DKA Flashcards
What is the cause behind DKA?
Not enough insulin to pull glucose from the blood and put into the cells, this leads to burning more carbs and fats
What is the byproduct of breaking down carbs and fats?
Ketones
Essentials of DKA?
- Hyperglycemia >250 mg/dl
- Acidosis pH < 7.3
- Ketones in blood
- Serum bicarb <15
Clinical presentation?
- Polyuria
- fatigue
- nausea and vomiting
- mental stupor
- Kussmaul breathing
- fruity breathe
- Mild hypothermia
- abdominal pain
Tx for DKA?
- Fluids first
* Insulin .15 units/kg IV (Consult MO)
Keys to tx for DKA?
Restore intravascular volume
Dispo for DKA?
MEDEVAC - can lead to AMI, renal failure
What is rhabdomyolysis?
breakdown of muscle fibers
What is being released into the blood from breakdown of the muscle tissues?
Myoglobin and CK
What is causing the renal damage in rhabdo?
myoglobin
What do you do if, If plasma glucose level fails to fall at least 10% in the first hour of insulin tx?
Give repeat loading dose
What will insulin administration do to potassium levels?
Potassium will drop because insulin will drive it into the cells, therefore you may have to add potassium to treatment
Causes of rhabdo?
- Trauma/muscle compression
- Electrical
- Exertional
- Drugs (opioids)
- Toxins (snake venom and CO)
Symptoms of rhabdo?
- Muscle tenderness
- Muscle weakness
- Dark urine
- Altered mental status
What is hallmark lab for rhabdo?
Elevation of CK
How does hyperkalemia present on EKG?
Peaked T waves
Tx for rhabdo?
- IV fluids
Dispo for rhabdo?
- Can keep onboard if no altered mental status
When do MEDEVAC for rhabdo?
- Altered mental status
- Temp >105
- Unresponsive to IV fluids
What is defined as circulatory insufficiency that creates an imbalance between tissue oxygen supply and demand resulting in global tissue hypoperfusion. This leads to hypoxia, acidosis, and eventual end organ damage and failure?
Shock
What are the 4 categories of shock?
- Hypovolemic
- Cardiogenic
- Distributive
- Obstructive
Cardiac output =
Stroke volume x Heart rate
Decrease blood or
fluid volume lead to decrease stroke volume, as a way to
compensate the HR will increase to maintain CO until it no longer
can maintain CO and then you go into shock
True
So what causes hypovolemic shock?
decreased intravascular volume secondary to blood loss
or loss of fluid and electrolytes
What type of shock does DKA cause?
Hypovolemic
Labs for shock?
- CBC
- EKG
- Chems
- lactic acid level
Tx for shock?
maintain adequate tissue perfusion
If loosing blood what do you give?
Blood
Medications for hypovolemic shock?
- Vasopressors
- Norephinepherine IV
- Epi IV
- Dopamine IV
What is causing cardiogenic shock?
Pump failure secondary to AMI, Cardiac contusion, Arrhythmia, Valvular incompetence or stenosis
Signs of cardiogenic shock?
- Elevated JVP
7) Tachypnea
8) Pulmonary edema
9) Irregular pulse if arrhythmia
1) Hypotension (SBP < 90 mmHg)
2) Mental status changes
3) Oliguria
- Elevated JVP
What does the JVP pressure look like on hypovolemic shock?
It’s low
Tx for cardiogenic shock?
ACLS
Fluid replacement if needed
Vasopressors (Epi/Dopamine)
What causes distributive shock?
reduction in Systemic vascular resistance
- Severe vasodilation
What is the most common form of distributive shock?
Sepsis
Other causes of distributive shock?
- Anaphylaxis
* Neurogenic
Sepsis findings?
a) Evidence of infection (fever, tachycardia) in the setting of persistent hypoperfusion despite volume resuscitation
b) Check CBC (will reveal elevated WBC)
c) History should help point you to the source of the infection
Anaphylaxis findings?
a) Evidence of diffuse urticaria, angioedema, bronchospasm, SOB, fullness of the throat, hoarseness
b) History of an insect bite, exposure to certain food, etc.
Neurogenic findings?
a) Evidence of acute traumatic spinal cord injury and hypotension without compensatory tachycardia
b) Unresponsive to fluid resuscitation, Bradycardia
c) Warm, dry skin
Tx for sepsis?
- Ertapenem
- Fluids
- Consider vasopressors
Tx for anaphylaxis?
- ABCs
- Epi
- IV
- Benadryl
- Solumedrol
Tx for Neurogenic?
ABCs
IV fluids
What causes obstructive shock?
extracardiac causes of cardiac pump failure and often associated with poor right ventricle output
2) Caused by: Massive PE, Tension pneumothorax, Pericardial Tamponade, Restrictive cardiomyopathy, or abdominal compartment syndrome
Findings of obstructive shock?
1) Depends on the etiology
2) Massive PE: shock, JVD, elevated JVP, LE pitting edema
3) Tension PTX: deviated trachea, absent breath sounds on one side
4) Pericardial Tamponade: distal or muffled heart tones, JVD, elevated JVP
Tx for obstructive shock?
1) ABCs, IV, O2 to keep saturation >92%, Monitor
2) Thrombolytics or endovascular thrombus retrieval for PE
3) Needle decompression or chest tube for PTX
4) Pericardiocentesis to drain pericardial fluid
5) IV fluids LR or NS 250ml bolus at a time to see response
