SCEN Medical Emergencies Flashcards
Medical and psychosocial
How many of these questions are on the test?
25
what are three main causes of hyperkalemia?
Cellular death such as rhabdo, crush or burns
Acidosis such as DKA or addisons
Renal failure because the kidneys push the potassium out
what are the early s/s of hyperkalemia?
muscle excitability, which causes irritability, nausea, vomiting, diarrhea
what are the late s/s of hyperkalemia?
what are some of the things that it causes? (6)
muscular weakness
which causes fatigue, generalized weakness, distal limb parethesias, tetany, respiratory depression, and ascending paralysis
when potassium reaches a level of 8-9, what happens?
there is the same amount of potassium on either side of the cell causing the late s/s
what is the progression in EKG abnormalities as the level of potassium rises? (6)
normal peaked T wave - hurts to land on elongated PR interval Absent P wave enlarged QRS complex sine wave - after that asystole
what is the treatment for hyperkalemia for the short term, a few hours?
(3)
calcium chloride or calcium gluconate - will wear off though
Insulin as a carrier protien with dextrose to push the potassium back into the cells
albuterol to move potassium back into the cells
what are some methods of treating hyperkalemia for the long term?
hemodialysis
NSS with furosemide
kaexelate
why is calcium chloride and calcium gluconate used to treat hyperkalemia?
it produces a cardioprotective effect against arrhythmias
how does kayexelate work to decrease potasium?
it works as an ion exchange resin
how does a pH level affect potassium?
acidosis will cause potassium to go up and alkalosis will cause potassium levels to drop
what are some causes of hypokalemia?
losses through vomiting, diarrhea, intestinal obstruction
shifts from the uses of insulin, beta 2 antagonists, aldosterone, alkalosis
decreased intake from alcoholism and malnutrition
true or false
generally healthy people may not show symptoms of hypokalemia
true
most people who show symptoms have preexsisting conditions such as cardiac disease, but generally healthy people might not show symptoms until they’re down in the 2-3 range
what are the s/s of hypokalemia?
5
hyporeflexia
latent tetany
paralysis to the lower extremities or respiratory failure
paresthesias
what are the EKG wave s/s of hypokalemia?
2
- more prominent U wave, making a biphasic T wave or a double “camel hump” T wave
- depressed ST segment
what are the treatments for hypokalemia?
oral and IV potassium replacement
must be given gradually
what other condition tends to occur simultaneously with hypokalemia?
hypomagnesemia
the two should be corrected at the same time
high magnesium levels cause what?
decreased muscular activity and irritability, leading to weakness
low magnesium levels cause what?
increased muscular irritability and activity
Mild to moderate hypomagnesemia may cause what s/s?
may be asymptomatic
gotcha
severe hypomagnesemia may cause what s/s?
10
muscle cramping palpitations vertigo/ataxia depression siezures hyperreflexia PR/QT prolongation Afib, torsades, Vfib
what are some things you would see in a persone with hypermagnesemia?
(7)
decreased deep tendon reflexes hypotension QRS widening QT/PR prolongation respiratory insufficiancy heart block cardiac arrest
what is the normal range for magnesium?
1.7 - 2.2 mg/dl
or
0.85 - 1.10 mmol/L
what would you expect to see in a person with a Magnesium level of 4-5?
decreased deep tendon reflexes
what would you expect to see in a person with a Magnesium level of 5-7?
hypotension, QRS widening, QT/PR prolongation
what would you expect to see in a person with a Magnesium level of 10?
respiratory insufficiency
what would you expect to see in a person with a Magnesium level of 10-15?
heart block
what would you expect to see in a person with a Magnesium level of 10-24?
cardiac arrest
what are two bedside tests tht you can do to test for hypomagnesemia?
Chvostek’s sign (show vos tec)
Trousseau’s sign (true-so’s)
how do you perform a Chvostek’s sign test?
tap on the patients facial nerve
lateral to the cheekbone
how do you perform Trousseau’s sign test?
place a blood pressure cuff on the patient and pump it up to 20mmHg higher than the known SBP and you will see the contracture
how can mild hypomagnesemia be treated through diet?
legumes bananas avacado green leafy vegetables chocolate seeds
what are some ways to treat hypermagnesemia?
fluid administration
loop diuretics
dialysis (may be given IV calcium while awaiting dialysis)
what are the two electrolytes that have a seesaw inverse relationship?
calcium and phosphate
what are some causes of hypocalcemia and hyperphosphatemia?
