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MODULE 16.

In this module, we are covering some endocrine emergencies, specifically diabetes and the thyroid gland. (To be perfectly blunt, if you have worked your way to this point in the ED training program and can't say something sensible about diabetes you probably shouldn't be sitting the exam...)

watch. 

There are a couple of videos below for you to watch:
  • a case presentation from the Mayo Clinic which covers Myxoedema Coma quite well
  • an overview of hyperthyroidism from HQMEDEd

Thyroid Storm from HQMedEd on Vimeo.


READ

There are a couple of resources for you this week. Again, it's worth paying attention to Cameron's chapters for relevant multi-choice factoids.

Below is a blog discussing the latest evidence on cerebral oedema in DKA from resus.com.au.

We often find lifeintehfastlane.com a bit overwhelming in terms of the content for exam preparation (although it's an excellent website otherwise), but there are two mindmap pages worth reviewing this week for diabetes, via the links below:
  1. The clinical features of DKA and HHS.
  2. A question from the CICM exam discussing the relevant differences between DKA and HHS. Interestingly only 51% of CICM candidates passed the question. The answers provided are a nice overview of the differences. Be aware this has also been asked on the ACEM exam before. 
Picture

solve.

Since we went over ABGs again at the face to face we thought we would revisit them again this week.

No new SAQ style questions today. Below is an ABG. Get as much out of it as you can in the next ten minutes.

​GO!
An 11 year old boy presents with his mother with acute dyspnoea. She states she thinks he has asthma and has been treating him with his brother's salbutamol inhaler. His vital signs are:
  • HR 152 /min
  • BP 69/52 mmHg
  • RR 45 /min
  • Sats 100% 40% O2
  • T 37.7 oC

An arterial gas is taken in the resus room.

FiO
2               0.40
pH                  6.92

PO2                260 mmHg
PCO
2             13 mmHg
HCO
3-            3.1 mmol/L
BE                  -21


Na+              126 mmol/L
K
+                 2.2 mmol/L
Cl
-                 90  mmol/L
Urea             6.2 mmol/L
Creatinine   78
μmol/L
Lactate        4.48 mmol/L
Glucose       31.6 mmol/L 
Click here for the answer!

write.

OK, after the last module, you're hopefully refreshed and relaxed! So here we go!

Write 2 SAQs:
- one on a topic related to diabetes with a prop of some sort
- one related to thyroid disease 

Write 3 MCQs relating to diabetes and thyroid disease.

Answers into dropbox please.


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