Endocrine System & Diabetes Mellitus

Endocrine System Overview

• The endocrine system regulates body functions via hormones.
• The pancreas regulates blood sugar by producing insulin and glucagon.
• Insulin lowers blood sugar and helps glucose enter cells.
• Glucagon raises blood sugar when it's low

Diabetes Mellitus

• Diabetes Mellitus is the name for a group of metabolic disorders in which the body does not produce enough insulin or use it effectively.

Type 1 Diabetes

• It’s an autoimmune disorder
• The body does not produce insulin and requires external insulin to survive.
• Often diagnosed in childhood.
• Complications include:
  • Diabetic ketoacidosis (DKA) is a condition that can occur if insulin is missed.
  • High blood sugar can lead to ketone production, resulting in acidosis.

Type 2 Diabetes

• Cells become resistant to insulin.
• Obesity and lifestyle factors are linked to Type 2.
• Treatments involve diet, exercise, oral medications, or insulin.
• A complication is Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS).

Diabetic Emergencies

Hyperglycemia (High Blood Sugar)

• Causes of hyperglycemia include too much food and not enough insulin.
• Stress and infection can be a cause
• Poor medication compliance can be a factor
• Signs and Symptoms include:
  • Gradual onset
  • Excessive urination, thirst, hunger (polyuria, polydipsia, polyphagia)
  • Warm, dry skin
  • Fruity-smelling breath (DKA)
  • Kussmaul respirations (deep, rapid breathing)
• Treatment usually includes fluids and insulin in a hospital setting, and supplemental oxygen if there is respiratory distress

Diabetic Ketoacidosis (DKA) - Type 1

• Blood glucose is usually > 400 mg/dL.
• Fat metabolism leads to ketone buildup, leading to metabolic acidosis.
• Signs include Kussmaul respirations, fruity breath, and altered mental status.

HHNS - Type 2

• Blood Glucose > 600 mg/dL
• Involves severe dehydration, confusion, and dark urine
• No ketones present

Hypoglycemia (Low Blood Sugar)

• Causes of hypoglycemia include too much insulin or medication.
• Skipping meals
• Increased exercise can cause it
• Signs & Symptoms include:
  • Rapid onset
  • Pale, sweaty skin
  • Altered mental status, seizures, unconsciousness
  • Tachycardia, dizziness
• Treatment includes:
  • Oral glucose, if the person is conscious
  • If unconscious, administer IV glucose or IM glucagon
  • Rapid transport if unresponsive

Hematologic Emergencies

Sickle Cell Disease

• It’s an inherited disorder, mostly in African, Caribbean, South American populations.
• Misshapen RBCs block blood flow, causing painful crises.
• Complications include vaso-occlusive crises (severe pain), infections, stroke, or organ failure.
• Treatment includes:
  • High-flow oxygen (12-15 L/min)
  • Pain management (hospital)
  • Fluids, transport

Hemophilia

• Due to a lack of clotting factors, leading to uncontrolled bleeding.
• It’s more common in males.
• Emergency Care:
  • Be alert for internal bleeding.
  • Minimize movement.
  • Transport ASAP

Deep Vein Thrombosis (DVT)

• Blood clot in a deep vein (usually leg).
• Risk factors: Surgery, immobility, smoking, obesity.
• Major risk: Pulmonary embolism (clot travels to lungs).
• Treatment:
  • Anticoagulants (hospital care)
  • Preventive measures: Compression stockings, movement

Assessment & Management

• Scene Size Up: Check for insulin pumps, syringes
• Take standard precautions
• Primary Assessment:
  • Airway & Breathing:
    • Kussmaul respirations may indicate DKA
    • Shallow, rapid breathing may indicate Hypoglycemia
  • Circulation:
    • Dry, warm skin → Hyperglycemia
    • Pale, moist skin → Hypoglycemia
• Secondary Assessment:
  • Check blood glucose if available
  • Look for medical alert bracelets
  • Ask SAMPLE Questions, e.g., Do you take insulin or pills? Have you eaten today? Have you had any recent illness, stress, or unusual activity?

Emergency Treatment Overview

• Hypoglycemia: Rapid onset, sweating, confusion is treated with glucose.
• Hyperglycemia: Gradual onset, thirst, fruity breath requires transport.
• Sickle Cell: Pain crisis + oxygen needed.
• Hemophilia: Risk of severe bleeding needs transport ASAP.
• When in doubt, check blood sugar levels.

Overview of the Abdominal Systems

Major Organ Systems

• Gastrointestinal System: Digestion, absorption, and waste elimination.
• Urinary System: Filters waste, regulates fluid balance, and removes excess fluids.
• Reproductive System: Includes male and female reproductive organs.

