EM Cases Flashcards
HALT-IT Trial results
for TXA in unstable GI bleed: largest trial yet, RCT with 12000, intervention of TXA 1 g IV followed by 3 g maintnenace, results: no difference in 5 day mortality due to bleeding, it did not reduce transfusions or surgery, no benefit from giving int early, it caused increase inVTE; thus do not use TXA in gi bleeds
pediatric DKA fluid MGMT and cerebral edema - PECARN study results
fast (10 ml/kg bollus + 10 ml/kg bolus with 10% fluid deficient replacement and maintenance vs. slow (10 ml/kg bolus with 5% fluid deficit and maintnaence over 48 hours; showed no difference in mental status, cerebral injury or post DKA cognitive function; thus it is safe to start with 10 ml/kg NS bolus regardless of fluid status and repeat if still hypoperfused
pediatric DKA diagnosis
can occur in type or type 2 DM; diabetes (>11.1 BG, ketonuria + acidosis), sx: polyuria, polydipsia, weight loss, dehydration, kussmaul breathing, HA, decreased LOC, abdo pain, vomiting
pediatric DKA ED MGMT
ABCs, neurovitals, rapid CBG, VOMIT, inv for VBG, urine, serum osmoles, urine ketones, urinalaysis; fluid MGMT: 10ml/kg NS bolus over 30 mins if no sx of cerebral edema, if persistent after bolus showing sx of hypoperfusion (cap refill > 2, cool extremities, tachycardia, repeat 10 ml/kg bolus, and reassess). change to D10NS when glucose is < 15 mmol/L or decreasing by > 5 mmol/L per hour; add KCL if K < 5, insulin infusion of 0.1 U/kg/hr after 1 hour of fluids; do not give IV insulin bolus or sodium bicarb
cerebral edema in DKA pediatrics MGMT
call peds help, ABCs, elevate to 30 degrees; if hypoperfused, (Tachycardia, cap refill, col extremities), give 10 cc/kg bolus. consider 3% NaCl (5 cc/kg IV over 10 mins) or mannitol (0.5 - 1 g/kg/IV over 15 mins)
RECOVERY Trial results
dexamethasone in covid PNA: effective for these pt requiring ventilation or oxygenation, even with O2 sat of 94%
