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General Approach to a Test Question
- Read the last sentence of the question
- Read the answer choices
- THEN read the vignette
Common Scenarios with Quick Answers
- Hypotensive patients
- Give a fluid bolus
- Altered mental status
- Check a blood glucose
- Hypoglycemia
- Orange juice if can swallow safely
- D50 if patient cannot swallow and mildly altered
- IM glucagon if unresponsive
- Patient with altered mental status and possible drug overdose
- Give empiric naloxone
- Female patients of childbearing age
- Get a pregnancy test
- If you need to give contrast for a CT scan (example CTA for pulmonary embolism)
- Need renal function
Hyperkalemia
- Common scenarios
- Crush injury
- Severe burns
- End stage renal disease
- Especially if missed dialysis
- Leukemia on chemotherapy
- Remember: Don’t give succinylcholine to a patient with hyperkalemia
- Common EKG findings on test
- Hyperacute T waves
- Sinusoidal waves
- Treatment
- Stabilizes cardiac cell membranes
- Calcium
- Shifts potassium into the cells
- Insulin/Glucose
- Albuterol
- Sodium Bicarbonate
- Removes potassium
- Furosemide
- Dialysis
- Kayexalate
- Stabilizes cardiac cell membranes
Hypokalemia
- EKG findings
- Flattened T waves
- QTC prolongation
- U waves
- At risk for ventricular arrhythmias
- Treatment
- Oral potassium replacement
- IV potassium replacement
- Consider magnesium replacement
Hyponatremia
- Hypertonic saline IF
- Comatose
- Actively seizing
- Otherwise treat with normal saline
- Pseuohyponatremia
- Correct the sodium if patient has severe hyperglycemia
- Add 1.6 to sodium for every 100 glucose above normal limit
Hypercalcemia
- Symptoms
- “Stones, bones, groans, psychiatric overtones”
- Treatment
- IV fluids (promotes excretion) FIRST
- Then calcitonin/bisphosphates
Torsade de Pointes
- Common in patients with prolonged QTc
- Hypokalemia
- Hypocalcemia
- Treat with magnesium
Additional Reading
- Hyperkalemia (EM Clerkship)