Solid vs. Hollow Organs

• Solid Organs: Liver, spleen, pancreas, kidneys, ovaries; injury can cause shock and bleeding.
• Hollow Organs: Stomach, intestines, bladder, gallbladder; rupture can cause peritonitis (infection of abdominal cavity).

Gastrointestinal System & Emergencies

Key Components of the GI System

• Stomach: Breaks down food using gastric juices.
• Liver: Filters toxins, produces bile, stores glucose.
• Gallbladder: Stores and releases bile for fat digestion.
• Small Intestine: Absorbs nutrients (duodenum, jejunum, ileum).
• Large Intestine (Colon): Absorbs water, forms stool.
• Spleen: Stores blood, filters old RBCs (not part of digestion).

Common GI Conditions

Peritonitis

• Inflammation of the peritoneum (lining of the abdominal cavity).
• Causes: Blood, bile, pus, or bacteria leakage into the abdomen.
• Symptoms: Severe pain, distention, fever, nausea, vomiting.

Peptic Ulcer Disease (PUD)

• Erosion of stomach lining due to acid, NSAIDs, or H. pylori bacteria.
• Symptoms: Burning pain, nausea, vomiting, upper GI bleeding.

Gallstones & Cholecystitis

• Gallstones block bile duct, leading to gallbladder inflammation.
• Symptoms: RUQ pain, worse after fatty meals, nausea, vomiting.

Appendicitis

• Inflammation of the appendix, risk of rupture.
• Symptoms: RLQ pain, rebound tenderness, fever, nausea, vomiting.

Pancreatitis

• Inflammation of the pancreas, often due to alcohol or gallstones.
• Symptoms: LUQ pain radiating to back, nausea, vomiting, distention.

Diverticulitis

• Inflamed pockets in the colon due to trapped feces.
• Symptoms: LLQ pain, fever, chills, nausea, changes in bowel habits.

Gastrointestinal Bleeding

• Upper GI Bleed (Stomach/Esophagus) causes vomiting blood, black stools.
• Lower GI Bleed (Colon/Rectum) causes bright red blood in stool.
• Causes: Ulcers, esophageal varices, diverticulitis, cancer.

Esophageal Varices

• Swollen veins in esophagus (often from liver disease).
• Symptoms: Vomiting bright red blood, jaundice, shock signs.

Gastroenteritis

• Inflammation of stomach/intestines (viral or bacterial).
• Symptoms: Diarrhea, nausea, vomiting, fever, cramps.

Hernias

• Organ protrudes through abdominal wall.
• Strangulated hernias cut off blood flow, which is an emergency.
• Symptoms: Sudden pain, discoloration, non-reducible mass.

Urinary System & Emergencies

Key Components of the Urinary System

• Kidneys: Filter blood, regulate fluids.
• Ureters: Transport urine to bladder.
• Bladder: Stores urine.
• Urethra: Eliminates urine from body.

Common Urinary Conditions

Urinary Tract Infections (UTIs)

• Bladder infection due to bacteria.
• Symptoms: Painful urination, frequent urge, cloudy urine, fever, can progress to pyelonephritis (kidney infection) if untreated.

Kidney Stones

• Crystals form in kidney, blocking ureters.
• Symptoms: Severe flank pain, hematuria (blood in urine), nausea.

Acute & Chronic Kidney Failure

• Acute Kidney Failure: Sudden loss of function, reversible with treatment.
• Chronic Kidney Failure: Irreversible, requires dialysis or transplant.
• Symptoms: Edema, confusion, lethargy, ammonia breath odor.

EMS Assessment & Management

• Observe for trauma, environmental factors
• Airway & Breathing: Monitor for distress, vomiting.
• Circulation: Check for shock signs (tachycardia, hypotension, pale skin).
• Secondary Assessment:
  • OPQRST: Onset, Provocation, Quality, Radiation, Severity, Time.
  • SAMPLE History: Medications (NSAIDs?), alcohol use, prior conditions. Palpate Abdomen: Quadrant pain can indicate specific conditions.
    • RUQ: Gallbladder (Cholecystitis), Liver (Hepatitis)
    • LUQ: Pancreatitis, Spleen Injury
    • RLQ: Appendicitis
    • LLQ: Diverticulitis
• Treatment & Transport:
  • Shock Management: Oxygen, position of comfort, rapid transport.
  • Pain Control: Avoid oral meds, allow hospital to manage.
• Dialysis Patients: Monitor AV fistula sites for bleeding.

