Metabolic

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Author:
jayama
ID:
149015
Filename:
Metabolic
Updated:
2012-04-21 07:25:49
Tags:
Metabolic
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Description:
Metabolic
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  1. Nexus
    • No Xray
    • - blunt injury
    • - no posterior tneder
    • no focal neuro
    • normal alertness
    • no intox
    • no distracting
  2. Nexus sens and spec
    • 99%
    • 13%
  3. Canadian C-Spine Rule
    High Risk
    • High Risk:
    • - age>65
    • - extremity parasthesia
    • fall>1m/5 stairs
    • axial load to head
    • high speed MVA
    • rollover
    • ejection
    • cycle motorised rec vehicle
  4. Canadian C-spine
    Low risk
    • - walking
    • -sitting in ED
    • - simple rear end
    • - delayed pain
    • - non-tender
    • - 45 deg rotation
  5. Sens and Spec
    • 100%
    • 40%
  6. High Anaion Gap Acidosis
    • Lactate - hypoperf/ DKA/ poisoning/ Metform
    • Ketoacids - DKA/AKA
    • PO4/SO4 - renal failure
    • Formate - METOH
    • Oxalate - ethylene glycol/ isopropyl ETOH
    • Hippurate - toulene tox/RF
    • Paraladehyde
  7. Low anion gap
    • hypoalb
    • Increase in other cations - calcium/lithium/proteins (myeloma)
    • nitrites
    • bromide
  8. Non-anion gap acidosis
    • HCO3 loss
    • - compensated for by Cl- rentention = no anion gap
    • Acid ingestion
    • Renal loss
    • - RTA
    • - carbonic anydrase inhibitors
    • -0 adrenocoritcal inssufficiency
    • Lower GI loss
  9. Diagnosis of labour
    • increasing severity of contractions
    • increasing frequency of contractions
    • cervical effacement
    • cervical dilatation
  10. Vaginal Delivery
    • - gestation al age
    • - antenatal care
    • - AMPLE
    • - delivery pack
    • - PV if hd no crowning
    • - determine presenting part
    • - dilatation and effacement
    • - level of descent
    • - deliver head (OA)
    • - free cord (clamp and cut)
    • - ext rotate head
    • - anterior shoulder (turtle = dystocia)
    • - check for twin
    • - clamp and cut cord (1min)
    • - oxytocin
    • - manage 3rd stage <30mins
    • - controlled cord traction
  11. MUDPILES + rhabdo, metformin, toulenes
    • Methanol (formate)
    • Ureamia (SO4/PO4)
    • DKA (lactate/ketoacids
    • Paraldehyde/ Propylene glycol
    • Infection (lactate) Irone Isoniazid Inborn errors
    • Lactate
    • Ethylene glycol (oxalate
    • Salicylates
  12. Anion gap
    • Na-HCO3-Cl
    • 12+/-4
  13. Corrected sodium in hyperglycaemia
    Sodium +(glucose-5)/3
  14. GAp:Gap in metabolic acidosis
    • delta AG/ delta HCO3-
    • = AG-12/24-HCO3-
  15. Gap:Gap
    • <0.4 = low or normal AG acidsois
    • 0.4-0.8 = normal and high AG acidosis
    • 0.8-2.0 - pure high metablic acidosis
    • >2 = metabolic acidosis and metabolic alk or resp acid
  16. Ur:Cr prerenal
    >100
  17. Ur:crea post-renal
    40-100
  18. Ur:Cr intrarenal
    <40
  19. Expected PCO2 in metabolic acidosis
    1.5 x HCO3 + 8
  20. Expected PCO2 in metabolic alkalosis
    0.7 x HCO3- + 20
  21. Expected HCO3 in resp acidosis
    • acute = 24+(PCO2-40)/10
    • Chronic 24+(PCO2-40)/10 x4
  22. Expected bicarb in resp alkalosis
    • Acute = 24-(40-PCO2)/10x2
    • Chronic = 24 - (40-PCO2)/10x5

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