Syncope and electrolyte abnormalities

Question 1

What are the components of the CHESS mnemonic?

Answer 1

• CHF
• HCT less than 30%
• EKG abnormalities
• SOB
• SBP less than 90 mmHg

Question 2

What type of exertion is particularly concerning?

Answer 2

Exertional syncope

Question 3

What family history is concerning for syncope?

Answer 3

Sudden cardiac death

Question 4

What should always be considered with a new onset seizure?

Answer 4

v-fib

Question 5

Which abx classically causes QTc prolongation?

Answer 5

Macrolides or floxacins

Question 6

What is the classic finding of arrhythmogenic right ventricular cardiomyopathy?

Answer 6

Epsilon wave

Question 7

What physical exam findings can be had with aortic stenosis, besides the systolic murmur?

Answer 7

-Slow, delayed carotid pulse

Question 8

Chronic AS + acute CHF = dispo?

Answer 8

Admit for surgery

Question 9

Syncope in a sexually active woman of childbearing age is a what until proven otherwise?

Answer 9

Ectopic pregnancy

Question 10

What are the 4 major medications that can cause hyperkalemia?

Answer 10

• ACEI/ARBS
• NSAIDs
• Potassium sparing diuretics
• Bactrim

Question 11

When is the only time calcium is indicated for hyperkalemia?

Answer 11

If there is a wide QRS

Question 12

What type of calcium do kids get?

Answer 12

Calcium gluconate

Question 13

How many grams of glucose are in an amp of D50?

Answer 13

25g, since it’s 50 per 100 mL, and an amp is 50 mL

Question 14

What is the ratio of glucose to insulin?

Answer 14

amp of d50 to 10 units regular insulin

Question 15

What are the 5 components of treatment for DKA?

Answer 15

• volume
• insulin
• K
• bicarb
• phosphate

Question 16

What are the 3 most common causes of hypokalemia?

Answer 16

• Decrease intake
• Increased losses (emesis, diarrhea)
• Intracellular shift (hyperventilation, metabolic alkalosis)

Question 17

What are the 5 ECG changes in hypokalemia?

Answer 17

• Loss of T waves
• U waves
• Prolonged QTc
• Torsades
• Diffuse nonspecific ST/T wave changes

Question 18

When is hypokalemia an emergency?

Answer 18

If at risk for arrhythmia

Question 19

What is the best way to estimate total body K loss?

Answer 19

0.4 mEq/L requires 100 mEqs of KCl

Question 20

What is the general rule of thumb for determining urine [Na] should be (relatively)?

Answer 20

Should be near serum [Na]

Question 21

How fast can you raise someone’s serum Na?

Answer 21

0.5 mEq/hr or 8 mEq/day

Question 22

What are the 5 causes of AMS?

Answer 22

• Vital signs
• Toxic-metabolites
• Structural
• Infectious
• Psych

Question 23

What are the three indications for hypertonic saline?

Answer 23

• seizures
• coma
• focal findings

Question 24

What [Na] is needed to use hypertonic saline?

Answer 24

100-110 mEq

Question 25

What is the concentration of hypertonic saline used to correct seizures?

Answer 25

3%

Question 26

What is the rate of giving hypertonic saline for seizures? (2)

Answer 26

- 100 cc over 10 minutes | - Second dose of 100 cc over 50 minutes

Question 27

What is the first line treatment for hypercalcemia?

Answer 27

Saline

Question 28

How long should you give NS for in patient's with hypercalcemia? Why?

Answer 28

Just until vitals normalize or improvements had, since they will quickly lose Ca once you start

Question 29

What is the rate to give NS in hypercalcemia?

Answer 29

150-250 cc/hr

Question 30

What is the role of lasix in treating hypercalcemia?

Answer 30

- Inhibits reabsorption - Use only once volume is normalized - Use only 40 mg IV - Only for volume overload

Question 31

What is the role of bisphosphonates in treating hypercalcemia?

Answer 31

- Not an ED decision | - Takes hours/days to work

Question 32

What are the two biggest errors in treating hypercalcemia?

Answer 32

- Lasix before rehydration | - Too much saline

Question 33

What are the 5 steps of treating hypercalcemia?

Answer 33

- ABCs - NS - Lasix if overloaded - Follow K and Mg - Call internist

Question 34

What other electrolyte abnormalities must be watched closely with hypercalcemia?

Answer 34

K and Mg

Question 35

What is the maintenance rate of Mg?

Answer 35

0.5 g/hr

Question 36

What is the rate of giving Mg in a bolus?

Answer 36

1-2 g over 0-60 minutes

Question 37

What are the causes of hypophosphatemia?

Answer 37

- Malnourished - DKA or alcoholic ketoacidosis - hyperventilation

Question 38

What are the major consequences of hypophosphatemia in terms of s/sx?

Answer 38

- Decreased muscle strength (heart, diaphragm = decreased contractility, decreased ventilation) - Rhabdo

Question 39

What is the significance of the 1.5, 1.0, and 0.5 levels in hypophosphatemia?

Answer 39

- 1.5 = consider therapy - 1.0 = symptomatic - 0.5 = usual cc/hr for repletion