Brain Food is a project to drip feed clinical knowledge (in the form of mock SAQs) to satisfy those hungry neurons. Sources are credited & answers are from the source and prone to ageing. Leave a comment if you don't understand or something doesn't seem right...
PS we don't use the mock questions uploaded to ACEMs official mocks
Her past medical history includes polymyalgia rheumatica and osteoporosis.
Her medications are: aspirin 100mg mane, prednisone 12mg mane, alendronate 10mg mane.
She is pale, drowsy and generally weak, but with no focal neurological deficits.
She is peripherally cool, with dry mucous membranes. Her abdomen is soft, with no focal tenderness.
On examination her vitals are:
O2 sats 98% RA
Despite an initial 1000ml N.Saline fluid bolus, her systolic BP remains in the 70s.
Initial bedside VBG:
- Known steroid dependence/steroid, with concurrent illness
- Consistent presentation: refractory shock, hypoglycaemia, NAGMA, hyponatremia
IV hydrocortisone/dexamethasone: 100mg IV hydrocortisone OR 4-8mg IV
IV fluids: Further 1L N Saline bolus IV then commence inotropes if SBP <100mmHg
Inotropes: Noradrenaline 5-10 mcg/min IV infusion aim SBP >100mmHg/MAP>65 or
improved end organ perfusion
Broad spectrum antibiotics for sepsis: (marks for anything reasonable to cover either
sepsis ? source or intra-abdominal sepsis): flucloxacillin 2g IV PLUS gentamicin 7mg/kg
IV, or piptaz 4.5g IV
or tripling PO steroids.