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Lernmaterialien für Emergency Medicine an der University of Calgary

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Other adverse effects of insulin therapy
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Lipohypertrophy (enlargement or thickening of tissue) is due to frequent use of same inj site leading to unpredictable absorption from that site. Rotate injection sites to resolve this.
Lipoatrophy, ie  skin depression is due to insulin antibodies that destroy fat at the site of injection.

Allergic rxns: not xommon with human insulins but switch products to a diff manufacturer if seen.

Immune- mediated insulin resistance: due to antibody prodn also rare. Switch products and consider <dose at initiation of the switch
Lösung ausblenden
TESTE DEIN WISSEN
Goal of therapy time line for newly diagnosed T2DM 
Lösung anzeigen
TESTE DEIN WISSEN
Achieve desired HbA1c in 3-6 months
Lösung ausblenden
TESTE DEIN WISSEN
What is Lactic acidosis 
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TESTE DEIN WISSEN
A rare adverse effect of Mefformin xterized by increased lactate lvls that can cause Sx like hypotension, bradycardia, hypothermia, respiratory distress
Lösung ausblenden
TESTE DEIN WISSEN

What is the use and adverse effects of ipratropium and tiotropium?

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Use:

  • Bronchodilator

Adverse effects:

  • Dry mouth
  • constipation
  • dizziness
Lösung ausblenden
TESTE DEIN WISSEN
Screening for retinopathy, nephropathy, foot, cardio
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TESTE DEIN WISSEN
T1DM: 5 years after diagnosis in pple 》15
T2DM: all at diagnosis
If retinopathy is not present, 
T1DM: rescreen every year
T2DM: rescreen q 1- 2 yrs

Screen with random urine ACR and serum cr for eGFR at diagnosis then annually
Diagnose with repeat confirmed ACR》2.0mg/mmol and or eGFR <60ml/min

For CVD, Resting ECG every 3-5years if age >40, dm>15yrs and age >30, end organ damage, >1 CV risk factor, DM complications 
Foot yearly
Lösung ausblenden
TESTE DEIN WISSEN
Moa of metformin
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TESTE DEIN WISSEN
<es hepatic glucose production, <es intestinal glucose absorption and enhances insulin sensitivity in the peripheral tissues which is why it lowers dose of insulin required ie insulin mediated glucose uptake. <es HbA1c by 1- 1.5%. 
Targets FPG
Lösung ausblenden
TESTE DEIN WISSEN
Components of Glasgow-Blatchford Bleeding Score
Lösung anzeigen
TESTE DEIN WISSEN
This is a score for UGIB -
Hemoglobin
BUN
Systolic BP 
Sex
Tachycardia
Melena 
Recent Syncope 
Hepatic Disease History 
Cardiac Failure Present
Lösung ausblenden
TESTE DEIN WISSEN
Approach to management of T2DM 
Lösung anzeigen
TESTE DEIN WISSEN
Depends on HbA1c & clinical Sx. 
If <1.5% of personalized target, nonRx but initiate meds if not met in 3 months.
If > 1.5% start Metformin c/ç another drug if it is unreasonable to achieve control with Metformin monotherapy.
If high glucose, very symptomatic or showing signs of metabolic decompensation, start insulin c/ç metformin.
Goal is to achieve desired HbA1c in 3-6months
Lösung ausblenden
TESTE DEIN WISSEN
What deficiency is present in chronic alcoholics and what is a complication of this deficiency?
Lösung anzeigen
TESTE DEIN WISSEN
Thiamine deficiency because they are lacking intake of normal nutrients. Can cause Wernicke’s encephalopathy (reversible) or at extreme, Korsakoff’s
Lösung ausblenden
TESTE DEIN WISSEN
Common strep skin infections: 

