Endocrine (DKA, HHS, Myxedema)
When should a patient in a suspected myxedema coma be treated?
Immediately (Do not wait for lab results)
What is the blood test for real time analysis of the internal clotting cascade?
TEG (Thromboelastography)
What are two common assessment findings of a upper GI bleed?
Nausea/vomiting
Bloody, coffee ground emesis
Black, tarry stool
Upper GI discomfort
What does GFR stand for and what is the normal rate?
Glomerular filtration rate
125 ml/hour
What is rhabdomyolysis?
Release of myoglobin, CK, and potassium into the extracellular and intravascular spaces due to muscle damage.
What are the two hallmark signs/symptoms of a myxedema coma?
Decreased mental status plus one or more of the following:
Hypothermia
Hyponatremia
Hypercapnia
Which of these (HIT or DIC) is not a primary diagnosis?
DIC (Disseminated intravascular coagulation)
What are three labs associated with pancreatitis?
Amylase
Lipase
Glucose
Which renal failure (pre or intra) does not respond to Lasix?
Intra renal
What are two signs and symptoms of rhabdomyolysis?
Dark, tea colored urine
Low urine output
Myoglobin in urine
Elevated CK above 10,000 U/L
Muscle cramps and arrhythmias
What is a drug we frequently use that can cause a myxedema coma?
Amiodarone
What is the definition of HIT?
Heparin Induced Thrombocytopenia
Decrease in platelet count by 30-50%
Increased risk of thrombosis
What are two of the fastest ways to diagnose a GI perforation?
FAST exam
CT
What is is the BUN/Creatinine ratio in intrarenal failure?
Narrower ration
10-15:1
What are two causes of rhabdomyolysis?
Crush injury
Prolonged immobility
Compartment syndrome
Hyperthermia
DTs
Which evolves more rapidly - DKA or HSS? AND what are the two distinguishing differences?
DKA
HHS - absence of ketoacidosis and a greater degree of hyperglycemia
What are two signs/symptoms of DIC?
Unexplained petechiae
Ecchymosis
Hematomas
Spontaneous epistaxis
Bleeding from orifices/lines, etc.
What are three labs associated with liver failure?
Ammonia
Lactate
LFT (ALT, AST)
PT/INR
Bilirubin
What are two of the four causes of prerenal failure?
Impaired cardiac function
Vasodilation
Vasoconstriction
Intravascular volume
What are two consequences of rhabdomyolysis?
Hypovolemia
Hyperkalemia
Metabolic acidosis
Acute renal failure
What is the treatment triad for both DKA and HHS? They must be named in the correct treatment order.
Fluids
Electrolyte replacement
Insulin
Depending on your TEG results, there are four treatments. What are they? (YOU WILL RECEIVE AN EXTRA 100 POINTS if they are in order)
FFP
Cryoprecipitate
Platelets
TXA
What are four body systems affected by intra-abdominal HTN? (YOU WILL RECEIVE AN EXTRA 100 POINTS if you can explain how each system is affected.)
CNS
Thoracoabdominal
Hepatic
GI
Pulmonary
CV
Renal
(see chart)
What are four ways to manage intrarenal failure?
Maintain fluid volume
Maintain normal electrolyte balance
Maintain acid-base balance
Prevent malnutrition
Dialysis if needed
Prevention (uremia, infection, anemia, bleeding, drug accumulation)
What are two treatments for rhabdomyolysis?
Fluids to maintain urine output at 300-500 ml/hr
NaHCO3 infusion to alkalinize the urine
Mannitol
Monitor and treat for hyperkalemia
Monitor CK for peak and downward trend
Continue until myoglobin clears from urine