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! Y6 Emergency Care - Laura Lazzari > Endo Emergencies > Flashcards

Endo Emergencies Flashcards

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1
Q

What are the three things needed for rapid Dx of DKA

A

D - BM >11
K - Ketones >3
A - acidosis ph<7.3

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2
Q

What are investigations necessary for DKA

A 
Capillary ketones, glucose 
Assess damage (BLOODS: CBG, lab glucose, ketones, FBC, U&E, BC, WCC, CRP -- ABG) 
ECG 
Consider CXR, urine dip 
Find cause
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3
Q

What can trigger a DKA

A 
V - MI
Infection
Trauma 
AI 
Metabilic - insulin missed, alcohol 
Inflammation - pancrewattis 
Neoplastic 
Drugs: insluin missed
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4
Q

Where may you have to transfer a DKA patient if severe

A

ITU /HDU

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5
Q

How do you manage DKA

A 
Fluids 
Insulin
Potassium 
Dextrose 
VTE prophylaxis (as dehydratred)
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6
Q

How much fluid do you give for DKA

A

500ml bolus over 15mins if SBP <90&raquo_space; then 1L/HOUR

if SBP normal: start giving 1L/h immediately NaCò

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7
Q

How much insulin do you give for DKA

A

Add 50U of insulin to 50ml NaCl

infuse. at rate of 0.1U/kg/hr
Fixed rate IV insulin infusion

+ patient’s normal long acting SC insulin

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8
Q

How muck K+ do you give in DKA

A

Run 40mmol KCl in NaCl even if K+ is normal
(not in first bag through - only when K+ between 3.5 and 5.5)
This is because insulin can cause hypokalaemia

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9
Q

How much dextrose do you give in DKA and when

A

10% dextrose when BM<14, 100ml/h

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10
Q

What are common complications of DKA

A

Cerebral oedema
aspiration pneumonia
VTE
electrolyte imbalance

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11
Q

How does insulin cause hypokalaemia

A

it drives potassium into skeletal and hepatic cells

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12
Q

What is HHS

A

Hyperglycaemic hyperosmolar state

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13
Q

What kinds of patients does HHS occur in, and what are RF

A

Patients with T2DM

Usually if non-adherent to medications, infection, steroids…

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14
Q

What are sx of HHS

A 
longer history than DKA (1 week)
polyuria
polydipsia 
decreased consciousness 
severe dehydration, volume depletion
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15
Q

How do you manage HHS

A

LMWH (high VTE risk)
Start IV fluids - 0.9% 1L NaCl over 2h
Start fixed rate insulin infusion 0.05U/kg/h only if glucose stops falling or if ketonuria 2+

THEN:
Slow rehydration over 48 hours - at half the rate of DKA fluids
Replace K+ when UO increases

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16
Q

What investigations must you get in a patient with suspected poisoning

A

ALL UNCONSCIOUS patients: glucose, paracetamol, salicylate levels
FBC, U&E, LFT, INR, ABG, ECG

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17
Q

How do you reverse benzo

A

Flumazenil

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18
Q

How do you reverse opiate

A

naxolone

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19
Q

how to you reverse paracetamol

A

N-acetylcysteine

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20
Q

How do you reverse. aspirin

A

sodium bicarb

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21
Q

How do you assess Burn Size

A

Rule of 9 Rule (“Lung and Browder”)

The palm is 1% of body area

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22
Q

Why is it important to estimate burn size

A

So you can estimate inflamm response and fluid shift > it may require fluid resus

> 10-15% TBSA will require fluid resus

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23
Q

Why is it important to assess thickness. of burn?

A

It influences healing time and scarring

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24
Q

What are the degrees of burns and can you describe them

A

1st degree: mild erythema
2nd degree: painful erythema
3rd degree: do not blister, no sensation, look leathery/brown/black

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25
Q

How do you manage burns patient

A
  1. fluid resus using Parkland’s formula – give crystalloid
  2. Dressing

Parkland’sformula = %burns x weight (kg) x 4 = mL of Hartmann’s solution to give in the first 24 hours

26
Q

What is the Parkland formula for fluid resus

A

4ml x weight (kg) x % burn

27
Q

What is hypothermia

A

Core rectal temperature <35 degrees

28
Q

what are. investigations you need to do for hypothermia

A
  1. axillary / oral temp&raquo_space; if less than 36.5, measure PR probe / infra-red ear thermometer
  2. Full bloods (urgent U&E, glucose, amylase, FBC, TFTs, cultures, gases)
  3. ECG (may show J waves)
29
Q

What do you see on ECG in hypothermia

A 
Bradyarrhythmia 
Osborne waves (J waves) 
Prolonged PR, QRS, QT interval 
Shivering artefact 
Ventricular ectopics 
Cardiac arrest (VT, VF, Asystole)
30
Q

How do you manage hypothermia

A

A>E (do not expose to cold, start warm humidified oxygen, remove wet clothes)

Slowly rewarm at 0.5 deg /h, via blanket and warm IV infusion

Cardiac monitoring

31
Q

What. are symptoms of CO poisoning.

