AMS trigger

Question 1

If diminished LOC what types of Ddx should we focus on

Answer 1

coma/stupo

Question 2

for + neuro deficits in AMS what types of ddx should we look for

Answer 2

structural defects of the brain

Question 3

if altered behavior in a pt who is awake, alert, w/o neuro deficit perform what exam to differentiate between confusion/delerium from a psych disorder

Answer 3

MMS (mini mental status exam?)

Question 4

If your patient comes in with refractory hypoglycemia and reports they take glipizide for their DM, what would you treat them with

Answer 4

ocreotide

sulfonyureas!! (glipizide, glimepiride, glyubride)

Question 5

A social hx of chronic alcohol/malnutrition in an AMS patient could suggest what etiology

Answer 5

wernicke’s encephalopathy

Question 6

what are the 6 DM medications that immediatly warrant admission in pts w hypoglycemia for serial glucose monitoring

Answer 6

• Prandin (repaglinide)
• Starlix (nateglinide).
• glipizide
• glyburide
• glimpiride
• long acting insulin

Question 7

what are typically the first symptoms to occur in ketoacidosis (be speific )

Answer 7

polydipsia
polyuria

Question 8

RFs for DKA with initial BG of < 250

Answer 8

• recently recieved insulin
• T1DM young and vomiting
• alcohol abuse/liver failure (impaired gluconeogenesis)
• low caloric intake
• depression
• pregnancy

Question 9

what are the levels of potassium that determine whether correction of potassium deficits are needed in hypoglycemia

Answer 9

> 5.2 = only need insulin.
3.3-5.2 = 20-30 mEq of K to each LITER of NS + insulin
< 3.3 = only need K

Question 10

If glucose does not decrease by 10% 1 hour after giving initial insulin bolus/drip what should you do

Answer 10

give .14U/kg bolus then resume normal drip

Question 11

If youre treating a pt w insulin and their glucose decreases faster than 75md/dL/hr what should you do

Answer 11

decrease insulin drip by half

Question 12

once a patients glucose reaches 200mg/dL after treatment for DKA, what do you do

Answer 12

• switch IV fluids to D5(1/2) NS
• decrease insulin dose to .02-.05 U/kg/hr

Question 13

what type of fluid do you give a pt with DKA for fluid rescucitation

Answer 13

• .9% NS 15-20ml/kg/hr for 1 hr
• .45NS TKO
• After initial bolus if Na is normal/elevated switch to 1/2NS
• if Na is low after initial bolus stay on .9%NS

Question 14

what are the goals for monitoring after management of DKA

Answer 14

• recheck electrolytes, AG, VBG Q2 hrs
• Goal: return all electrolytes to normal ranges and keep K+ between 3.3-5.2 mEq/dL
• Goal: Reduce AG and improve acid-base balance

Question 15

Indications and criteria for Thrombectomy

Answer 15

Indications:
1. tPA CI
2. tPA ineffective in a pt w NIHSS >/=6

Criteria:
1. Large artery occlusion in anterior circulation (CT/MRA dx)
2. small infarct core w no hemorrhage!
3. 24hrs of symptom onset
4. must be at stroke center w experienced surgeons

Question 16

izzie stevens is a resident at grey sloan memorial hospital, she is seeing visual hallucinations of her dead husband (denny duquette) but he doesnt talk to her. The etiology of her hallucinations is likely (medical/psychological)

Answer 16

Visual=Medical!!!

auditory would be psychological
she had metastatic melanoma remember (in the tv show, not in this lecture…. just a way to remember this for my greys girlies)

Question 17

what is the SADPERSONS pneumonic and what is considered a high risk

Answer 17

Sex - male
Age (45-64)
Depression
Previous attempt
Ethanol use
Rational thinking loss
Social support lacking
Organized plan
No spouse
Sickness