Emergancies Flashcards
What’s myxeodema coma and the Rx?
Severe hypothyroid - lethargy, carrot skin, oedematous, large, bradycardiac, coma, hypothermic.
Rx: pure Thyroxine (T3) parenteral route. Plus consider hypopit and the need for steriods (hydrocortisone)
How do you treat thyroid storm?
Beta blockers - propranolol Cool down - ice packs Prophylthiouracil Lugols iodine or potassium iodide PO Reduce peripheral conversion of T4-T3 -> give hydrocortisone
What investigation helps differentiate thyroiditis from other causes of hyperthyroid?
Radio isotope scan (not producing T4/3) doesn’t light up - just releases them thyroid
Which thyroid patients do you not give radio iodine?
People with Graves eye disease
Smokers
Causes of primary adrenal insufficiency?
Autoimmune
TB
Malignancy
HIV related
How to treat addisonian crisis?
IM hydrocortisone (stays for longer!!) 4hrly for 24 hours then taper down.
Once eating and drinking change to oral (3 times day)
Replace salt and fluid losses
Some fludrocortisone (once E&D)
Differentiating between ATCH dependant and independent Cushing’s?
High dose dexamethosone suppression test
ATCH dependant - suppress with high dose
ATCH independant - doesn’t suppress
Now days - imaging
Why are people with acromegaly at higher risk of malignancy?
High GH - more things like polyps
What’s the time course for phaeochromocytoma crisis?
Attacks build over a few minutes and fade gradually over 15mins or so…
Hypertension, impending death, palpitations, N&V, anxiety, (a and b receptor overload by catecholamines)
More prone to hypertensive complications e.g. Retinopathy
Treatment for phaeochromocytoma?
Block A receptors first (phenoxybenzamine, doxazosin) wait 48hrs then give B receptors second (propranolol)
Definitive - surgery
What ECG changes do you get in hypercalemia?
Prolonged QT (also get this in hypocalemia)
