Episode 15.0 – Adrenal Crises + D-dimer in Aortic Dissection - a podcast by Core EM

Pearls from a core content talk on adrenal emergencies, a journal update looking at D-dimer in aortic dissection and some acid/base cases.







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Tags: Acid Base, Adrenal Gland, Adrenal Insufficiency, Aortic Dissection, Congenital Adrenal Hyperplasia, D-dimer











Show Notes

Shownotes

Asha SE, Miers JW. A systematic review and meta-analysis of D-dimer as a rule-out test for suspected acute aortic dissection. Ann Emerg Med 2015. PMID: 25805111

Dierks DB et al. Clinical policy: critical issues in the evaluation and management of adult patients with suspected acute nontraumatic thoracic aortic dissection. Ann Emerg Med 2015; 65: 32-42. PMID: 25529153

Acid-Base Cases

 

Quick questions & answers:



* For acute respiratory acidosis or alkalosis, how much does the pH change for every 10mm change of PCO2?

* What is the Winter’s formula?

* For stable chronic respiratory acidosis, for every 10 mm increase in PCO2, how much should the pH decrease by?



For each of the following cases, please analyze the acid-base status (i.e. anion gap metabolic acidosis, respiratory alkalosis, non-AG metabolic acidosis with respiratory acidosis, etc…) for further discussion in the workshop.



1) A 25 year old woman is found at home c/o thirst, shortness of breath, and spasms of her arms and legs.

Vital signs: BP 90/50 mmHg; pulse 155/min; RR 32/min; afebrile; RA O2 sat 98%.

137     84   18   274    Calcium 9.6

2.4     29   1.2

VBG:   7.66   / 25.5   / 29.1



* What is the acid base abnormality?

* What abnormality is responsible for her neuromuscular symptoms?

* What other electrolyte abnormalities would you expect?

* How should she be treated?





2) A 21 yo female presented to ED after reportedly ingesting an entire bottle of pills (drug and formulation unknown) and now complaints oftinnitus, nausea, and vomiting.

Exam: A, O x3, Pupils – dilated, reactive, Neuro – no hyperreflexia, rigidity or clonus

Lungs – + tachypnea, CV – tachycardia, no murmurs, skin nl

VS:   BP 92/67, HR 100/min, RR 18/min, T 98.6, RA O2 sat 99%

135   104     12   145

3.8       11     0.9                  Ca 7.8

ABG:   7.47 /   14   /109   /10



3) A 56 yo female with a past medical history of heroin use...

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