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EM Final Study Guide > Pages 41-52 > Flashcards

Pages 41-52 Flashcards

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1
Q

Labs in DKA?

A 
Plasma glucose: over 250
Arterial pH:  under 7.30
Serum bicarb: under 18
Urine ketones: +++
Serum ketones: +++
Serum osmolality: increased 
Anion gap: over 12
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2
Q

Labs in HHS?

A 
Plasma glucose (mg/dL): over 600
Arterial pH: over 7.30
Serum bicarbonate: over 18
Urine ketones: negative
Serum ketones: negative 
Serum osmolality: greatly increased
Anion gap: Normal (12-16)
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3
Q

Average fluid loss in KDA and HHS?

A

DKA: 3-6 liters
HHS: 8-10 liters

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4
Q

How to correct fluids in DKA and HHS?

A
  1. Start with isotonic saline 15-20 ml/kg per hour
  2. Switch to one-half isotonic saline serum Na
  3. Add dextrose to IVF when serum glucose reaches 250
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5
Q

How to administer insulin in DKA and HHS?

A
  1. Only after adequate fluid resuscitation
  2. Start with an infusion of regular insulin at 0.1 U/kg/hr.
  3. Double dose if glucose doesn’t fall by 50-70 mg/dL in first hour
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6
Q

How to correct K in HHS and DKA?

A
  1. If the K under 3.3, DELAY insulin therapy until fluid and potassium replacement
  2. Administer K w/ initial IVF if K is normal or low and maintain between 4 - 5 mEq/L
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7
Q

When is bicarb administration needed in DKA and HHS?

A
  1. Severe acidosis with pH < 6.90
  2. Severe life-threatening hyperkalemia
  3. Seizures
  4. Cardiac or persistently hypotensive patient
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8
Q

Monitoring of labs in HHS and DKA?

A
  1. Glucose every hr. until stable, then every 2 - 4

2. BMP and blood pH every 2 - 4 hours until patient stabilizes

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9
Q

What can HYPOglycemia mimic?

A
  1. Coma
  2. Stroke
  3. Seizures
  4. Syncope
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10
Q

Oral administration of glucose in hypoglycemia?

A

300g (1200cal) of carbohydrate should be given:

  • Soda, juice, sandwich, snacks
  • Complex carbohydrates better at maintaining levels
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11
Q

IV administration of glucose in hypoglycemia?

A

Adults: 50 ml of 50% Dextrose in Water (D50)
Peds: 1 ml/kg of 25% Dextrose in water

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12
Q

What needs to be given to alcoholics with glucose?

A

Thiamine to prevent Wernicke’s Encephalopathy

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13
Q

Use of glucagon in hypoglycemia?

A

Can be used when no IV access

  • Adults: administer 1 mg IM
  • Kids: 0.5 mg if under 20 kg
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14
Q

Use of octreotide in hypoglycemia?

A

May be useful in the setting of sulfonylurea-induced hypoglycemia not responsive to other therapies

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15
Q

Triad thyroid storm?

A
  1. High fever (sometimes as high as 106)
  2. Exaggerated tachycardia
  3. CNS dysfunction
    Also
  4. Tremulousness
  5. Agitation
  6. Psychosis
  7. N/V
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16
Q

Diagnosis thyroid storm?

A
  1. Elevated T3/T4
  2. Elevated T3 uptake
  3. LOW TSH
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17
Q

How does PTU work?

A

Blocks synthesis of thyroid hormone

- Preferred over methimazole because PTU also reduces peripheral conversion of T4 to T3

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18
Q

How do you block release of thyroid hormone?

A
  1. Inorganic iodine at least 1 hour after antithyroid meds
  2. Lugol’s solution
  3. Can use lithium if allergic to iodine
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19
Q

How do you stop effects of thyroid hormone?

A

Propranolol - antagonizes the hyperadrenergic effects of thyroid hormone

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20
Q

How to treat hyperthermia in thyroid storm?

A

Acetaminophen

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21
Q

Definition hyperkalemia?

A

Serum potassium of greater than 5.5 mEq/L

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22
Q

Effect of hyperkalemia on the heart?

A

2nd and 3rd degree heart block, wide complex tachy, and progression to v-fib and asystole

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23
Q

Diseases leading to hyper K?

A
  1. CKD
  2. DKA
  3. Rhabdo
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24
Q

Hyper K on EKG?

