation, emotional changeability,
insomnia, poor heat tolerance, weight
loss despite increased appetite,
weakness, dyspnea, tachycardia.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Thyroid Gland
– Graves' disease
 Can cause exophthalmos (protrusion of
eyeballs).
 Interaction of autoantibodies with thyroid
tissue often produces diffuse goiter
(enlarged thyroid gland).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Exophthalmos. (© Custom Medical Stock Photo, Inc.)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Generalized enlargement of the thyroid gland (goiter). (© Edward T. Dickinson, MD)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Thyroid Gland
– Thyrotoxic crisis (thyroid storm)
 Life-threatening emergency; can be fatal
within 48 hours if untreated.
 Associated with severe physiologic stress.
 High fever, irritability, delirium or coma,
tachycardia, hypotension, vomiting,
diarrhea.
 Field management: supportive care.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Thyroid Gland
– Hypothyroidism and myxedema
 Hypothyroidism congenital or acquired;
both sexes affected.
 Low metabolic state; early signs reflect
poor organ function and poor response to
challenges such as exercise or infection.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Thyroid Gland
– Hypothyroidism and myxedema
 Myxedema: thickening of connective
tissue in skin and tissues, including
heart.
 Myxedema coma: hypothermic,
stuporous state; can be fatal if
respiratory depression occurs.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Thyroid Gland
– Hypothyroidism and myxedema
 Lethargy, cold intolerance, constipation,
decreased mental function, decreased
appetite with increased weight.
 Classic appearance of myxedema:
unemotional, puffy face; thinned hair;
enlarged tongue; pale, cool skin that
looks and feels like dough.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Doughy, edematous skin typical of myxedema. (© Biophoto Associates/Photo Researchers, Inc.)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Thyroid Gland
– Hypothyroidism and myxedema
 Heart distress not uncommon; maintain
ABCs and close monitoring of cardiac and
pulmonary status.
 Patients with myxedema coma require
intubation and ventilatory assistance.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Adrenal Glands
– Cushing's syndrome: caused by
excessive adrenocortical activity.
– Addison's disease: caused by deficient
adrenocortical activity.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Adrenal Glands
– Cushing's syndrome
 Common disorder of adrenals; caused by
high levels of cortisol in blood.
 Affects middle-aged persons; women
more than men.
 Long-term exposure to excess
glucocorticoids.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Adrenal Glands
– Cushing's syndrome
 Weight gain, trunk of body, face, neck;
“moon-faced” appearance develops.
 Accumulation of fat on upper back
referred to as “buffalo hump.”
 Skin changes common and early clue.
 Mood swings and impaired memory or
concentration.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Facial features of Cushing's syndrome. (© Biophoto Associates/Photo Researchers, Inc.)
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Adrenal Glands
– Cushing's syndrome
 These patients have higher incidence of
cardiovascular disease, including
hypertension and stroke.
 Pay attention to skin preparation when
starting IV lines; skin fragility and
susceptibility to infection.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Adrenal Glands
– Adrenal insufficiency (Addison's disease)
 Adrenal glands fail to produce adequate
amounts of steroid hormones (cortisol
and aldosterone).
 Due to cortical destruction; 90% due to
autoimmune disease.
 Heredity plays prominent role.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Adrenal Glands
– Adrenal insufficiency (Addison's disease)
 Addisonian crisis: acute stresses such as
infection or trauma; potentially lifethreatening emergency.
 Congenital adrenal hyperplasia (CAH):
can affect all adrenal hormones; causes
both hyperadrenalism and
hypoadrenalism.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Adrenal Glands
– Adrenal insufficiency (Addison's disease)
 Waterhouse-Friderichsen syndrome
(WFS) called hemorrhagic adrenalitis:
overwhelming bacterial infection causes
massive adrenal hemorrhage.
 Low mineralocorticoid activity key to
changes of Addison's.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Adrenal Glands
– Adrenal insufficiency (Addison's disease)
 Causes major disturbances in water and
electrolyte balance.
 Progressive weakness, fatigue, decreased
appetite, weight loss; hyperpigmentation
of skin and mucous membranes.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Adrenal Glands
– Adrenal insufficiency (Addison's disease)
 Electrolyte imbalances, low blood
volume, hypotension, and increased
potential for cardiac arrhythmias.
 Emergency management: maintain
ABCs; close monitoring of cardiac and
oxygenation status and blood glucose
level.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Endocrine Disorders and
Emergencies
• Disorders of the Adrenal Glands
– Adrenal insufficiency (Addison's disease)
 Hypoglycemia poses its own threat.
 Be aggressive in fluid resuscitation.
 Follow local protocols.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• In conjunction with nervous system,
endocrine system regulates body
functions.
• Majority of endocrine emergencies you
encounter will involve complications of
diabetes mellitus (hypoglycemia or
ketoacidosis).
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Other endocrine emergencies rare.
• Always suspect diabetes when patient
presents with unexplained changes in
mental status.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Quick check with glucometer will
indicate patient's glucose level.
• Hypoglycemia (most urgent diabetic
emergency) must be quickly treated to
prevent serious nervous system
damage.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• When you cannot determine type of
diabetic emergency, treat for
hypoglycemia.
• When patient's glucose level low, skin
becomes cool and clammy; when
glucose level high, skin warm and dry.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• If unable to obtain glucose level in
known diabetic who has altered level of
consciousness, treating for
hypoglycemia will not be detrimental,
even if patient is hyperglycemic.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
Summary
• Hyperglycemic patient, especially one
in diabetic ketoacidosis (DKA), will need
long-term treatment that will require
hospitalization and monitoring.
• Primary responsibility for any diabetic
emergency: maintain stable airway,
oxygenate patient, establish IV line,
transport.
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.