Endocrinal emergencies 2

1. Endocrinal emergencies 2 Dr. Miada Mahmoud Rady

2. LECTURE 2 APPROACH TO ENDOCRINAL CASE (patient assessment)

3. Patient Assessment

4. Scene size-up • Ensure safety , secure safe access to the patient . • Address hazards, and follow standard precautions. • Check for medications that may give you clues. • Bring any medication bottles to the hospital . • Review dispatch information , notify dispatch about any additional requests needed and alert area hospital if necessary.

5. Primary assessment

6. Primary assessment Identify and manage life threats Form a general impression Address ABCS Transport decision

7. Identify and manage life threats immediately: • Check for a medical identification bracelet or necklace in patients with altered mental status. • Form a general impression : • Position • Work of breathing • Apparent attentiveness • Skin color • Any obvious wounds noted • Any body fluids Your first impression sick or not sick

8. Shake and shout Are you ok ? Responsive Unresponsive Assess speaking and look for signs of obs. Open air way and clear any obstruction

9. Patient’s position : • May offer clues as to the severity of the condition. • Unresponsive patient may be having an endocrine crisis as: • Hypoglycemia . • Hyperglycemia . • Myxedema coma with severe thyroid deficiency . • Diaphoresis ( excessive sweating and distress ) : • Sign of severe distress. • Present in thyrotoxicosis.

10. Signs and symptoms of specific conditions : • Buffalo hump , moon face and acne are signs of Cushing disease. • Exophthalmos ( bulging eye) is a sign of thyrotoxicosis .

11. Address ABC • Airway • Assess ability to speak • Note signs of airway obstruction or respiratory insufficiency. • Compromised airway must be secured manually Using jaw thrusts or chin lift , Or with adjunct equipment : • Oral or nasal airways • Suction • Advanced airway device

12. Air way checking Signs of obstruction Open and clear Open and clear air way Breathing

13. Airway opening maneuvers Head tilt , chin left Jaw thrust

14. Breathing • Assess breathing effort. • Administer oxygen if : • The rate is greater than 24 breaths/min. • The rate is less than 8 breaths/min. • Supplemental oxygen is recommended in all cases of suspected respiratory involvement even with a normal pulse oximetry reading .

15. Circulation • Assess skin color, moisture, and temperature : • Pale, cool, moist skin may be a sign of: • Hypoglycemia • Hot, dry skin may be a sign of: • Hyperglycemia • Evaluate pulse . • Obtain blood pressure . • Capillary refill time . • IV administration or blood replenishment may be necessary.

16. CPR is as easy as CAP

17. History taking • Especially useful in diabetic emergencies (genetic disease) : Family history • Consider the patient’s signs and symptoms: • Polyuria, polydepsia , polyphagia → symptoms of uncontrolled OR undiagnosed D.M. • Tackycardia, cardiac arrhythmias → thyrotoxicosis. • If a patient is unresponsive → obtain a blood glucose level. • Use SAMPLE and OPQRST to gather information.

20. Ascertain any allergies prior to administering medication. • Document the following: • Medications the patient is currently taking. • Whether the patient has been compliant or not. Not documented AS Not done

21. Secondary assessment • Detailed head to toe examination to detect any atypical finding regarding patient generally and problem related : • Appearance • position • consciousness • Vital signs . Look , listen and feel for every body system

22. Secondary assessment • General appearance : ( sick or not sick ) . • The position • Abnormal position often indicates brainstem damage. • Level of consciousness : • Using AVPU score or Glasgow coma score. • Will be used later to determine whether patient is improving or deteriorating . • Find signs that may provide clue to the cause of coma.

24. Vital signs • Look for a combination of hypertension and bradycardia Suggests increased intracranial pressure in DKA . • Be alert for abnormal respiratory patterns, such as: • Cheyne-Stokes breathing Usually points to a non- neurologic source of coma . • Kussmaul respirations often present in patients with diabetic ketoacidosis (DKA) .

25. Reassessment • Continually reassess the patient for changes : • Reassess critical patients at least every 5 minutes. • Noncritical patients may be reassessed every 15 minutes. • Document your findings. • A patient whose gag reflex is absent cannot protect his or her own airway from aspiration. • Be prepared to suction the airway. • Consider intubation if the patient does not regain consciousness with treatment.

26. If breathing is abnormally slow or shallow : assist with bag-mask ventilation. • Give supplemental oxygen , whether the patient is breathing spontaneously or being ventilated . • Obtain blood specimens early in patients with diabetes : administration of prehospital dextrose or other medications will significantly change the result of subsequent blood samples.

27. If altered mental status establish either IV with 0.9% NS or saline lock. • Immediately determine the blood glucose level : If less than 60 mg/dL→ Initiate treatment of 12.5 g to 25 g of D50. • Monitor the cardiac rhythm of every comatose patient. • Address the patient’s emotional needs.

28. Recheck vital signs, pupils, and level of consciousness. • Every 5 minutes in unstable patients • Every 15 minutes in stable patients • Record your findings immediately. • Every patient you transport should have at least two sets of vital signs documented part of the patient’s medical record.

29. Summary • Endocrinal emergencies can affect every body system so detailed examination is required. • Standard method of examination should be followed with focus on symptoms related to endocrine disease symptoms and signs .

30. any questions ?