ICM Regional Teaching
Sam Gaw - Case Report
Testing ANKI
| Flashcard | type:basic |
|---|---|
| What is "beta cell switch off" in T2DM? | Burn out of beta cells in T2DM, no longer producing insulin |
| What is the term in T2DM when the pancreatic beta cells burn out? | "Beta Cell Switch Off" |
| What is the main neuro complication to be worried about in Hyperglycaemic Hyperosmolar Syndrome? | Venous Sinus Thrombosis |
| If someone has a cerebral venous sinus thrombosis, how do you treat it? | Therapeutic Dose Heparin |
| How long do patients need heparin for if they've had a cerebral venous sinus thrombosis? | 3 Months to a Year |
| If someone has a cerebral venous sinus thrombosis, plus intracranial haemorrhage, how do you treat it? | Still anticoagulate with heparin! |
HHS - Steve Cleland
| Flashcard | type:basic |
|---|---|
| How acidotic are you allowed to be and still have HHS? | H+ needs to be less than 50 |
| How ketotic are you allowed to be and still have HHS? | Ketones needs to be less than 3 |
| What is the hospital mortality for HHS? | 15-20% |
| How long does it take to develop HHS? | Days to Weeks |
| What is the main clinical sign for HHS, what do you pretty much HAVE to have? | Dehydration |
| Can you have a ketoacidosis in HHS? | Yes but only mild |
| Which has a greater mortality, HHS or DKA? | HHS |
| Why does HHS have a greater mortality than DKA? | Older/frailer patients More hypercoagulable More iatrogenic ha |
| Can you have HHS and DKA at same time? | Yes! |
| What does hyperkalaemia tell you in patients with HHS/DKA? | Insulin is so low that you can't even run the Na/K Atpase pump anymore |
| What is the ideal rate of fall of osmolality in HHS? | 3-8mOsm/kg/hr (more 3 than 8) |
| What's the important measure in managing HHS? | Osmolality |
| Should you care about the Sodium falling when managing HHS? | No! Rising Na compensates for falling glucose, that's good! |
| Should you switch 0.9% NaCl to 0.45 or 0.18 when Na rising in HHS? | No! Let it rise, even to 170s! |
| When in HHS should you switch from 0.9 NaCl to 0.45 or other fluids? | ONLY if euvolaemic but osmolality not falling. NOT for just hypernatraemia. |
| When in HHS should you give insulin? | ONLY when blood glucose no longer falling with fluids alone. OR if significant ketoacidosis. |
| In managing HHS, do you give fixed rate or variable rate insulin. | Fixed rate (0.05units/kg/hr) - but NOT Initially (unless acidotic) |
| What rate of insulin do you give in HHS? | 0.05units/kg/hr |
| Should you give insulin at the start in non ketotic non acidotic HHS? | No! You'll make the glucose fall too fast and osmolality fall too fast |
| Should you give insulin when acidotic in HHS? | Yes as you need to clear ketotic acidosis |
| When managing HHS, should you use measured or calculated osmolality? | It doesn't really matter, so use calculated but send measured away |
Law - Joe Hawkins
2018 EWCOP 39 - Birmingham
- A middle aged patient with an OOHCA, D3-4 with poor progostic EEG
- Got to a month, when theres an Explicit Best Interests meeting
- further deterioration with worsening infection
- clinicians offered a treatment plan which put treatment limitations in, family disagree
- deadlock that ended to courts
- court ended up siding with family is that CPR should be offered
2020 Hayden J - AB
- Trust wanted to continue treatment but to not provide CPR in event of arrest
- Brother wanted CPR:
- also wanted ivermectin, hydroxychloroquine, azithromicin, zinc, vit C and Vit D
- Went to the court:
- Court decided that DNACPR would be valid ass CPR would be futile
OPENCOURTOFPROTECTIONPROJECT - Celia Kitzinger