12
hypoparathyoidism pancreatitis malabsorption chronic nephritic syndrome or nephritis cushings syndrome overdose of calcium channel blockers multiple blood trnsfusions (more than 10, because of additives) hydrofluoric acid exposure hypoalbuminemia hyperventilation
what are the s/s of hypocalcemia / hyperphosphatemia?
9
muscular irritability muscle cramping perioral or finger paresthesias SOB (bronchospasm) tetanic contractions positive Chvostek's or Trousseau's sign hypotension heart failure
what are some s/s of hypercalcemia / hypophosphatemia?
8
non focal abdominal pain that can mimic appendicitis
constipation
anorexia
nausea and vomiting
fatigue and body aches
bradycardia
neuropsychiatric (anxiety, depression, confusion, hallucinations)
what are some s/s of hypercalcemia / hypophosphatemia?
8
non focal abdominal pain that can mimic appendicitis
constipation
anorexia
nausea and vomiting
fatigue and body aches
bradycardia
neuropsychiatric (anxiety, depression, confusion, hallucinations)
what are some s/s of hypercalcemia / hypophosphatemia?
8
non focal abdominal pain that can mimic appendicitis
constipation
anorexia
nausea and vomiting
fatigue and body aches
bradycardia
neuropsychiatric (anxiety, depression, confusion, hallucinations)
what are the EKG s/s of hypocalcemia / hyperphosphatemia?
prolonged QT interval
what causes a hyper/hypo natremia imbalance?
when the intake of water and sodium don’t match to balance each other out
what are the s/s of hyponatremia?
7
related to water retention generalized swelling confusion (cerebral edema) apathy sense of impending doom seizures muscle cramps
what are the s/s of hypernatremia?
indications of dehydration
altered mental status (fatigue, lethargy, confusion, coma)
weakness
diarrhea
how would mild and severe hyponatremia be corrected?
mild - fluid restriction
severe - slow, over 48 - 72 hours correction with 3-5% saline solution
what would be the result of rapid correction of hyponatremia?
central myelinolysis causing flacid paralysis, dysarthia, dysphagia, hypotension
what are some underlying causes that can cause hypernatremia?
fever
vomiting
diabetes insipidus
acute pre-renal failure can be caused due to conditions the ___ blood flow to the kidney such as
decrease hypovolemia decreased cardiac output decreased vascular resistance obstruction of the renal vascular system
what is the difference between pre renal failure and intra renal failure
pre renal failure is related to causes that occur before the kidney, whereas intra renal failure occurs from reasons inside the kidney
what are some causes of intra renal failure?
10
damage to the tubules or nephrotoxic agents NSAIDS crush injury rhabdomyolysis hypertension contrst dye diabetes lupus and infectious processes certain Abx such as aminoglycosides
what is post renal failure?
renal failure that has a cause after the kidney
what are some causes of post renal failure?
calculi prostate hypertrophy tumors strictures neurogenic bladder
what are some s/s of renal failure involving pH and electrolytes?
(5)
hyperkalemia hypernatremia hyperphosphatemia hypocalcemia metabolic acidosis due to the kidneys not being able to regulate hydrogen ions
what is the term for elevated BUN and creatinine?
Azotemia
not all endocrine glands create emergent conditions, so we are going to only focus on three, what are they?
thyroid gland
pancreas
adrenal gland
a diminished thyroid function causes what condition?
What is it called when the condition becomes life threatening?
hypothyroidism
Myxedema coma
an elevated thyroid function is called what?
it’s not hyperthyroidism. well, it is but it isn’t
graves disease
what is it called when the thyroid has a life threatening over-function?
thyroid storm
what condition is caused by diminished pancreatic function?
what is it called when it becomes life threatening?
