MedBugs: SAQ #83

Case: Dizzy and Short of Breath

A 62-year-old female is brought into the resuscitation area of your department by ambulance. She woke from sleep this morning and felt dizzy and short of breath. She has a past medical history of end-stage renal failure secondary to diabetic nephropathy and has haeomodialysis through a vascath 3 times a week. She had a left mastectomy for cancer 12 months ago and has a left above knee amputation. On assessment, vitals are as follows : T 36.5, HR 43, BP 120/80, RR 16, Sats 95% on RA

1. List (5) potential causes of her shortness of breath given in the above history and justify each cause 5 marks

2. List (4) investigations that may help delineate the diagnosis, giving justification for each 4 marks

A VBG taken on room air is shown below :

FiO2	0.21
pH	7.31
PaCO2	46
PaO2	20
HCO3-	22
Na	143
K	7.9
Anion gap	21
Glucose	24.5
Lactate	6.5

You are about to arrange treatment for the patient when she has a PEA arrest. ALS is commenced

3. Outline the specific treatment of hyperkalaemic cardiac arrest in this patient 4 marks

ILCOR recommends modifications to the ALS algorithm in certain special situations.

4. Give (5) examples of and a recommendation/modification to the ALS algorithm for each 5 marks

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Case: Dizzy and Short of Breath

1. List (5) potential causes of her shortness of breath given in the above history and justify each cause 5 marks

2. List (4) investigations that may help delineate the diagnosis, giving justification for each 4 marks

3. Outline the specific treatment of hyperkalaemic cardiac arrest in this patient 4 marks

4. Give (5) examples of and a recommendation/modification to the ALS algorithm for each 5 marks

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