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

Endo Emergencies Flashcards

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
How do you manage burns patient
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
What is the Parkland formula for fluid resus
4ml x weight (kg) x % burn
27
What is hypothermia
Core rectal temperature <35 degrees
28
what are. investigations you need to do for hypothermia
1. axillary / oral temp >> 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
What do you see on ECG in hypothermia
``` Bradyarrhythmia Osborne waves (J waves) Prolonged PR, QRS, QT interval Shivering artefact Ventricular ectopics Cardiac arrest (VT, VF, Asystole) ```
30
How do you manage hypothermia
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
What. are symptoms of CO poisoning.
``` headache N&V Vertigo Confusion Subjective weakness Pink skin. and mucosa, hyperpyrexia, arrythmia ```
32
What investigatons fo you need to do for CO poinsoning
``` Pulse oxymetry (will be falsely high) > do ABG/VBG High carboxyhaemoglobin levels ```
33
How. do. you manage CO poisoning
100% O2 via NRB for min 6h> target is 100% SpO2
34
What occurs in HHS
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
What condition commonly occurs following HHS
AKI
36
How do you diagnose someone with HHS
HYPERGLYCAEMIC: Glu > 30 HYPEROSMOLAR: Osmolarity >320
37
How do you work out osmolarity
2 (Na + K) + urea + glucose
38
How do you manage hypoglyacaemi
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
what is a myxoedema coma
Severe hypothyroidism, due to culmination of severe longwithstanding hypothyroidism
40
What are precipitants of myxoedema coma
MI, stroke infection trauma
41
What are signs of myxoedema coma
ALL ORGANS SLOW DOWN - bradycardia a - deterioration in mental status (seizures, psychosis) - hypthermia - hyporeflexia
42
How do you investigate myxoedema com
``` TFT FBC U&E cortisol glucose ABG ```
43
How do you manage myxoedema coma
IV T3 (up to 20mcg/12h) IV hydrocortisone consider warming blanket, fluid, abx if suspecting antibiotics
44
What causes a thyrotoxic storm
Untreated / undertreated hyperthyroidism + precipitant Same precipitants as myxoedema coma: MI, stroke infection trauma
45
What are sx of thyrotoxi. storm
``` EXTREME HYPERTHYROID fever agitation confusion coma tachycardia AF diarrhoea and vomiting ```
46
How do you manage thyrotoxic storm
IV propanolol 60mg QDS > carbimazoole (inhibits TPO) > hydrocortisonee or dexamethasone
47
What is an addisonian crisis
Body cannot produce sufficient cortisol and aldosterone (usually precipitated by trigger in known addison't patient) > SHOCK AND HYPOGLYCAEMIA
48
What are symptoms of addisonian crisis
SHOCK AND HYPO
49
How do you manage addisonian crisis
IM hydrocortisone 100mg STAT | IV fluid bolus
50
what do you need to check hourly in DKA
capillary blood glucose and ketones
51
what do you need to check every 2h (or as required) in DKA
VBG
52
what other interventions should you consider in DKA
inserting a CATHETER if they haven't passed urine within first hour NG tube if vomiting / drowsy LMWH for ALL
53
when do you continue fixed rate insulin until (DKA)
until pt stable: pH>7.3, ketones <0.6, bicarb >15
54
What do you do once patient stable (DKA)
Give SC insulin infusion Wait 30 mins, then stop addtional insulin
55
what is the max rate of potassium you can give - per hour - per bag
Max potassium per hour: 20mmol Ideally not more than >10mmol/hour, continuous cardiac monitoring with any more | max potassium per bag: 40mmol
56
What do you do if when attempting to treat paracetamol overdose they get a rash?
NAC often gives you a rash STOP it and RESTART at a lower rate
57
How do you treat paracetamool overdose if presenting <1h
activated charcoal then check paracetamol levelss 4 hours after ingestion NAC if indicated
58
what do you do if paracetamol overdose presents >1h post injection
check paracetamol levels 4h after ingestion | then give NAC if indiixated
59
sx of salicylate (Aspirin) overdose
tintinnus, hyperventilation, vertigo | vomiting, sweating, dehydration
60
in DKA patient, which of their own insulin do you keep giving and which do you stop?
Keep giving their SC LONG ACTING insulin | STOP their SHORT acting insulin

! Y6 Emergency Care - Laura Lazzari (9 decks)

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