Key Takeaways:

• Rapid assessment and transport are necessary.
• Abdominal pain with shock signs means emergency.
• Flank pain, hematuria = Kidney stones
• Black stools = Upper GI Bleed; Red blood = Lower GI Bleed
• Always consider peritonitis in severe abdominal pain! When in doubt, transport immediately!

Introduction to Toxicology

• Toxicology is the study of toxic or poisonous substances.
• A poison is any substance that can damage body structures or impair function.
• A toxin is a poisonous substance produced by bacteria, animals, or plants.
• Routes of Exposure:
  • Inhalation (gases, fumes)
  • Absorption (skin contact)
  • Ingestion (swallowed)
  • Injection (drugs, venom)
• EMS Role in Toxicology:
  • Recognize poisoning symptoms.
  • Identify the poison if possible.
  • Contact Poison Control for guidance.
  • Provide emergency care and transport.

Routes of Poison Exposure & Treatment

Inhaled Poisons

• Inhaled poisons include carbon monoxide, chlorine gas, and fumes.
• Symptoms include respiratory distress, dizziness, headache, and confusion.
• Remove patients from exposure.
• Provide high-flow oxygen and transport immediately.

Absorbed Poisons (Surface Contact)

• Absorbed poisons include industrial chemicals, plant toxins, and acids.
• Symptoms include skin irritation, burns, rashes, and systemic effects.
• Treatment includes:
  • Remove clothing and brush off dry chemicals.
  • Flush with water for 15-20 minutes.
  • Avoid contaminating yourself.

Ingested Poisons

• Ingested poisons include: medications, household cleaners, food poisoning.
• Symptoms: Burns around mouth, vomiting, abdominal pain, and altered mental status.
• Treatment includes assessing ABCs, considering activated charcoal (if protocol allows), and transporting and notifying Poison Control.

Injected Poisons

• Include: Drug overdoses, insect/reptile venom.
• Symptoms include: Local swelling, pain, dizziness, weakness, and shock symptoms.
• Treatment: Monitor airway and breathing.

Specific Poisons & Overdoses

Carbon Monoxide (CO) Poisoning

• Colorless, odorless gas from fires, vehicle exhaust.
• Symptoms: Headache, dizziness, confusion, cherry-red skin (late sign).
• Treatment: High-flow oxygen, hyperbaric therapy (hospital setting).

Alcohol Intoxication & Withdrawal

• Effects: CNS depression, liver damage.
• Symptoms:
  • Intoxication: Slurred speech, uncoordinated movements.
  • Withdrawal: Delirium tremens (DTs) – hallucinations, seizures, and tremors.
• Treatment: Airway support, fluids, and transport.

Opioid Overdose (Heroin, Fentanyl, Morphine)

• Symptoms: Pinpoint pupils, respiratory depression, unconsciousness.
• Treatment: Administer Naloxone (Narcan) per protocol, airway support, and high-flow oxygen.

Sedative-Hypnotics (Benzodiazepines, Barbiturates)

• Examples: Valium, Xanax, Rohypnol.
• Symptoms: Drowsiness, confusion, and respiratory depression.
• Treatment: Airway support and transport.

Stimulants (Cocaine, Meth, Ecstasy)

• Symptoms: Increased heart rate, hypertension, paranoia, and seizures.
• Treatment: Keep patient calm, transport, and monitor vitals.

Hallucinogens (LSD, PCP, Mushrooms)

• Symptoms: Visual hallucinations, anxiety, paranoia.
• Treatment: Provide reassurance and minimize stimulation.

Cholinergic (Pesticides, Nerve Agents)

• Mnemonic: DUMBELS.
  • Diarrhea
  • Urination
  • Miosis (pupil constriction)
  • Bradycardia, bronchospasm
  • Emesis (vomiting)
  • Lacrimation (tears)
  • Salivation, seizures
• Treatment: DuoDote Auto-Injector (Atropine + Pralidoxime) and oxygen with airway support.

Emergency Assessment & Management

• Scene Size-Up: Look for pill bottles, chemicals, and paraphernalia; ensure scene safety.
• Primary Assessment:
  • ABCs: Airway, Breathing, Circulation.
  • Provide oxygen and ventilation if needed.
• Secondary Assessment:
  • Obtain SAMPLE history: What was taken? When and how much? Any treatments given?
  • Look for track marks, burns, and pinpoint pupils.
• Treatment & Transport Considerations:
  • Contact Poison Control for guidance.
  • Manage symptoms, not just the poison.
  • Transport for further evaluation.

