20 Cards Flashcards
What is the recommended maximum sodium correction for chronic hyponatremia?
10 mmol/L in 24 hours
Complication of rapid correction of hyponatremia
osmotic demyelination syndrome
What can help prevent the development of osmotic demyelination syndrome?
Desmopressin
What is the recommended correction rate for sodium in hyponatremia?
6-8 mmol/L per 24 hours
Risk factors for osmotic demyelination syndrome
Chronic alcoholism, malnutrition, liver disease, hypokalemia
Management of diuretic induced metabolic alkalosis?
Volume repletion with normal saline and potassium replacement. Severe cases: use acetazolamide
First line treatment for mild hyperkalemia without ECG changes
calcium resonium
First line treatment for hyperkalemia with ECG changes
calcium gluconate
https://app.emedici.com/storage/media/a6c471ef-7df4-4329-869c-b8bfc78fdd96.jpg
diffuse bilateral patchy opacities,
RIPE - Image Quality Assessment:
Rotation:
The patient is slightly rotated to the left, as evidenced by asymmetry in the clavicles and spinous processes.
Inspiration:
Difficult to assess accurately in a supine AP film, but fewer ribs are visible than expected for adequate inspiration. This is typical for a supine film.
Projection:
AP Supine view (as indicated by “SUPINE MOBILE”). Portable CXR typically done for bedridden patients.
Structures appear magnified, particularly the heart.
Exposure/Penetration:
Suboptimal. The vertebral bodies are not well seen behind the heart, suggesting underpenetration.
ABCDE - Systematic Review of Anatomy:
Airways:
The trachea appears central.
No obvious tracheal deviation.
Breathing (Lungs & Pleura):
Diffuse bilateral opacities are present, more prominent on the right side.
These opacities are likely alveolar in nature, suggestive of pulmonary edema, infection, or aspiration pneumonia.
No obvious pleural effusions or pneumothorax seen.
Cardiac:
The heart size appears enlarged, but this could be due to AP magnification.
Cardiac borders are slightly obscured, particularly the left heart border, which may be related to adjacent lung opacities.
Diaphragm:
The costophrenic angles are blunted, particularly on the right side, which could indicate small effusions or related pathology.
The diaphragm appears slightly elevated, but this may be positional.
Everything Else (Bones, Soft Tissues, Tubes/Lines):
The bones (clavicles, ribs, shoulders) appear intact with no obvious fractures.
Lines and tubes are visible, but their precise locations should be assessed against clinical notes.
No subcutaneous emphysema or other soft tissue abnormalities are noted.
Summary:
The CXR shows bilateral diffuse opacities, more prominent on the right, consistent with pulmonary edema, aspiration pneumonia, or infection.
The heart appears enlarged, but this is likely due to AP projection magnification.
Mild blunting of the right costophrenic angle suggests small effusion or related pathology.
The alveolar nature of the opacities can be suspected based on several key features:
🔍 Features Suggesting Alveolar (Airspace) Opacities:
Appearance:
The opacities appear as hazy, confluent areas that blur normal lung markings.
They are not sharply defined like interstitial markings would be.
Distribution:
The opacities are diffuse and bilateral, which is typical of alveolar filling processes like pulmonary edema, pneumonia, or aspiration.
They are more prominent on the right side, suggesting possible aspiration pneumonia if the patient has been lying on their back (right main bronchus is straighter and more vertical).
Silhouette Sign:
The left heart border is somewhat obscured, suggesting alveolar opacities are present in the adjacent lung tissue (lingula).
This loss of the normal silhouette can be due to consolidation or edema.
Pattern (if present):
Fluffy or cloud-like opacities suggest alveolar filling rather than discrete lines or nodules, which would suggest interstitial disease.
Air Bronchograms (if present):
If air-filled bronchi are visible within the opacified area, it strongly suggests alveolar filling (though I couldn’t clearly see this in the image).
Comparison to Interstitial Disease:
Interstitial disease usually appears as reticular (lines), nodular, or reticulonodular patterns.
What we are seeing here is more homogeneous and diffuse, fitting the description of alveolar pathology.
Criteria for ARDS
BERLIN CRITERIA
Timing: within one week of a known clinical insult or new or worsening respiratory symptoms
Chest imaging: bilateral opacities not fully explained by effusions, lobar or lung collapse, or nodules
Origin of oedema: respiratory failure not fully explained by cardiac failure or fluid overload
Oxygenation: PaO2/FiO2 ≤ 300 mmHg
ARDS is an acute diffuse, inflammatory lung injury, leading to increased pulmonary vascular permeability, increased lung weight, and loss of aerated lung tissue…[with] hypoxaemia and bilateral radiographic opacities, associated with increased venous admixture, increased physiological dead space and decreased lung compliance.”
Severity of ARDS
Mild: 200 mmHg > PaO2/FiO2 ≤300 mmHg with positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) ≥5 cm H2O
Moderate: 100 mm Hg > PaO2/FiO2 ≤200 mmHg with PEEP ≥5 cm H2O
Severe: PaO2/FiO2 ≤ 100 mmHg with PEEP ≥5 cm H2O
how/ why does NIV work
NIV works by reducing the work of breathing, improving gas exchange, and allowing respiratory muscles to rest
First line management for acute hypercapnic respiratory failure in COPD exacerbations
NIV
Most important determinant of mortality in acute pancreatitis
Organ dysfunction
Most commonly affected organ systems in acute pancreatitis
resp (ARDS), CV (shock) , renal (aki)
Complications of severe pulmonary hypertension include:
RV failure, hepatic congestion, peripheral edema
