Special circumstances

Question 1

Causes of hyperkalaemia

Answer 1

Renal failure
Drugs - ACEi, ARBs, potassium sparing diuretics, NSAIDs, beta-blockers, trimethoprim
Tissue breakdown - rhabdomyolysis, tumour lysis syndrome, haemolysis
Metabolic acidosis - DKA
Endocrine disorders - addisons disease
Diet

Question 2

ECG changes in hyperkalaemia

Answer 2

Tall tented T waves
Prolonged PR interval
Flattened/absent P waves
ST depression
Widened QRS
VT
Bradycardia

Question 3

Hyperkalaemia management

Answer 3

• Protect heart with 30ml 10% calcium gluconate over 15 mins
• 10 units short acting insulin and 25g glucose IV over 15-30 mins
• 10-20 mg nebulised salbutamol

Question 4

Modifications to cardiopulmonary resuscitation with hyperkalaemia

Answer 4

Protect heart - 10ml calcium chloride 10% IV by rapid bolus
Shift potassium into cells (insulin+glucose)
Sodium bicarbonate 50 mmol (50 mL of 8.4% solution) IV
Remove potassium from body - dialysis

Question 5

Causes of hypokalaemia

Answer 5

GI loss (diarrhoea)
Drugs - diuretics, laxatives, steroids
Renal losses - renal tubular disorders, DI, dialysis
Endocrine disorders - Cushings syndrome, hyperaldosteronism
Metabolic alkalosis
Magnesium depletion
Poor dietary intake

Question 6

ECG features of hypokalaemia

Answer 6

U waves
T wave flattening
ST segment changes

Question 7

Benzodiazepines antidote

Answer 7

Flumazenil

Question 8

Asthma Emergency Management

Answer 8

Oxygen - target 94-98%
Salbutamol 5mg via nebuliser
Nebulised ipratropium bromide 500 mcg every 4-6 hours
Steroids (pred 40-50mg orally or hydrocortisone 100mg IV every 6 hrs)
Single dose IV magnesium sulfate 2g (8mmol) IV over 20 mins
Aminophylline - senior advice

Question 9

Anaphylaxis criteria

Answer 9

Sudden onset and rapid progression of symptoms
Life-threatening airway and breathing and circulation problems
Skin and/or mucosal changes (flushing, urticaria, angioedma)

Question 10

Anaphylaxis management

Answer 10

500 mcg adrenaline IM
IV fluid challenge (500ml 0.9% NaCl bolus)

Question 11

Causes of cardiac arrest in pregnancy

Answer 11

Cardiac disease
Pulmonary embolism
Epilepsy and stroke
Sepsis
Mental health conditions
Bleeding
Malignancy
Hypertensive disorders

Question 12

Accidental hypothermia CPR modifications

Answer 12

Withhold adrenaline and other CPR drugs until the patient has been warmed to a core temperature >30 degrees
Once >30 degreees drugs can be given but double to intervals between drugs

Question 13

Accidental hypothermia CPR modifications

Answer 13

Withhold adrenaline and other CPR drugs until the patient has been warmed to a core temperature >30 degrees
Once >30 degrees drugs can be given but double to intervals between drugs
As normothermia is approach >35 degrees use standard interval timings

Question 14

Rewarming principles after accidental hypothermia

Answer 14

Remove from cold environment and body dried and insulated
Conscious individuals mobilise as exercise increases body temperature
chemical heat packs to the trunk
Heated IV fluids and warm humidified gases