Lösung anzeigen
TESTE DEIN WISSEN
-Erysipelas 
- Nec Fas (SURGICAL DEBRIDEMENT EMERGENTLY)
Lösung ausblenden
TESTE DEIN WISSEN
Signs and symptoms of L heart failure
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TESTE DEIN WISSEN
Orthopnea
Dyspnea on exertion
Fatigue 
Lösung ausblenden
TESTE DEIN WISSEN
Acute Kidney Injury Approach
Lösung anzeigen
TESTE DEIN WISSEN
Prerenal - not enough blood to the kidneys (shock, edematous states, hypovolemia) (FeNa <1%)
Renal - kidneys not functioning (ATN, AIN, GN) 
Post renal - obstruction of outflow (BPH, prostate cancer) 
Lösung ausblenden
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Q:
Other adverse effects of insulin therapy
A:
Lipohypertrophy (enlargement or thickening of tissue) is due to frequent use of same inj site leading to unpredictable absorption from that site. Rotate injection sites to resolve this.
Lipoatrophy, ie  skin depression is due to insulin antibodies that destroy fat at the site of injection.

Allergic rxns: not xommon with human insulins but switch products to a diff manufacturer if seen.

Immune- mediated insulin resistance: due to antibody prodn also rare. Switch products and consider <dose at initiation of the switch
Q:
Goal of therapy time line for newly diagnosed T2DM 
A:
Achieve desired HbA1c in 3-6 months
Q:
What is Lactic acidosis 
A:
A rare adverse effect of Mefformin xterized by increased lactate lvls that can cause Sx like hypotension, bradycardia, hypothermia, respiratory distress
Q:

What is the use and adverse effects of ipratropium and tiotropium?

A:

Use:

  • Bronchodilator

Adverse effects:

  • Dry mouth
  • constipation
  • dizziness
Q:
Screening for retinopathy, nephropathy, foot, cardio
A:
T1DM: 5 years after diagnosis in pple 》15
T2DM: all at diagnosis
If retinopathy is not present, 
T1DM: rescreen every year
T2DM: rescreen q 1- 2 yrs

Screen with random urine ACR and serum cr for eGFR at diagnosis then annually
Diagnose with repeat confirmed ACR》2.0mg/mmol and or eGFR <60ml/min

For CVD, Resting ECG every 3-5years if age >40, dm>15yrs and age >30, end organ damage, >1 CV risk factor, DM complications 
Foot yearly
Mehr Karteikarten anzeigen
Q:
Moa of metformin
A:
<es hepatic glucose production, <es intestinal glucose absorption and enhances insulin sensitivity in the peripheral tissues which is why it lowers dose of insulin required ie insulin mediated glucose uptake. <es HbA1c by 1- 1.5%. 
Targets FPG
Q:
Components of Glasgow-Blatchford Bleeding Score
A:
This is a score for UGIB -
Hemoglobin
BUN
Systolic BP 
Sex
Tachycardia
Melena 
Recent Syncope 
Hepatic Disease History 
Cardiac Failure Present
Q:
Approach to management of T2DM 
A:
Depends on HbA1c & clinical Sx. 
If <1.5% of personalized target, nonRx but initiate meds if not met in 3 months.
If > 1.5% start Metformin c/ç another drug if it is unreasonable to achieve control with Metformin monotherapy.
If high glucose, very symptomatic or showing signs of metabolic decompensation, start insulin c/ç metformin.
Goal is to achieve desired HbA1c in 3-6months
Q:
What deficiency is present in chronic alcoholics and what is a complication of this deficiency?
A:
Thiamine deficiency because they are lacking intake of normal nutrients. Can cause Wernicke’s encephalopathy (reversible) or at extreme, Korsakoff’s
Q:
Common strep skin infections: 

A:
-Erysipelas 
- Nec Fas (SURGICAL DEBRIDEMENT EMERGENTLY)
Q:
Signs and symptoms of L heart failure
A:
Orthopnea
Dyspnea on exertion
Fatigue 
Q:
Acute Kidney Injury Approach
A:
Prerenal - not enough blood to the kidneys (shock, edematous states, hypovolemia) (FeNa <1%)
Renal - kidneys not functioning (ATN, AIN, GN) 
Post renal - obstruction of outflow (BPH, prostate cancer) 
Emergency Medicine

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