Ray Fowler, MD is Professor of EM / EMS at UTSW / Parkland. Edited by Alex Koyfman, MD.45 male with intense epigastric pain radiating to his left arm with associated NV and diaphoresis.
55 female with crushing anterior chest pain and diaphoresis.
A sinus tachycardia is present in this 54 year old man with severe chest pain radiating to the left arm.
This is a narrow complex tachycardia in a 31 year-old female that is perfectly clock regular. There is no obvious atrial activity seen. The QRS is narrow.
This 65 year-old woman presents with lightheadedness and worsening dyspnea on exertion.
This 81 year old man had a syncopal episode. He presents a little confused, GCS 14 (lies with his eyes closed), and is “not right” per his wife. His BP is 110/76, and he has the cardiogram below.
This is an odd 12 lead ECG to have done in this 54 year old man. The rate is profoundly slow, in the 20’s or so. The rhythm is regular. There is no evident atrial activity. The QRS is very widened.
- When you are suspicious for DKA do you obtain a VBG or an ABG? How good is a VBG for determining acid/base status?
- Do you use serum or urine ketones to guide your diagnosis and treatment of DKA?
- Do you use IV bicarbonate administration for the treatment of severe acidosis in DKA? If so, when?
- When do you start an insulin infusion in patients with hypokalemia? Do you give a bolus followed by a drip?
Thus far we have discussed resuscitation in trauma and sepsis. What distinguishes those two from the resuscitation goals in DKA is timing. In trauma and sepsis, it’s all about early recognition, aggressive and quick optimization, and understanding all the possible treatment options at your disposal. In the management of DKA, it’s quite the opposite. If you remember anything from this discussion, it’s that slow and steady wins the race! In fact, overaggressive resuscitation is what leads to the most significant morbidity and mortality in DKA patients. Patients in DKA don’t die from the disease process – they die because we kill them! [...]