A 
headache
N&V 
Vertigo 
Confusion
Subjective weakness 
Pink skin. and mucosa, hyperpyrexia, arrythmia
32
Q

What investigatons fo you need to do for CO poinsoning

A 
Pulse oxymetry (will be falsely high) > do ABG/VBG 
High carboxyhaemoglobin levels
33
Q

How. do. you manage CO poisoning

A

100% O2 via NRB for min 6h> target is 100% SpO2

34
Q

What occurs in HHS

A

trigger (MI, infection etc) > lower insulin production > hyperglycaemia > glycosuria (osmotic diuresis) > loss or water and electrolyes > dehydration, low fluid intake > HYPEROSMOLARITY + impaired renal function (AKI)

35
Q

What condition commonly occurs following HHS

A

AKI

36
Q

How do you diagnose someone with HHS

A

HYPERGLYCAEMIC: Glu > 30
HYPEROSMOLAR: Osmolarity >320

37
Q

How do you work out osmolarity

A

2 (Na + K) + urea + glucose

38
Q

How do you manage hypoglyacaemi

A

DEPENDING ON CONSCIOUS STATE:

  • conscious, orientated, able to swallow: carbohydrate snack
  • conscious but uncooperative: buccal glucose e.g. glucogel
  • unconscious: glucose IVI 20% 100ml/10mins or IM glucagon
39
Q

what is a myxoedema coma

A

Severe hypothyroidism, due to culmination of severe longwithstanding hypothyroidism

40
Q

What are precipitants of myxoedema coma

A

MI, stroke
infection
trauma

41
Q

What are signs of myxoedema coma

A

ALL ORGANS SLOW DOWN

  • bradycardia a
  • deterioration in mental status (seizures, psychosis)
  • hypthermia
  • hyporeflexia
42
Q

How do you investigate myxoedema com

A 
TFT 
FBC 
U&E 
cortisol 
glucose 
ABG
43
Q

How do you manage myxoedema coma

A

IV T3 (up to 20mcg/12h)
IV hydrocortisone
consider warming blanket, fluid, abx if suspecting antibiotics

44
Q

What causes a thyrotoxic storm

A

Untreated / undertreated hyperthyroidism + precipitant

Same precipitants as myxoedema coma:
MI, stroke
infection
trauma

45
Q

What are sx of thyrotoxi. storm

A 
EXTREME HYPERTHYROID 
fever 
agitation 
confusion 
coma 
tachycardia 
AF
diarrhoea and vomiting
46
Q

How do you manage thyrotoxic storm

A

IV propanolol 60mg QDS > carbimazoole (inhibits TPO) > hydrocortisonee or dexamethasone

47
Q

What is an addisonian crisis

A

Body cannot produce sufficient cortisol and aldosterone (usually precipitated by trigger in known addison’t patient) > SHOCK AND HYPOGLYCAEMIA

48
Q

What are symptoms of addisonian crisis

A

SHOCK AND HYPO

49
Q

How do you manage addisonian crisis

A

IM hydrocortisone 100mg STAT

IV fluid bolus

50
Q

what do you need to check hourly in DKA

A

capillary blood glucose and ketones

51
Q

what do you need to check every 2h (or as required) in DKA

A

VBG

52
Q

what other interventions should you consider in DKA

A

inserting a CATHETER if they haven’t passed urine within first hour

NG tube if vomiting / drowsy

LMWH for ALL

53
Q

when do you continue fixed rate insulin until (DKA)

A

until pt stable: pH>7.3, ketones <0.6, bicarb >15

54
Q

What do you do once patient stable (DKA)

A

Give SC insulin infusion

Wait 30 mins, then stop addtional insulin

55
Q

what is the max rate of potassium you can give

  • per hour
  • per bag
A

Max potassium per hour: 20mmol

Ideally not more than >10mmol/hour, continuous cardiac monitoring with any more

max potassium per bag: 40mmol

56
Q

What do you do if when attempting to treat paracetamol overdose they get a rash?

A

NAC often gives you a rash

STOP it and RESTART at a lower rate

57
Q

How do you treat paracetamool overdose if presenting <1h

A

activated charcoal
then check paracetamol levelss 4 hours after ingestion
NAC if indicated

58
Q

what do you do if paracetamol overdose presents >1h post injection

A

check paracetamol levels 4h after ingestion

then give NAC if indiixated

59
Q

sx of salicylate (Aspirin) overdose

A

tintinnus, hyperventilation, vertigo

vomiting, sweating, dehydration

60
Q

in DKA patient, which of their own insulin do you keep giving and which do you stop?

A

Keep giving their SC LONG ACTING insulin

STOP their SHORT acting insulin

! Y6 Emergency Care - Laura Lazzari (9 decks)

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