DKA
HHS, or hyperosmolar hyperglycemic syndrome
what is the condition caused by a pancreas with an elevated function?
hypoglycemia
an adrenal gland with a diminished function is called what?
what is it called when it becomes life threatening?
Addison’s disease
Addison’s crisis
what is it called when the adrenal gland over functions?
cushings syndrome
what are the treatments for thyroid storm?
beta blockers
iodine
glucocorticoids
antipyretics (acetaminophen)
what is the treatment for myxedema coma?
mechanical ventilation for reduced respiratory rate
IV thyroid hormone replacement
levothyroxine
passive rewarming
what are some of the s/s of hypoglycemia? and what causes them?
sweating, tachycardia, pallor, anxiety, restlessness, shaking, palpitations, hunger, tingling of the lips
the body responds by releasing epinephrine, which stimulate glucagon in the liver, so you see s/s of epinephrine
name three conditions that may predispose you to hypoglycemic unawareness
long standing diabetes
patients on beta blockers
alcoholism
hypoglycemia that gets to the point where the brain can’t extract oxygen is called what?
neuroglycemia
what IV fluids are used to treat hypoglycemia?
why are the concentrations different for pediatrics?
Adults D50
child D25
infant D10-12.5
because of the size of the dextrose molecule, can have an osmotic effect and cause dehydration
what medication do you give to treat hypoglycemia in someone without an IV?
what should you look out for after giving it?
IM glucagon
watch out for vomiting and position the patient to avoid aspiration
why does DKA cause dehydration?
glucose is trapped in the bloodstream, is highly osmolar and causes fluid buildup in the bloodstream, which is then diuresed, causing dehydration
how does DKA cause acidosis?
glucose cannot enter the cell, so the cell makes energy by breaking down fatty acids which releases a hydrogen ion and a ketone body, which results in acidosis, Kussmauls respirations, ketoneuria, and an acetone smell to the breath
what are the s/s of DKA?
think fluids, respirations, HR, BP, ect.
(8)
dehydration Kussmauls respirations acetone breath tachycardia hypotension poor skin turgor altered mental status abdominal pain
what type of diabetic is more likely to develop HHS and why?
what does it stand for?
type II
hyperosmolar hyperglycemic syndrome
T2 diabetics still make some insulin, so the cell doesn’t have to break down fatty acids that cause DKA, but glucose is still stuck in the bloodstream
what is the big difference between DKA and HHS?
acidosis
DKA involves acidosis whereas HHS does not
what are the mortality rates for DKA and HHS?
what are some reasons?
DKA 3-10%
HHS 20-60%, because of lack of s/s, obesity comorbidities, and pts are slow to seek care, and it takes days or weeks to develop
why would the treatment of DKA and HHS involve IV insulin rather than sub Q?
due to dehydration fluid might not be absorbed through the sucutaneous route
what is the typical dose of IV insulin for the treatment of DKA and HHS?
0.1 units regular insulin per kg of body weight bolus and then and then an infusion of 0.1 units per kg per hour
what 2 hormones do the adrenal glands regulate?
cortisol and aldosterone
what does cortisol do?
regulates blood sugar
what does aldosterone do?
facilitates sodium and water reabsorption and indirectly affects potassium excretion, as it comes from the adrenal glands seated on top of the kidneys
when the adrenal glands function too much, what condition does it cause?
cushings
what condition is caused when the adrenal glands don’t function enough?
addisons disease
what glucose and electrolyte imbalances are associated with cushings disease
high glucose levels
low potassium
high sodium
what glucose and electrolyte imbalances are associated with Addisons disease
low glucose levels
high potassium
low sodium
what is the main cause of cushings disease?
taking exogenous prednisone, because prednisone is an adrenal hormone
if you have a patient who looks like a cushings patient, but presents as a Addisons crisis, what could be the cause?
cold turkey from prednisone, due to the adrenal glands shrinking from being on prednisone
A decrease in which of the following factors is associated with effective treatment of Addison's crisis a sodium b glucose c potassium d blood pressure
c potassium, which runs high with Addison’s, so treatment would bring it down
an elevated red blood cell count is called what?
polycythemia
an decreased red blood cell count is called what?
anemia
an elevated white blood cell count is called what?
infection or leukemia
how many types of white blood cells are there?
and what is it called when they are ALL at a low level?
