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You are a 35 year old patient who has been admitted with kidney problems, you do not know anymore details than this.

You have been feeling dizzy over the last couple of hours

You are not on any regular medications

You have no drug allergies

You are a 35 year old patient who has been admitted with kidney problems, you do not know anymore details than this.

You have been feeling dizzy over the last couple of hours

You are not on any regular medications

You have no drug allergies

Category Question
Done
Excellent
Introduction Candidate appropriately introduced themselves with:
Full name
Medical school / Year / grade
Clarifies who they are talking to
Asks patient for preferred name


History
Patient has been admitted with kidney problems, you do not know anymore details than this.
You have been feeling dizzy over the last couple of hours
No regular medications
No known drug allergies


A Airway assessment
Patient talking, airway patent


B Breathing assessment
Oxygen saturation = 97% on RA
Respiratory rate = 18
Position of trachea = central
Chest expansion = equal
Chest sounds = clear


C Circulation assessment
Blood pressure – 120/75
Heart rate – 85
Peripheral and central cap refill – < 2 seconds
Heart sounds = I + II + 0


C Circulation investigations
ECG
2 large bore IV cannulae
Bloods = FBC, U&E, CRP, VBG


C
Please interpret the following ECG:

PR interval prolonged
Broad, bizarre QRS complexes
Peaked T waves


VBG result
Please interpret the following VBG

Acidosis
Hyperkalaemia


Working diagnosis
Candidate verbalizes diagnosis of Hyperkalemia
Category of hyperkalemia = severe


Hyperkalemia treatment
10ml of 10% Calcium Gluconate IV over 3 minutes
10 units of Actrapid Insulin in 50ml of 50% dextrose IV over 15 minuets


D Disability assessment
Blood glucose = 6.5
Temperature = 37
A on AVPU
Pupils equal and reactive to light


Reassess
Candidate offers to reassess patient in an ABC approach


Question After you have completed your initial assessment who would you contact?
Medical registrar


Question Apart from calcium gluconate and insulin, what are the additional treatment options for hyperkalemia?
Salbutamol 5mg Neb
Sodium bicarbonate 1.2% IV over 4 hours



Score