Key Takeaways:

• Recognize poisoning early - Altered mental status is common!
• Assess route of exposure (inhalation, absorption, ingestion, injection).
• Use activated charcoal if indicated (not for acids, alkalis, or petroleum).
• Naloxone (Narcan) reverses opioid overdoses.
• Call Poison Control for all toxic exposures.
• When in doubt, provide oxygen and rapid transport!

Medical Emergencies

Introduction to Medical Emergencies

• Medical emergencies include illnesses or conditions caused by disease.
• Trauma emergencies include physical injuries.
• Some people experience both types of emergencies.

Types of Medical Emergencies:

• Respiratory Emergencies: Affect breathing and oxygen supply, e.g., asthma, COPD, pneumonia, pulmonary edema.
• Cardiovascular Emergencies: Affect the heart and circulation, e.g., heart attack, congestive heart failure, hypertension.
• Neurologic Emergencies: Affect the brain and nervous system, e.g., stroke, seizures, syncope.
• Gastrointestinal & Urologic Emergencies: Involve digestive and urinary systems, e.g., appendicitis, diverticulitis, pancreatitis, kidney stones.
• Endocrine Emergencies: Often related to diabetes complications, e.g., diabetic ketoacidosis (DKA), hypoglycemia.
• Hematologic Emergencies: Related to blood disorders, e.g., sickle cell disease, clotting disorders.
• Immunologic Emergencies: Involve allergic reactions and immune responses, e.g., anaphylaxis.
• Toxicologic Emergencies: Involve poisoning and substance abuse, e.g., drug overdose, chemical poisoning.
• Psychological & Behavioral Emergencies: Mental health-related crises, e.g., suicidal ideation, anxiety disorders.
• Gynecologic Emergencies: Conditions affecting female reproductive organs, e.g., ectopic pregnancy, pelvic inflammatory disease.

Patient Assessment Process:

• Scene Size-up:
  • Ensure scene safety.
  • Use standard precautions (PPE).
  • Determine Nature of Illness (NOII).
• Primary Assessment:
  • General Impression: Appearance, level of distress.
  • Level of Consciousness: AVPU scale (Alert, Verbal, Pain, Unresponsive).
  • Airway: Open and clear?
  • Breathing: Rate, depth, effort.
  • Circulation: Skin color, pulse, bleeding.
• History Taking (SAMPLE & OPQRST)
• SAMPLE History:
  • Signs & Symptoms
  • Allergies
  • Medications
  • Past Medical History
  • Last Oral Intake
  • Events Leading to Illness
• OPQRST for Pain Assessment:
  • Onset
  • Provocation
  • Quality
  • Radiation
  • Severity
  • Time
• Secondary Assessment
  • Focused Exam for conscious patients.
  • Head-to-Toe Exam for unconscious patients.
• Take Vital Signs:
  • Pulse, Respirations, Blood Pressure
  • Oxygen Saturation (Pulse Oximetry)
  • Blood Glucose Level (if indicated)
• Reassessment:
  • Monitor changes in patient condition.
  • Check interventions (oxygen, medication, transport decisions).

Management & Transport Considerations:

• Transport Decision:
  • Critical patients are a rapid transport.
  • Consider closest appropriate facility.
• Mode of Transport:
  • Ground Ambulance: EMTs and Paramedics.
  • Air Transport: Critical Care Team for severe cases.
• Infectious Disease Precautions:
  • Standard Personal Protective Equipment (PPE) (gloves, masks, eye protection).
  • Special precautions for respiratory infections (N95 mask).
• Special Considerations:
  • Patients with multiple conditions (heart disease + diabetes).
  • Elderly patients may have vague or atypical symptoms.
  • Pediatric patients require different assessments.

Infectious Diseases Overview

Common Infectious Diseases:

• Influenza: Viral respiratory illness.
• HIIV/AIDS: Bloodborne virus affecting immunity.
• Hepatitis: Liver infection (A, B, C types).
• Meningitis: Inflammation of the meninges (brain covering).
• Tuberculosis (TB): Chronic lung infection requiring N95 mask protection.
• MRSA: Antibiotic-resistant bacterial infection.

Epidemics & Pandemics:

• Epidemic: Local outbreak of disease.
• Pandemic: Global spread of an illness (e.g., COVID-19).

Travel-Related Infections:

• Always ask about recent travel history and to consider tropical diseases (malaria, Zika, Ebola).

Key Takeaways:

Medical emergencies vary widely; thorough assessment is key! SAMPLE and OPQRST help guide history-taking. Always prioritize Airway, Breathing, Circulation (ABCs). Use PPE for infection control (gloves, mask, eye protection). Rapid transport for unstable patients is critical. Be aware of emerging infectious diseases and global outbreaks. When in doubt, transport and reassess!