Simulation cases Flashcards
(39 cards)
autonomic features of hypoglycaemia
- sweating
- palpitations
- tremor
- hunger
neurological features of hypoglycaemia
- confusion
- drowsiness
- behavioural changes
- speech abnormalities
- incoordination
other symptoms of hypoglycaemia can include
nausea
headache
normal reference range for fasting plasma glucose
4 - 5.8mmol/l
what defines hypoglycaemia
plasma glucose of less than 3mmol/l
in hospitalised patients <4.0 mmol should be treated if patient is symptomatic
SBARR handover
Situation
- who, where, when, what aspect of patients management you need advice on, current working diagnosis
Background
- relevant pmh, surgical hx, medication, allergies, investigation results
Assessment
- vitals, clinical examination, overal clinical impression
Recommendations
- suspected diagnosis, what needs to happen, time frame
Response and review
AIRWAY (hypoglycaemic patient)
can the patient talk !?
no:
- airway compromise: cyanosis, see-saw breathing, accessory muscle use, diminished breath sounds
- open mouth and inspect: secretions or foreign body
how would you open airway?
head-tilt-chin-lift manoeuvre
what would you do in airway if patient has suffered significant trauma with potential spinal involvement ?
jaw thrust
other interventions for airway?
- nasopharyngeal airway
- oropharyngeal airway (Guedel)
breathing assessment for hypoglycaemic patient
- resp rate
- patients with severe hypoglycaemia may develop slow, irregular pattern of breathing
investigations for hypoglycaemic patient
- arterial blood gas to quantify degree of hypoxia
- CXR if abnormalities are heard on x-ray
pulse and blood pressure: hypoglycaemia patient
- tachycardia in the context of hypoglycaemia
bradycardia is a late sign often precedes cardiac arrest
investigations and procedure hypoglycaemia patient:
intravenous cannula
blood tests:
- fbc (anaemia and infection)
- U&Es to assess renal function and electrolyte levels
- CRP to screen for evidence of infection
- serum glucose
ECG
interventions for hypoglycaemia patient
if patient conscious:
- glucose gel by mouth
- repeat capillary blood glucose 10-15mins after
- if still hypoglycaemic administer more
if patient unconscious
- intravenous glucose
- when consciousness regained then oral glucose
- IV access not possible then do IM glucagone
disability assessment of hypoglycaemic patient
AVPU
- alert
- verbal
- pain
- unresponsive
The Cushing’s triad
- bradycardia
- irregular respirations
- hypertension
physiological response tor raised ICP , attempts to improve perfusion
what Is coning?
herniation of cerebellar tonsils through foramen magnum
compression of brainstem
when does the classical ‘blown pupil’ appearance occur in traumatic brain injury patients
- herniation of uncus of temporal lobe
- through tentorial notch
- leads to compression of oculomotor nerve
- blown pupil appearance
primary brain injury
- initial injury caused to brain tissue
- skulls fractures, haematoma formation
secondary brain injury
- indirect damage to brain injury post primary insult
- inadequate perfusion of brain
interventions for hypoxia and hypercapnia
- try and maintain oxygen sats 94-98%
- intubation in patients unable to protect their airway
intervention for patients who have hypotension and are hypovolaemic
- resus with fluids or blood products
- vasopressors
intervention for patients with cerebral oedema and raised ICP
- avoid tight c-spine collars
- position 30 degrees to aid venous drainage
- mannitol or hypertonic saline to reduce ICP
- intubation and hyperventilation strategies
