Medical Emergencies Quick

Question 1

DKA

Answer 1

-Patient is in hypovolemic shock
so fluid resuscitation with an isotonic solution is the priority
-DKA causes metabolic acidosis so see Kussmauls respirations to compensate by blowing off CO2
-Ketones in urine and BUN elevated due to dehydration
-Monitor glucose and potassium level closely
-Insulin infusion only when potassium stable, no insulin bolus to avoid risk of cerebral edema
*Do not stop insulin infusion gap is closed
-Increased HCO3increases showing resolution o f acidosis and ketosis

Question 2

HHS

Answer 2

-Higher blood sugars since gradual increase in glucose and severe dehydration
-No ketones or acidosis
-Require more fluids, but less insulin
-Risk or renal failure and DVT since severe dehydration

Question 3

Thyroid storm

Answer 3

-tachy, restless and in pulmonary edema
-TSH low, T3 or T4 elevated
-No aspirin or elevates T4 higher
-treat with beta blockers initially then PTU then iodine an hour after PTU

Question 4

Adrenal crisis

Answer 4

-See in Addison’s disease or sudden discontinuation of steroids.
-Labs-hyponatremia, hypoglycemia, and hyperkalemia.
-Treat with NS and glucocorticoids
Improved if BP increasing, since patient is in hypovolemic shock

Question 5

Hyperkalemia

Answer 5

Tall, tented T waves initially on EKG, then widened complex the Sine wave
-Treat initially with calcium gluconate, insulin, and dextrose