CritMedic

Critical Care Paramedicine Podcast

Episode 15: Scenario: The DKA Patient


You respond to a rural ED for a 1 hour transfer to a tertiary facility MICU for higher level of care. Patient is a 44 YOF (5’5″, 100 kg ABW) with a history of IDDM with a current diagnosis of DKA. Laboratory blood glucose at 940 mg/dl (68.6 gr/pt). Patient’s GCS is 2/2/4. She is breathing 30 – 40 per minute and saturating 88% on a NRB. She has an 18 gauge IV in the Right AC and received 1000 ml of saline. She is being transferred with insulin running at 12 units/hr. She has vomited x4 since being admitted to the ED.

Vitals and labs are as follows:
BP – 94/40
HR – 118 bpm
RR – 30 – 40 bpm
SpO2 – 88% on 15 LPM
GCS – 8
EKG – Sinus Tachycardia

pH 7.06, PaCO2 25, PaO2 53, HCO3 11

RBC 7, HGB 21, HCT 63, WBC 10,000, Plt 350,000

Na 114, Cl 106 K 2.3, BGL 940, BUN 26, Cr 2

Medications: Paxil, Lantus, Humalog, Prolixin, Zyprexa, Lyrica, Hydrocodone
History: Depression, Schizophrenia, Bipolar, Fibromyalgia, IDDM
Allergies: Haldol, NSAIDs, Sulfa, PCN

How do you manage this patient?

In this episode we discuss:

  • SBP vs MAP
  • Compensatory Respiratory Alkalosis
  • Hyperglycemia / DKA
  • Effect of Glucose on Sodium Values
  • Hypokalemia
  • Effects of Insulin on Potassium
  • Dangers of Intubation / RSI
  • Ventilator settings
  • Smothering patients with pillows

 

Show Notes

CritMedic © 2016