CCS Flashcards
Quid of DKA criteria (4)
blood sugar level > 250 mg/dl
Bicarb < 15
Ketonemia
elevated anion gap
Could Amylase and lipase elevated in DKA
yes
Normal bicarb
24-30
How to control Anion Gap
Na- (Cl +Hco3)
normal anion Gap
10-14 meq
criteria for hyperosmolar state(5)
glucose more than 600 mg/dl serum osmolarity more than 330 absent or minimal ketonemia arterial PH above 7.3 serum bicarb above 20
Mechanism of fluid and electrolytes depletion in HS
osmotic diuresis
How to calculate serum osmolarity
2Na + glucose/18 + BUN/2.8
Normal serum osmolarity
275-295
normal arterial PH
7.35-7.45
corner stone of DKA treatment (3)
Hydration
Insulin
Potassium replacement
Hydration urgency phase in DKA (3)
1-2 liters in bolus
500 ML per hour during first 4 hours
continue with 250 ml for several hours
second phase of hydration in DKA if no signs of dehydration
continue with 1/2 NS 250-500 cc per hour for 3 to 4 hours
volume repletion in DKA
4 to 10 liters
What to do in DKA when glycemia is < ou egal a 250
DW 5 or 10%
How to give insulin
O,1 U/kg en bolus followed by 0,1 U/kg per hour in continuous infusion
Potassium replacement in DKA criteria (3)
K < 5.3
No EKG changes
Normal renal function
what about Bicarb and phosphore replacement
no evidence of clinical relevance
Quid of ABCD
Airway
breathing
circulatory
drugs
Airway quid (3)
Airway suction
give O2
Pulse oxymetry
Quid of Breathing
Endotracheal intubation
criteria for endotracheal intubation (3)
If you cannot protect the airway
No improvement with nasal or face mask o2
pao2 < 55 or Paco2 > 50
quid of C
IV access
Cardiac monitoring
foley
Obtain a finger stick glucose
Quid of D (3)
drugs if unconscious without trauma
give thiamine
Naloxone
Dextrose 50%
Narcotic overdose signs(2)
Hypotension
Pinpoint pupils
Why hypotension in narcotic overdose
Peripheral vasodilation
treatment of narcotic overdose
Naloxone
Activated charcoal if intoxication comes from ingestion
clue indicating hemolytic anemia (3)
Jaundice with indirect bilirubin predominant
Bite cells on peripheral smear
Anemia
intravascular hemolysis cause
IGM causing destruction by IGM
Extravascular hemolysis cause
IGG causing GR destruction using Macrophages in spleen or liver
Lab: intravascular hemolysis (3)
Hemoglobinuria High LDH Low haptoglobin shistocytes , helmet cells or fragmented red blood cells on Peripheral smear High reticulocytes count
Peripheral smear in intravascular hemolysis (3)
shistocytes
helmet cells
fragmented red blood cells
Lab in extravascular hemolysis
Increased indirect bilirubin high LDH low haptoglobin spherocytes High reticulocyte count
Peripheral smear in Extravascular hemolysis
spherocytes
Why low haptoglobin
Haptoglobin is a transporter of protein, transports newly released indirect bilirubin and is rapidly used up in hemolysis
