T: 35oC - Check sugar, give glucose Triggers - Administer antibiotics - Fluids given, blood work - Order CXR ordered, glucose corrected, or 10 - Order urinalysis min. 2. Blood work back - Start vasopressors after IVF - Capillary glucose not checked don’t correct BP by 5 min. 3. Seizure - Bedside U/S to assess for FF or PCE 2. Blood work back Clinically less Learner Actions Modifiers HR 110 dry. Still looks - ID hyperkalemia, do ECG - Give hydrocortisone BP to BP 85/40 unwell. - Treat hyperkalemia: 100/60 1) Calcium gluconate 1g iv Triggers 2) D50 + 10 units insulin R - Don’t recognize adrenal crisis 3) Ventolin 16 puffs by 12 min. 4. VF arrest 4) NaHCO3 1 amp - Don’t treat hyperkalemia by 12 - ID hyponatremia and treat min. 4. VF arrest slowly - Correct potassium and give - ID adrenal crisis as most hydrocortisone End Case likely diagnosis, treat with hydrocortisone 100mg iv 3. Seizure Patient having Learner Actions Modifiers HR 140 tonic clonic - Check blood glucose - Patient will keep seizing until BP unable seizures. - Correct glucose with D50 glucose given. RR no effort Triggers O2SAT 90% despite - Glucose given 2. Blood work FiO2 back - Intubation without glucose check 4. VF arrest 4. VF arrest Patient Learner Actions Rhythm VF pulseless with - Good quality CPR HR 180, no pulse VF rhythm x3 - Shock VF Triggers BP unable rounds. - Epinephrine - 15 min End Case - Amiodarone - ±Intubation Section VI: Scenario Progression Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results Na: 120 K: 7.5 Cl: 100 HCO3: 17 BUN: 10 Cr: 35 Glu: 1.5 VBG pH: 7.31 PCO2: 32 PO2: 45 HCO3: 18 Lactate: 3.1 WBC: 18.5 Hg: 140 Hct: 0.66 Plt: 550
T: 35oC - Check sugar, give glucose - Administer antibiotics - Order CXR - Order urinalysis - Start vasopressors after IVF don’t correct BP - Bedside U/S to assess for FF or PCE Triggers - Fluids given, blood work ordered, glucose corrected, or 10 min. 2. Blood work back - Capillary glucose not checked by 5 min. 3. Seizure 2. Blood work back HR 110 BP 85/40 Clinically less dry. Still looks unwell. Learner Actions - ID hyperkalemia, do ECG - Treat hyperkalemia: 1) Calcium gluconate 1g iv 2) D50 + 10 units insulin R 3) Ventolin 16 puffs 4) NaHCO3 1 amp - ID hyponatremia and treat slowly - ID adrenal crisis as most likely diagnosis, treat with hydrocortisone 100mg iv Modifiers - Give hydrocortisone BP to 100/60 Triggers - Don’t recognize adrenal crisis by 12 min. 4. VF arrest - Don’t treat hyperkalemia by 12 min. 4. VF arrest - Correct potassium and give hydrocortisone End Case 3. Seizure HR 140 BP unable RR no effort O2SAT 90% despite FiO2 Patient having tonic clonic seizures. Learner Actions - Check blood glucose - Correct glucose with D50 Modifiers - Patient will keep seizing until glucose given. Triggers - Glucose given 2. Blood work back - Intubation without glucose check 4. VF arrest 4. VF arrest Rhythm VF HR 180, no pulse BP unable Patient pulseless with VF rhythm x3 rounds. Learner Actions - Good quality CPR - Shock VF - Epinephrine - Amiodarone - ±Intubation Triggers - 15 min End Case Section VI: Scenario Progression Section VII: Supporting Documents, Laboratory Results, & Multimedia Laboratory Results Na: 120 K: 7.5 Cl: 100 HCO3: 17 BUN: 10 Cr: 35 Glu: 1.5 VBG pH: 7.31 PCO2: 32 PO2: 45 HCO3: 18 Lactate: 3.1 WBC: 18.5 Hg: 140 Hct: 0.66 Plt: 550
adrenal-crisis-case.docx