Syncope and electrolyte abnormalities Flashcards
What are the components of the CHESS mnemonic?
- CHF
- HCT less than 30%
- EKG abnormalities
- SOB
- SBP less than 90 mmHg
What type of exertion is particularly concerning?
Exertional syncope
What family history is concerning for syncope?
Sudden cardiac death
What should always be considered with a new onset seizure?
v-fib
Which abx classically causes QTc prolongation?
Macrolides or floxacins
What is the classic finding of arrhythmogenic right ventricular cardiomyopathy?
Epsilon wave
What physical exam findings can be had with aortic stenosis, besides the systolic murmur?
-Slow, delayed carotid pulse
Chronic AS + acute CHF = dispo?
Admit for surgery
Syncope in a sexually active woman of childbearing age is a what until proven otherwise?
Ectopic pregnancy
What are the 4 major medications that can cause hyperkalemia?
- ACEI/ARBS
- NSAIDs
- Potassium sparing diuretics
- Bactrim
When is the only time calcium is indicated for hyperkalemia?
If there is a wide QRS
What type of calcium do kids get?
Calcium gluconate
How many grams of glucose are in an amp of D50?
25g, since it’s 50 per 100 mL, and an amp is 50 mL
What is the ratio of glucose to insulin?
amp of d50 to 10 units regular insulin
What are the 5 components of treatment for DKA?
- volume
- insulin
- K
- bicarb
- phosphate
What are the 3 most common causes of hypokalemia?
- Decrease intake
- Increased losses (emesis, diarrhea)
- Intracellular shift (hyperventilation, metabolic alkalosis)
What are the 5 ECG changes in hypokalemia?
- Loss of T waves
- U waves
- Prolonged QTc
- Torsades
- Diffuse nonspecific ST/T wave changes
When is hypokalemia an emergency?
If at risk for arrhythmia
What is the best way to estimate total body K loss?
0.4 mEq/L requires 100 mEqs of KCl
What is the general rule of thumb for determining urine [Na] should be (relatively)?
Should be near serum [Na]
How fast can you raise someone’s serum Na?
0.5 mEq/hr or 8 mEq/day
What are the 5 causes of AMS?
- Vital signs
- Toxic-metabolites
- Structural
- Infectious
- Psych
What are the three indications for hypertonic saline?
- seizures
- coma
- focal findings
What [Na] is needed to use hypertonic saline?
100-110 mEq
What is the concentration of hypertonic saline used to correct seizures?
3%
What is the rate of giving hypertonic saline for seizures? (2)
- 100 cc over 10 minutes
- Second dose of 100 cc over 50 minutes
What is the first line treatment for hypercalcemia?
Saline
How long should you give NS for in patient’s with hypercalcemia? Why?
Just until vitals normalize or improvements had, since they will quickly lose Ca once you start
What is the rate to give NS in hypercalcemia?
150-250 cc/hr
What is the role of lasix in treating hypercalcemia?
- Inhibits reabsorption
- Use only once volume is normalized
- Use only 40 mg IV
- Only for volume overload
What is the role of bisphosphonates in treating hypercalcemia?
- Not an ED decision
- Takes hours/days to work
What are the two biggest errors in treating hypercalcemia?
- Lasix before rehydration
- Too much saline
What are the 5 steps of treating hypercalcemia?
- ABCs
- NS
- Lasix if overloaded
- Follow K and Mg
- Call internist
What other electrolyte abnormalities must be watched closely with hypercalcemia?
K and Mg
What is the maintenance rate of Mg?
0.5 g/hr
What is the rate of giving Mg in a bolus?
1-2 g over 0-60 minutes
What are the causes of hypophosphatemia?
- Malnourished
- DKA or alcoholic ketoacidosis
- hyperventilation
What are the major consequences of hypophosphatemia in terms of s/sx?
- Decreased muscle strength (heart, diaphragm = decreased contractility, decreased ventilation)
- Rhabdo
What is the significance of the 1.5, 1.0, and 0.5 levels in hypophosphatemia?
- 1.5 = consider therapy
- 1.0 = symptomatic
- 0.5 = usual cc/hr for repletion
