Emergency Medicine

Diabetic Emergencies

Do the following things, in this order of priority.

  • Dehydration – rehydrate with IV fluids
  • Insulin – to combat hyperglycaemia
  • Electrolytes – potassium shifts are a concern

A simple acronym solves everything. The point is not to let the patient DIE.

Pancreatic Enzyme Tests

Enzymes

Lipase is more specific for pancreatic disorders than amylase.

Memory Aid

Lipase has a p in it. So does pancreas.

Amylase has nothing.

It’s magic!

References

  1. Healthline. (2018). Amylase and Lipase Tests: Preparation, Procedure, and Results. [online] Available at: https://www.healthline.com/health/amylase-and-lipase-tests#understanding-your-results [Accessed 12 Jul. 2018].

Hypokalaemia ECG Changes

There are three major ones, plus more!

  1. ST depression
  2. Flattened T waves
  3. Abnormally prominent U waves

The way to remember this is that, in line with the subpar nature of hypokalaemia, everything is weak and low!

ST depression is a depression, so it is low.

The T waves have low amplitude, so they too are low.

The dip of the letter U, as in U waves, looks like the minimum point of a parabola, so it’s also low.

Conveniently, it all follows an alphabetical pattern: ST, T, U.

References

  1. ECG Learning Center. (n.d.). 12. Nice Seeing “U” Again. [online] Available at: https://ecg.utah.edu/lesson/12 [Accessed 4 Jul. 2018].
  2. Burns, E. (n.d.). Hypokalaemia. [online] LITFL. Available at: https://lifeinthefastlane.com/ecg-library/basics/hypokalaemia/ [Accessed 4 Jul. 2018].

Treatment Options For Hyperkalaemia

If hyperkalaemia is indeed real and not caused by haemolysis or a bad sample, treatment can be appropriate. It’s urgent if there are ECG changes.

  • Calcium gluconate
    • Stops membrane depolarisation
    • Does not reduce the serum potassium level
  • Sodium bicarbonate IV
    • To treat metabolic acidosis, which can be a potential underlying cause
      • Potassium moves out of cells because it exchanges with hydrogen ions
  • Insulin and glucose IV
    • Use short-acting insulin
    • To promote uptake of potassium into cells
    • Effective in kidney failure
  • Polystyrene resin orally
    • Removes potassium from bowel lumen by exchanging it for sodium or calcium
    • Comes in sodium or calcium varieties, called Resonium
      • Sodium type adds to sodium load in body
      • Calcium type avoids this but is unsuitable in hypercalcaemia
  • Dialysis
    • Last resort if extreme hyperkalaemia and nothing else works

Of course, the underlying cause should be treated; if it’s hypoaldosteronism, such as from adrenal insufficiency, corticosteroids should be given. If it’s volume depletion, that should be corrected. If the hyperkalaemia is caused by a medication, that medication should be ceased.

References

  1. Electrolyte abnormalities. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited (eTG November 2017 edition); 2017 Nov.
  2. acutecaretesting.org. (2013). On the relationship between potassium and acid-base balance. [online] Available at: https://acutecaretesting.org/en/journal-scans/on-the-relationship-between-potassium-and-acid-base-balance [Accessed 17 Feb. 2018].

Contraindications To Lumbar Puncture

A lumbar puncture is a procedure that involving drawing out cerebrospinal fluid, fondly known as CSF. For example, it can be used to check CSF for immune cells and glucose levels in suspected meningitis.

Lumbar puncture is considered an invasive procedure. But even with that aside, it’s not appropriate for everyone. That is, it does not suit all patients.

Contraindications to lumbar puncture are:

  • Skin infection at the lumbar puncture site
  • Uncorrected coagulopathy
  • Increased intracranial pressure
  • Trauma to the spinal cord

References

  1. Queen’s University School of Medicine. (n.d.). Contraindications. [online] Available at: https://meds.queensu.ca/central/assets/modules/lumbar_puncture/contraindications.html [Accessed 2 Feb. 2018].

American Compact Disc

Colles and Smith fractures are both fractures of the distal radius.

Colles fracture

  • Dorsal angulation of the fractured fragment
  • Memory aid: CD

Smith fracture

  • Volar angulation of the fractured fragment
    • Volar means palmar
  • Memory aid: VS almost looks like US, which is quite American

And that’s how an American CD is made.

References

  1. Luijkx, T. and Desai, P. (2018). Colles fracture. [online] Radiopaedia. Available at: https://radiopaedia.org/articles/colles-fracture [Accessed 15 Jan. 2018].
  2. Luijkx, T. and Gaillard, F. (2018). Smith fracture. [online] Radiopaedia. Available at: https://radiopaedia.org/articles/smith-fracture [Accessed 15 Jan. 2018].