DKA

Question 1

What is the cause behind DKA?

Answer 1

Not enough insulin to pull glucose from the blood and put into the cells, this leads to burning more carbs and fats

Question 2

What is the byproduct of breaking down carbs and fats?

Answer 2

Ketones

Question 3

Essentials of DKA?

Answer 3

• Hyperglycemia >250 mg/dl
• Acidosis pH < 7.3
• Ketones in blood
• Serum bicarb <15

Question 4

Clinical presentation?

Answer 4

• Polyuria
• fatigue
• nausea and vomiting
• mental stupor
• Kussmaul breathing
• fruity breathe
• Mild hypothermia
• abdominal pain

Question 5

Tx for DKA?

Answer 5

• Fluids first

* Insulin .15 units/kg IV (Consult MO)

Question 6

Keys to tx for DKA?

Answer 6

Restore intravascular volume

Question 7

Dispo for DKA?

Answer 7

MEDEVAC - can lead to AMI, renal failure

Question 8

What is rhabdomyolysis?

Answer 8

breakdown of muscle fibers

Question 9

What is being released into the blood from breakdown of the muscle tissues?

Answer 9

Myoglobin and CK

Question 10

What is causing the renal damage in rhabdo?

Answer 10

myoglobin

Question 11

What do you do if, If plasma glucose level fails to fall at least 10% in the first hour of insulin tx?

Answer 11

Give repeat loading dose

Question 12

What will insulin administration do to potassium levels?

Answer 12

Potassium will drop because insulin will drive it into the cells, therefore you may have to add potassium to treatment

Question 13

Causes of rhabdo?

Answer 13

• Trauma/muscle compression
• Electrical
• Exertional
• Drugs (opioids)
• Toxins (snake venom and CO)

Question 14

Symptoms of rhabdo?

Answer 14

• Muscle tenderness
• Muscle weakness
• Dark urine
• Altered mental status

Question 15

What is hallmark lab for rhabdo?

Answer 15

Elevation of CK

Question 16

How does hyperkalemia present on EKG?

Answer 16

Peaked T waves

Question 17

Tx for rhabdo?

Answer 17

• IV fluids

Question 18

Dispo for rhabdo?

Answer 18

• Can keep onboard if no altered mental status

Question 19

When do MEDEVAC for rhabdo?

Answer 19

• Altered mental status
• Temp >105
• Unresponsive to IV fluids

Question 20

What is defined as circulatory insufficiency that creates an imbalance between tissue oxygen supply and demand resulting in global tissue hypoperfusion. This leads to hypoxia, acidosis, and eventual end organ damage and failure?

Answer 20

Shock

Question 21

What are the 4 categories of shock?

Answer 21

• Hypovolemic
• Cardiogenic
• Distributive
• Obstructive

Question 22

Cardiac output =

Answer 22

Stroke volume x Heart rate

Question 23

Decrease blood or
fluid volume lead to decrease stroke volume, as a way to
compensate the HR will increase to maintain CO until it no longer
can maintain CO and then you go into shock

Answer 23

True

Question 24

So what causes hypovolemic shock?

Answer 24

decreased intravascular volume secondary to blood loss

or loss of fluid and electrolytes

Question 25

What type of shock does DKA cause?

Answer 25

Hypovolemic

Question 26

Labs for shock?

Answer 26

* CBC * EKG * Chems * lactic acid level

Question 27

Tx for shock?

Answer 27

maintain adequate tissue perfusion

Question 28

If loosing blood what do you give?

Answer 28

Blood

Question 29

Medications for hypovolemic shock?

Answer 29

* Vasopressors - Norephinepherine IV - Epi IV - Dopamine IV

Question 30

What is causing cardiogenic shock?

Answer 30

Pump failure secondary to AMI, Cardiac contusion, Arrhythmia, Valvular incompetence or stenosis

Question 31

Signs of cardiogenic shock?

Answer 31

* * Elevated JVP 7) Tachypnea 8) Pulmonary edema 9) Irregular pulse if arrhythmia 1) Hypotension (SBP < 90 mmHg) 2) Mental status changes 3) Oliguria

Question 32

What does the JVP pressure look like on hypovolemic shock?

Answer 32

It's low

Question 33

Tx for cardiogenic shock?

Answer 33

ACLS Fluid replacement if needed Vasopressors (Epi/Dopamine)

Question 34

What causes distributive shock?

Answer 34

reduction in Systemic vascular resistance * Severe vasodilation

Question 35

What is the most common form of distributive shock?

Answer 35

Sepsis

Question 36

Other causes of distributive shock?

Answer 36

* Anaphylaxis | * Neurogenic

Question 37

Sepsis findings?

Answer 37

a) Evidence of infection (fever, tachycardia) in the setting of persistent hypoperfusion despite volume resuscitation b) Check CBC (will reveal elevated WBC) c) History should help point you to the source of the infection

Question 38

Anaphylaxis findings?

Answer 38

a) Evidence of diffuse urticaria, angioedema, bronchospasm, SOB, fullness of the throat, hoarseness b) History of an insect bite, exposure to certain food, etc.

Question 39

Neurogenic findings?

Answer 39

a) Evidence of acute traumatic spinal cord injury and hypotension without compensatory tachycardia b) Unresponsive to fluid resuscitation, Bradycardia c) Warm, dry skin

Question 40

Tx for sepsis?

Answer 40

* Ertapenem * Fluids * Consider vasopressors

Question 41

Tx for anaphylaxis?

Answer 41

* ABCs * Epi * IV * Benadryl * Solumedrol

Question 42

Tx for Neurogenic?

Answer 42

ABCs | IV fluids

Question 43

What causes obstructive shock?

Answer 43

extracardiac causes of cardiac pump failure and often associated with poor right ventricle output 2) Caused by: Massive PE, Tension pneumothorax, Pericardial Tamponade, Restrictive cardiomyopathy, or abdominal compartment syndrome

Question 44

Findings of obstructive shock?

Answer 44

1) Depends on the etiology 2) Massive PE: shock, JVD, elevated JVP, LE pitting edema 3) Tension PTX: deviated trachea, absent breath sounds on one side 4) Pericardial Tamponade: distal or muffled heart tones, JVD, elevated JVP

Question 45

Tx for obstructive shock?

Answer 45

1) ABCs, IV, O2 to keep saturation >92%, Monitor 2) Thrombolytics or endovascular thrombus retrieval for PE 3) Needle decompression or chest tube for PTX 4) Pericardiocentesis to drain pericardial fluid 5) IV fluids LR or NS 250ml bolus at a time to see response