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Hippos > Syncope and electrolyte abnormalities > Flashcards

Syncope and electrolyte abnormalities Flashcards

1
Q

What are the components of the CHESS mnemonic?

A
  • CHF
  • HCT less than 30%
  • EKG abnormalities
  • SOB
  • SBP less than 90 mmHg
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2
Q

What type of exertion is particularly concerning?

A

Exertional syncope

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3
Q

What family history is concerning for syncope?

A

Sudden cardiac death

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4
Q

What should always be considered with a new onset seizure?

A

v-fib

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5
Q

Which abx classically causes QTc prolongation?

A

Macrolides or floxacins

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6
Q

What is the classic finding of arrhythmogenic right ventricular cardiomyopathy?

A

Epsilon wave

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7
Q

What physical exam findings can be had with aortic stenosis, besides the systolic murmur?

A

-Slow, delayed carotid pulse

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8
Q

Chronic AS + acute CHF = dispo?

A

Admit for surgery

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9
Q

Syncope in a sexually active woman of childbearing age is a what until proven otherwise?

A

Ectopic pregnancy

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10
Q

What are the 4 major medications that can cause hyperkalemia?

A
  • ACEI/ARBS
  • NSAIDs
  • Potassium sparing diuretics
  • Bactrim
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11
Q

When is the only time calcium is indicated for hyperkalemia?

A

If there is a wide QRS

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12
Q

What type of calcium do kids get?

A

Calcium gluconate

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13
Q

How many grams of glucose are in an amp of D50?

A

25g, since it’s 50 per 100 mL, and an amp is 50 mL

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14
Q

What is the ratio of glucose to insulin?

A

amp of d50 to 10 units regular insulin

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15
Q

What are the 5 components of treatment for DKA?

A
  • volume
  • insulin
  • K
  • bicarb
  • phosphate
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16
Q

What are the 3 most common causes of hypokalemia?

A
  • Decrease intake
  • Increased losses (emesis, diarrhea)
  • Intracellular shift (hyperventilation, metabolic alkalosis)
17
Q

What are the 5 ECG changes in hypokalemia?

A
  • Loss of T waves
  • U waves
  • Prolonged QTc
  • Torsades
  • Diffuse nonspecific ST/T wave changes
18
Q

When is hypokalemia an emergency?

A

If at risk for arrhythmia

19
Q

What is the best way to estimate total body K loss?

A

0.4 mEq/L requires 100 mEqs of KCl

20
Q

What is the general rule of thumb for determining urine [Na] should be (relatively)?

A

Should be near serum [Na]

21
Q

How fast can you raise someone’s serum Na?

A

0.5 mEq/hr or 8 mEq/day

22
Q

What are the 5 causes of AMS?

A
  • Vital signs
  • Toxic-metabolites
  • Structural
  • Infectious
  • Psych
23
Q

What are the three indications for hypertonic saline?

A
  • seizures
  • coma
  • focal findings
24
Q

What [Na] is needed to use hypertonic saline?

A

100-110 mEq

25
Q

What is the concentration of hypertonic saline used to correct seizures?

A

3%

26
Q

What is the rate of giving hypertonic saline for seizures? (2)

A
  • 100 cc over 10 minutes

- Second dose of 100 cc over 50 minutes

27
Q

What is the first line treatment for hypercalcemia?

A

Saline

28
Q

How long should you give NS for in patient’s with hypercalcemia? Why?

A

Just until vitals normalize or improvements had, since they will quickly lose Ca once you start

29
Q

What is the rate to give NS in hypercalcemia?

A

150-250 cc/hr

30
Q

What is the role of lasix in treating hypercalcemia?

A
  • Inhibits reabsorption
  • Use only once volume is normalized
  • Use only 40 mg IV
  • Only for volume overload
31
Q

What is the role of bisphosphonates in treating hypercalcemia?

A
  • Not an ED decision

- Takes hours/days to work

32
Q

What are the two biggest errors in treating hypercalcemia?

A
  • Lasix before rehydration

- Too much saline

33
Q

What are the 5 steps of treating hypercalcemia?

A
  • ABCs
  • NS
  • Lasix if overloaded
  • Follow K and Mg
  • Call internist
34
Q

What other electrolyte abnormalities must be watched closely with hypercalcemia?

A

K and Mg

35
Q

What is the maintenance rate of Mg?

A

0.5 g/hr

36
Q

What is the rate of giving Mg in a bolus?

A

1-2 g over 0-60 minutes

37
Q

What are the causes of hypophosphatemia?

A
  • Malnourished
  • DKA or alcoholic ketoacidosis
  • hyperventilation
38
Q

What are the major consequences of hypophosphatemia in terms of s/sx?

A
  • Decreased muscle strength (heart, diaphragm = decreased contractility, decreased ventilation)
  • Rhabdo
39
Q

What is the significance of the 1.5, 1.0, and 0.5 levels in hypophosphatemia?

A
  • 1.5 = consider therapy
  • 1.0 = symptomatic
  • 0.5 = usual cc/hr for repletion

Hippos (23 decks)

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