Key Emergency Treatments

Question 1

Hyperkalemia

Answer 1

A three step process:

1) Protect the heart:
-Calcium Gluconate, 50 mL 10%
or
-Calcium Chloride, 10 mL 10%

2) Shift K+:
- 100 mL 50% glucose + 5 units insulin.
- 5 mg salbutamol neb

3) Remove K+:
- 40 mg IV Frusemide
- Kayexalate

• 4) Alkylize: if pH < 7.2
• bicarb

*if measures fail, dialyze.

Question 2

DKA

Answer 2

There are 4 problems:

1) Dehydration:
- 500-1000 mL hr for 4 hours
- Add D5W when sugar drops to 12-14

2) K+:
- 30mEq KCl per litre to maintain K+ >4

3) Acidosis:
- 0.1 U/kg/hr insulin. Titrate down when glusoce reaches 12-14

4) Hyperglycemia:
- will correct if you correct the other things.

Question 3

ARDS

Answer 3

1) 6-8 mL/kg tidal volume
2) RR 35 to maintain minute ventilation
3) PEEP at least 5
4) FiO2 for 88-95 sats
5) Goal is a plateau pressure < 30
6) Heavy sedation to minimize dysyncrony
7) Consider paralysis 48 hours
8) Consider proning
9) permissive hypercapnia while keeping pH > 7.2