Study These Flashcards
A
  1. Peaked T waves: 6.5-7.5
  2. Wide QRS, decreased amplitude of P: 7.5-8.0
  3. Sine wave, v. fib, asystole - K 10-12
25
How to stabilize cardiac membrane in hyper K?
1. Calcium gluconate: 10ml IV over 2-5 minutes | - May be repeated after 5 minutes if no improvement
26
How to redistribute K?
1. Insulin + D50: 10-20 units IV: if glucose less than 250 | 2. Albuterol 2.5-10 mg Nebulized
27
How to reduce total body K?
1. Kayexalate: binding resin that exchanges sodium for potassium in colon 2. Furosemide 20-40mg IV: rapid acting 3. Hemodialysis - indicated if hemodynamically unstable.
28
What is the coma cocktail?
1. Hypoxia: 100% O2 non rebreather 2. Hypoglycemia: POC fingerstick 3. Opioids: administer Narcan 0.4- 2mg IV
29
Signs of sympathomimetics?
1. Tachycardia 2. Hypertension 3. Mydriasis 4. Diaphoresis 5. Hyperthermia 6. Agitation
30
Drugs causing sympathomimetics signs?
1. OTC cold agents (containing ephedrine) 2. Cocaine 3. Amphetamines 4. Methamphetamine 5. Dietary supplements (ephedra) 6. MDMA: "ecstasy"
31
Signs of sedative hypnotic ODs?
1. Hypothermia 2. Bradypnea 3. Hypotension 4. Drowsiness / lethargy / coma 5. Dysarthria 6. Ataxia 7. Miosis 8. Nystagmus 9. Hyporeflexia
32
Signs anticholinergic OD?
1. Mad as a hatter - AMS 2. Blind as a bat: mydriasis=DILATION 3. Hot as Hades 4. Red as a beat 5. Dry as a bone
33
Toxins with anticholinergic properties?
1. TCA's Tricyclic antidepressants (TX WITH BICARB) 2. Antihistamines 3. Overactive bladder medication
34
Rx TXA overdose?
BICARB
35
Signs cholinergic toxicity?
``` "SLUDGE" Salivation Lacrimation Urination Diaphoresis and defecation Gastrointestinal upset Excessive bradycardia or tachycardia ```
36
Sources for cholinergic toxicity?
1. Organophosphate poisoning (pesticides) | 2. Nerve agents
37
Rx Cholinergic Toxicity?
1. Atropine 2. 2 PAM 3. Decontaminate
38
What is a toxic dose of acetaminophen?
Acute ingestion: 140-200 mg/kg or 7.5 gm | Chronic: 4 gm in 24 hours as a chronic ingestion
39
Antidote Acetaminophen toxicity?
NAC - N-acetylcysteine
40
When does NAC need to be given to be hepatoprotective?
Within 8 hours
41
What are heat cramps?
Brief intermittent / involuntary contraction (usually calves), from prolonged exercise in heat, from hydration with hypotonic fluids Rx: REST AND REPLACE FLUIDS/LYTES
42
What is heat stroke?
1. Prodrome: light-headedness, dizziness, N, postural hypotension - Resolves when lying horizontal and with cooling measures 2. Tachycardia / tachypnea 3. Confusion / bizarre behavior / lethargy 4. Ataxia / seizures / coma - A TRUE MEDICAL EMERGENCY. Core temp over 105 or 40.5 C rectal,
43
Temp for heat stroke?
Core temp over 105 or 40.5 C rectal
44
Rx heat stroke?
ACTIVE COOLING: Tepid water and fans, cooled IVFs, cooling blankets or ice packs to groin/axilla
45
Goal Rx in heat stroke?
Drop temp to 100-102 (STOP AT THIS POINT to AVOID OVERCOOLING) - NO ANTIPYRETICS
46
Temps in HYPOthermia?
Mild: 32-35 C or 92-95F
47
Rx frostbite?
Slow thaw in warm circulating water (100-104) with pain control
48
Grades frostbite?
3rd through muscle, 4th frozen to bone
49
Most common injury in lightning strike?
Ruptured tympanic membrane
50
Different in paralysis in Lyme and RMSF?
1. Tick paralysis: ascending paralysis that stops when tick removed 2. RMSF (centrifugal spread)
51
Abx in animal bites?
Amoxicillin-clavulanate
52
Sub Q Suture?
5-0 Polysorb or Dexon
53
Scalp thin suture?
4-0, 5-0 monofilament nylon or polyporlylene
54
Scalp thick suture and duration?
5-0 (5-7 days)
55
Face suture and days?
5-0, 6-0 (3-5days)
56
Mouth sutures?
5-0 Polysorb or Dexon, 4-0, 5-0 plain
57
Trunk sutures?
3-0, 4-0, 5-0 non absorbable (6-10 days)
58
Extremity sutures?
4-0, 5-0
59
Palm and sole sutures?
3-0, 4-0, 5-0 na (7-12 days)

EM Final Study Guide (29 decks)

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