Endocrine and Metabolic Emergencies - NREMT AEMT Level

1. What is the most appropriate initial field treatment for suspected adrenal crisis with shock?

   Treat shock with isotonic fluids and rapid transport. Fluids restore perfusion in hypotensive states while awaiting steroid replacement in hospital.

2. Which condition best fits: fruity breath, deep rapid respirations, BG $420\ \text{mg/dL}$?

   Diabetic ketoacidosis (DKA). Signs indicate ketosis, respiratory compensation for acidosis, and severe hyperglycemia.

3. What is the primary prehospital treatment priority for suspected DKA or HHS?

   Airway/ventilation support and isotonic fluid resuscitation. Addresses dehydration and respiratory compromise while definitive care is hospital-based.

4. Which endocrine emergency is most associated with hypoglycemia due to cortisol deficiency?

   Adrenal insufficiency (Addisonian crisis). Cortisol deficiency impairs gluconeogenesis and glycogenolysis, contributing to low blood sugar in crises.

5. What is the immediate airway-related action for an unresponsive diabetic patient with vomitus risk?

   Position, suction as needed, and provide ventilatory support. Prevents aspiration and ensures oxygenation in patients with decreased level of consciousness.

6. Which clinical finding most strongly suggests hypoglycemia rather than hyperglycemia?

   Diaphoresis with altered mental status. Hypoglycemia triggers sympathetic response causing sweating, while hyperglycemia typically presents with dry skin.

7. What medication is commonly given for severe hypoglycemia when IV access is not available?

   Glucagon per local protocol. It stimulates hepatic glycogenolysis to increase blood glucose when IV access is unobtainable.

8. Which breath odor is classically associated with diabetic ketoacidosis (DKA)?

   Fruity (acetone) breath odor. Ketone metabolism produces acetone, which imparts a characteristic fruity smell to exhaled breath.

9. Which patient population most commonly develops hyperosmolar hyperglycemic state (HHS)?

   Older adults with type 2 diabetes mellitus. Elderly type 2 patients are prone due to comorbidities and impaired thirst response.

10. What is the classic triad of signs and symptoms for thyroid storm?

    Hyperthermia, tachycardia, and altered mental status. Excess thyroid hormone causes hypermetabolism, fever, increased heart rate, and neurological changes.

11. Identify the better immediate action: BG $45\ \text{mg/dL}$, awake, follows commands, can swallow.

    Administer oral glucose (oral carbohydrate). Safe for conscious patients to quickly elevate glucose without invasive measures.

12. What breathing pattern is a classic compensatory sign of metabolic acidosis in DKA?

    Kussmaul respirations (deep, rapid breathing). It compensates for acidosis by increasing CO2 elimination through hyperventilation.

13. What is the most typical onset pattern of DKA compared with hypoglycemia?

    Gradual onset over hours to days. DKA develops slowly from progressive insulin deficiency, unlike rapid hypoglycemic crises.

14. What is the defining feature of hyperosmolar hyperglycemic state (HHS)?

    Severe hyperglycemia with profound dehydration and minimal ketosis. Extreme hyperglycemia causes osmotic diuresis and dehydration without significant ketone formation in type 2 diabetics.

15. What is the key contraindication to giving oral glucose to a hypoglycemic patient?

    Unable to protect airway or cannot swallow. Oral administration risks aspiration in patients with impaired airway protection or swallowing.

16. Which medication should an AEMT generally avoid initiating in the field for DKA or HHS?

    Insulin (unless specifically authorized by protocol/medical control). AEMTs lack authority for insulin in hyperglycemic crises to avoid complications like cerebral edema.

17. What is the primary hormone deficiency in type 1 diabetes mellitus?

    Insulin deficiency from pancreatic beta-cell failure. Type 1 diabetes results from autoimmune destruction of beta cells in the pancreas, leading to absolute insulin deficiency.

18. What is the classic presentation of myxedema coma (severe hypothyroidism)?

    Hypothermia, bradycardia, hypotension, and altered mental status. Profound thyroid hormone deficiency leads to slowed metabolism, cold intolerance, cardiovascular depression, and coma.

19. Identify the better immediate action: BG $38\ \text{mg/dL}$, unresponsive, gag reflex absent.

    Do not give oral glucose; manage airway and give IV dextrose/IM glucagon per protocol. Avoids aspiration risk in unconscious patients, prioritizing airway and alternative glucose administration.

20. What is the defining pathophysiology of diabetic ketoacidosis (DKA)?

    Insulin deficiency causing ketosis and metabolic acidosis. Lack of insulin leads to fat breakdown, ketone production, and acid accumulation in type 1 diabetics.

21. What is the primary problem in type 2 diabetes mellitus at the cellular level?

    Insulin resistance with relative insulin deficiency. Type 2 diabetes involves impaired insulin action at target tissues combined with inadequate compensatory insulin secretion.

22. What is the preferred treatment for severe hypoglycemia when IV access is available?

    IV dextrose per local protocol. Intravenous administration provides quick, controlled glucose delivery to reverse severe symptoms.

23. What blood glucose value commonly suggests hyperglycemia in the field assessment?

    Blood glucose $>250\ \text{mg/dL}$. This level indicates significant hyperglycemia, prompting assessment for conditions like DKA or HHS in symptomatic patients.

24. What is the best immediate treatment for a conscious patient who can swallow and is hypoglycemic?

    Oral glucose (oral carbohydrate). It rapidly raises blood glucose in alert patients without risking aspiration.

25. What blood glucose value defines hypoglycemia for prehospital treatment decisions?

    Blood glucose $<60\ \text{mg/dL}$. Prehospital protocols often use this threshold to initiate treatment for symptomatic hypoglycemia in adults.

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