Title 4 Emergency LMV 5.1.pdf ✅

1 | P a g e [ E m e r g e n c y ] © Copyright www.plab1keys.com (Constantly updated for online subscribers) Copyrights @ Plab1Keys.com Emergency Version 5.1 Corrected, Updated, Lighter PLAB 1 Keys is for PLAB-1 and UKMLA-AKT (Based on the New MLA Content-Map) With the Most Recent Recalls and the UK Guidelines ATTENTION: This file will be updated online on our website frequently! (Example: Version 2.6 is more recent than Version 2.5, and so on) Key 1 Hypoglycemia [blood glucose < 4 mmol/L] Hypoglycemia → [Blood glucose < 4 mmol/L] + tachycardia, sweating, confusion, shaking... etc. Causes of Hypoglycemia: √ Excess antidiabetic agents (e.g., insulin, gliclazide) especially if skipped meals. √ Excess Alcohol. √ Liver failure (impaired gluconeogenesis). √ Excess paracetamol, aspirin, sulphonylureas (e.g., glibenclamide, gliclazide). √ Others: Insulinoma, Addison’s, self-administration of insulin/sulphonylureas. Plab1keys.com Strict Copyrights! No Sharing or Copying Allowed by any means Compensations and Penalties Worldwide System is Active
2 | P a g e [ E m e r g e n c y ] © Copyright www.plab1keys.com (Constantly updated for online subscribers) Copyrights @ Plab1Keys.com Manifestations of Hypoglycemia: Tachycardia, Pounding heart, Hunger, Anxiety, Sweating, Confusion, Altered mentation, Coma Management of Hypoglycemia (Important): Can swallow = can tolerate orally, not vomiting. • If Conscious and Can swallow (can tolerate orally) → give 200 ml fruit juice Or Oral glucose gel. • If Unconscious OR Conscious but Cannot swallow → IV Glucose (In case of IV access is already put). OR IM or SC glucagon 1 mg (2 tubes) (In case of IV line is not available or not put yet or difficult to put as in patients who are having seizure/ convulsions).
3 | P a g e [ E m e r g e n c y ] © Copyright www.plab1keys.com (Constantly updated for online subscribers) Copyrights @ Plab1Keys.com Bear in mind that unconscious is different from confused. ◙ In-Hospital Management of Hypoglycemia (Summary): • If the patient is confused but able to swallow → glucose gel (can be squeezed into the mouth between the teeth and gums). • If the patient is confused and unable to swallow → IM glucagon or if there is already an IV line then give IV glucose. Sometimes, a question will not tell you if the patient is able to swallow or not. However, you may find in the stem that the patient has been vomiting. Thus, he cannot swallow (cannot tolerate orally). Examples of Used Concentrations (Important): IV Glucose Over 10 minutes 75 ml of 20% glucose 150 ml of 10% glucose Over 15 minutes 100 ml of 20% glucose 200 ml of 10% glucose Every 1-2 minutes 50 ml of 10% solution given every 1-2 minutes until patient is conscious or 250 ml has been given (5 times repititions). Important notes √ Glucagon is ineffective with alcohol-related hypoglycemia. So, if the cause of hypoglycemia is alcohol → insert IV access and administer IV glucose.
4 | P a g e [ E m e r g e n c y ] © Copyright www.plab1keys.com (Constantly updated for online subscribers) Copyrights @ Plab1Keys.com √ Oral glucose gel should never be used in unconscious patients because of the fear of chocking. Quick Scenarios (Asked Previously) • Quick Scenario (1): A patient with hypoglycemia who is drowsy, sweaty, tachycardic and confused cannot tolerate orally and keeps vomiting. IV access is not put yet. → IM or SC glucagon 1mg. (Confused + Unable to swallow + No IV line) • Quick Scenario (2): Unresponsive Hypoglycemic + Does not have IV access + Having seizure. → IM or SC glucagon 1mg. (He is having seizure; it would be difficult to gain IV access) (He is unresponsive → cannot swallow of course → glucose gel cannot be given). • Quick Scenario (3): Conscious but with altered mentation and confusion (aware of his diagnosis) + Hypoglycemic + Does not have IV access + The cause of his hypoglycemia is profound alcohol intake.