Leukopenia, or neutropenia/lymphopenia
or sometimes pancytopenia
an elevated platelet count is called what?
thrombocytosis
an decreased platelet count is called what?
thrombocytopenia
what are the conditions that can bring on a sickle cell crisis?
(5)
cold temperature high altitude infection acidosis stress
what is the treatment for sickle cell anemia?
pain management mild - NSAIDS,acetaminophen, Ultram severe - opiods, toradol O2, rehydration, consider transfusion, Abx for infection warm, moist heat to affected areas
what does DIC stand for?
what type of condition is it considered to be?
disseminated intravascular coagulation
coagulopathy
how does DIC result in both clotting and bleeding
overformation of clotting results in overproduction of fibrin degradation products that results in bleeding, and you can no longer clot because you used up all of your clotting factors
which of the following lab values are most consistent with DIC? Elavated D-dimer elevated fibrinogen level decreased pt decreased ptt
elevated D-dimer
because it is a fibrinogen degridation product
what is the treatment for full blown DIC?
call the priest
not much hope here vigorously treat underlying cause
hard to treat with the paradoxal challenge of DIC
85-90% of hemophillia patients have this type of hemophillia, which is a deficiancy of this factor.
Hemophillia A, or classic hemophillia, which is a deficiency of factor VIII (8)
Hemophillia B is a deficiancy of this clotting factor, and otherwise known as ___ disease
factor IX (9) Christmas disease
The third most common type of Hemophillia in the US, type C is also called what?
These patients can self treat at home, so why come to the ED?
Rosenthal’ syndrome
They may often need assistance with drainage from a muscle or joint, to avoid things like compartment syndrome.
DDAVP can be used to treat this type of hemophillia.
type A, because it can stimulate the release of factor 8 to treat minor cuts
what consideration should you take in performing venipuncture on a patient with hemophillia?
direct pressure for at least 5 minutes
what consideration should you give for IM injections in hemophilliac patients?
don’t do it, for risk of compartment syndrome
why is fever in an immunocompromised patient a medical emergency?
Immunocompromise is due to a deficiency of white blood cells of some kind. Pus, swelling, redness are all do to WBC, therefore, fever being the only sign of bacterial infection.
an immunocompromised patient could have a rip-roaring bacterial infection and the only symptom you would see is this.
Why?
Fever
Due to deficiency of WBC, which would be the cause of all other s/s of infection
A child under 28 days with a fever has an increased chance of having what?
bacterial infection
the older the child gets, the higher the chance of less serious viral infection
what can be said about the metabolic demands caused by a fever that affect HR and RR?
an increase in HR of 10 beats per minute for each 0.5 degree Celsius and an increase in RR of 5 breaths per minute for each 1 degree celsius
any fever above this degree celsius/F is known to denature the proteins of the brain and cause irreversible brain damage
41, or 105.8
what is the cascade of sepsis?
5
SIRS sepsis severe sepsis septic shock MODS
what does SIRS and MODS stand for?
Systemic Inflammatry response system
Multiple Organ Dysfunction Syndrome
what causes redness and swelling of a localized immune response?
vasodilatation and increased capillary permeability
what is the difference between sepsis and severe sepsis?
severe sepsis includes the failure of one organ system
sepsis bundles are to include what (5) and be completed within __ hours of triage
serum lactate blood cultures broad spectrum Abx 30 ml per kg bolus for map >65, if no response try pressors 3
Anaphylaxis is similar to this due to the release of mediators into the bloodstream
sepsis
what are some of the treatments for anaphylaxis? (medications) (9)
inhaled beta-2 agonists for bronchodilation
Corticosteroids to prevent delayed reaction
antihistamines
H1 blockers (Benadryl)
H2 blockers (famotidine, ranitidine, cimetidine)
mild anaphx - 1:1000 IM epi
severe anaphx - 1:10,000 IV epi
repeat q 15-20 minutes if needed
what type of epi should you never use via IV?
1:1000
because the patients HR will go to like, 500, you’ll probably kill the patient, and then get investigated by the joint commission
