SAQ 2010 – Dyspnoea and cardiac arrest in a dialysis patient

A 62-year-old woman is brought into the resuscitation area by ambulance. She woke from sleep this morning feeling dizzy and short of breath.

Her history includes end-stage renal failure secondary to diabetic nephropathy, haemodialysis through a vas-cath three times a week, left mastectomy for cancer 12 months ago, and a left above-knee amputation from complications of diabetes.

Observations are temperature 36.5 C, BP 120/80 mmHg, HR 43/min regular, SpO2 95% on room air and RR 16/min.

List five causes of shortness of breath in this patient and justify each.

(Marked out of 5.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Cause</th> <th>Justification</th> </tr> </thead> <tbody> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> </tbody> </table> <p>

/ 5

List four investigations that may help delineate the diagnosis and justify each.

(Marked out of 4.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Investigation</th> <th>Justification</th> </tr> </thead> <tbody> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> </tbody> </table> <p>

/ 4

A venous blood gas is taken on room air and the results are shown below. You are about to give calcium resonium when she has a PEA arrest and ALS is commenced.

Parameter	Result
FiO2	0.21
pH	7.31
pCO2	46 mmHg
pO2	20 mmHg
HCO3	22 mmol/L
Sodium	143 mmol/L
Potassium	7.9 mmol/L
Glucose	24.5 mmol/L
Lactate	6.5 mmol/L

List the specific treatment of hyperkalaemic cardiac arrest in this patient.

(Marked out of 4.0)

/ 4

ILCOR recommends modification to the ALS algorithm in certain special situations. Give five examples of these special situations and state a recommendation or modification to the ALS algorithm for each example.

(Marked out of 5.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Special circumstance</th> <th>ALS modification or priority</th> </tr> </thead> <tbody> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> <tr> <td></td> <td></td> </tr> </tbody> </table> <p>

/ 5

Total Score: 0 / 18

Percentage: 0%