ED Flashcards
What are the non shockable rythms?
PEA
Asystole
How do you treat PEA and asystole?
As the rythms are not compstible with life, CPR should be commenced immediately with interruptions minimised
Adrenaline 1mg IV is given in the first cycle and should a non shickable rythm persist then it should be given every other cycle (1,3,5)
What are shockable rythms?
Ventricular fibrillation
Pulseless ventricular tachycardia
What is the management of VD and pulseless VT?
Defibrillation and CPR are the mainstays of treatment
However if persistent, amiodarine 300mg IV and adrenaline 1mg IV (1:10,000) can br given after the third shock has been delivered
Amiodarone is given as a one off dose, howecer adrenaline may be repeated every other cycle folllwing a shock (cyclrs 3,5,7 etc)
What are the most common precipitating factors of DKA?
Infection
Missed insulin doses
MI
What are apthe features of DKA?
Abdo pain
Polyuria, polydipsia, dehydration
Kussmaul respiration (deep hyperventilation)
Acetone smelling breath (pear drops smell)
What is the diagnostic criteria of DKA?
Glucose >11mmol/l or known diabetes mellitus pH <7.3 Bicarb <15mmol/l Ketones >3mmo /l or urine ketones ++ on dipstick
What is the management of DKA?
Fluid replacement
Insulin infusion should be started at 0.1units/kg/hour
Once blood glucose is <15mmol/l an infusion of 5% dextrose should be started
Correction of electrolyte disturbance
So the serum potassium is actually often high on admission despite the total body potassium being low
The K+ often falls quickly woth insulin following treatment resulting in hypokalaemia
Potassium may need to be added to the replacement fluids
What is an example of a fluid regime used in DKA?
Volume
- 9% sodium chloride 1L 1000ml over 1st hour
- 9% sodium chloride 1L with potassium chloride 1000ml over next 2 hours
- 9% sodium chloride 1L with potassium chloride 1000ml over next 2 hours
- 9% sodium chloride 1L with potassium chloride 1000ml over next 4 hours
- 9% sodium chloride 1L with potassium chloride 1000ml over next 4 hours
- 9% sodium chloride 1L with potassium chloride 1000ml over next 6 hours
In a DKA, the amount of potassium you give depends on the potassium levels of the patient, what would you give if the potassium levels are
A) over 5.5
B) 3.5-5.5
C) below 3.5
A) Nil
B) 40
C) <3.5
What is the resolution of DKA defined as?
PH >7.3
Blood ketones <0.6mmol/L
Bicarbonate >15mmol/L
Both the ketonaemia and acidosis should have been resolved within 24 hours, if this hasnt happened the pt requires senior review from an endocrinologist
If DKA is resolved then switch to subcut insulin
What are the complications that may occur from DKA?
Gastric stasis Thromboembolism Arrythmias secondary to hyperkalaemia/iatrogenic hypokalaemia Cerebral oedema, hypoglycaemia ARDS AKi
What findings would you find on LP of someone with SAH?
The correct answer is raised opening pressure. This patient is presenting with the classical features of a subarachnoid haemorrhage (headache, neck stiffness, photophobia, vomiting). The lumbar puncture results show a picture of xanthochromia, due to the haemoglobin breaking down into oxyhaemoglobin (after 2 hours) and then bilirubin (after 10 hours). The other factor you would expect is a raised opening pressure, due to increased intracranial pressure from the haemorrhage collection.
What is the management of paracetamol OD?
TOXBASE should always be consulted
Minority of patients who present within 1 hour may benefit from activated charcoal to reduce absorption of the drug
Acetylcysteine should be given if;
There is a staggered overdose or there is doing over the time of paracetamol ingestion, regardless of plasma paracetamol concentration
OR
Plasma paracetamol concentration is on or above a single treatment line, joining the points of 100mg/L at 4 hours and 15mg/L at 15 hours, regardless of risk factors of hepatotoxicity
Acetylcysteine is now infused over 1 hour, rather than the previous 15 minutes, to reduce the number of adverse effects, acetylcysteine commonly causes an anaphylactoid reaction (these are generally treated by stopping the infusion and then restarting at a slower rate).
What does ventricular tachycardia look like on cardiac monitoring?
A regular broad complex tachycardia
