chbare Posted October 11, 2007 Share Posted October 11, 2007 With the information I currently have, I would have to go with DKA. Take care, chbare. Link to comment Share on other sites More sharing options...
Dustdevil Posted October 11, 2007 Share Posted October 11, 2007 Outbreak of the coxsackie B4 virus. Provoked an autoimmune response which attacked the beta cells in the pancreas, producing new onset type I diabetes and causing the other symptoms. You can't say "coxsackie" here. Link to comment Share on other sites More sharing options...
ERDoc Posted October 11, 2007 Author Share Posted October 11, 2007 You can't say "coxsackie" here. Coxsackie Link to comment Share on other sites More sharing options...
ERDoc Posted October 11, 2007 Author Share Posted October 11, 2007 With the information I currently have, I would have to go with DKA. Take care, chbare. We have a winner. Your overly eager (card still wet) medic partner hands you the bag that he has been collecting vomit with and tells you, "I haven't taken care of a kid with DKA yet. I'm gonna run this one." You just roll your eyes and give in. You guys get the pt loaded up for the ride to the closest peds hospital which is about an hour away. You help him with the IV and hop in the front. About 15 minutes into the transport your partner comes to you and says, "Maybe we should switch places. I can't get her to wake up." What is going on? What else do you want to know (you didn't think it was going to be too simple did you)? Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 11, 2007 Share Posted October 11, 2007 I still think its a modified version of Marburg but probably not. soooooooooooooo I'm gonna work her like any good medic should and begin assessment all over again since I handed over care to the newbie which after the shift I'm gonna kick myself in the ass and say, never never never again, YOU KNEW BETTER But after I reassess her with the following Vitals blood sugar again cardiac monitor pulse ox loc? IV RUnning OK? is she on oxygen? I'm going to assume that her sugar has skyrocketed and a diversion to a hospital with some insulin might be a step in the right direction. If I can't get a local yokel hospital to take her then I'm going to determine if a helicopter can get her to the peds facility faster than I can but I honestly think this kid needs some insulin and fast. I'm also going to start thinking about intubation if needed. And my guess for the underlying problem is she has a tumor on her adrenal glands that have started to go haywire and causing this problem. Either or, she needs defnitive treatment at a local hospital who can get her stabilized and she doesn't need a ramrod drive to a hospital over an hour away. Link to comment Share on other sites More sharing options...
ERDoc Posted October 11, 2007 Author Share Posted October 11, 2007 You step into the back and assess the pt. She is responsive to painful stimuli only. Gag reflex is intact. Vitals are the same as previous. IV is working well. Your partner has given her about a liter of fluid so far and has just started the second. Repeat finger stick is 370. EKG is still sinus tach. Your partner placed her on 3L NC and she is sating 100%. Your partner turns to you and says, "Dude, what the hell is going on?" You contact the closest helicopter and it is about 30 minutes out. The closest hospital is about 20 minutes lights and sirens, however they advise you that they are closed due to a bomb scare (or some other catastrophe that makes it impossible for you to go there, making this scenario more difficult). Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 11, 2007 Share Posted October 11, 2007 what are her pupils like? so I guess the original hospital is the place to go. the helicopter will get her to the hospital about the same time you can get her there so it's ground transport. So what are the roads like between us and the receiving facility?/ are they closed due to some tractor trailer cow transport crash or something like that? I think we need to look at the amount of fluid we are pushing in to this girl. What are her lungs sounding like with that liter of fluid? Let's get on the horn to the hospital and discuss this case with them. Or are the phones out in the area? AS for her pupils - these are key for cerebral edema How much does she weigh? We need a 20ml/kg bolus of fluid to start with. Then we can back that off as needed. But in all the research and info I'm seeing is that the definitive treatment for this little girl is insulin. Link to comment Share on other sites More sharing options...
Dustdevil Posted October 11, 2007 Share Posted October 11, 2007 With the information I currently have, I would have to go with DKA. And the "A" stands for... [spoil:4dffbc765f]ACIDOSIS[/spoil:4dffbc765f] :wink: Link to comment Share on other sites More sharing options...
Just Plain Ruff Posted October 11, 2007 Share Posted October 11, 2007 Wow not seeing the forest for the trees on this one. Let's give her some bicarb and let's see what develops. but I still stand by the fact that insulin is the treatment of choice but being stuck in the ambulance for an hour then the next best thing is to treat with bicarb in the big yellow/puke greenish box. Link to comment Share on other sites More sharing options...
chbare Posted October 11, 2007 Share Posted October 11, 2007 Initial BGL was 525, the current BGL is 370. This gives us a delta of 155 in 15 minutes. We typically do not want to drop BGL's by more than 100mg/dl/hour. I suspect cerebral edema. We have aggressively changed the osmolarity of the intravascular space with an isotonic solution as evidenced by the rapid drop in sugar. However, the intracellular space is still hyperosmolar compared to the intravascular space and water will move with the gradient. I have never seen this occur with a change in 155mg/dl; however, such a sudden change in this particular patient may be enough. We may need to bring her sugar up a bit. I would try to stay away from intubating a DKA patient if possible. We can really screw acid base/electrolyte balance up when we intubate a DKA patient and her vent settings will need close monitoring. Did my partner give any medications? Take care, chbare. Link to comment Share on other sites More sharing options...
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