@heli_med_james @TheResusRoom @laing_simon Cant wait for this one! Recently had patients pre hospitality with a high BM who are diabetic, kassmauls breathing and sustaining a systolic over 110mmhg.. and haven't given fluids as not indicated only to have A&E give fluids... why and why is it not indicated for pre hospital?

@KatieInnes9 @TheResusRoom @laing_simon Thanks Katie. Episode will be out soon! Regarding fluids, unfortunately the layout of the JRCALC app is not very intuitive and, at times, is contradictory. My SWAST version appears to support fluids to non-shocked patients but not sure if this is SWAST specific?

@heli_med_james @TheResusRoom @laing_simon Use of fluids and fluid boluses prehospital please🙂

@heli_med_james @TheResusRoom @laing_simon Yaaaaassss love managing a DKA in ED.

@heli_med_james @TheResusRoom @laing_simon Low ETCO2 = Confirming DKA?

@heli_med_james @TheResusRoom @laing_simon Role of capillary blood ketone measurements for prehospital care

@heli_med_james @TheResusRoom @laing_simon Urinary v blood ketones. Is there a difference in guided therapy for urinary ketones? Working in a trust that doesn’t have blood ketometers is a constant grey area for us.

@heli_med_james @TheResusRoom @laing_simon Patients are often initially hyperkalaemic alongside being hyperglycaemic (despite low total body potassium). Insulin/dextrose as normal? Insulin bolus? Insulin fixed rate only? Something in between?

@heli_med_james @TheResusRoom @laing_simon If not needing potassium supplementation is there a role for Hartmanns; chloride load vs difference in osmolality? Role of bircarbonate? Should we be placing midlines for repeated sampling?

@heli_med_james @TheResusRoom @laing_simon Who actually needs to go to HDU/ITU? The answer only ever seems to be “give more insulin/fluids”

@heli_med_james @TheResusRoom @laing_simon The “worse at one hour” phenomenon and hyperchloraemic acidosis please! 👍🏻

@heli_med_james @TheResusRoom @laing_simon Can type 2s end up in DKA?

@heli_med_james @TheResusRoom @laing_simon Pre hospital identification and management of DKA and HHS. Identifying patients who are hyperkalaemic and cautions/interventions when managing those patients pre-hospitally.

@heli_med_james @TheResusRoom @laing_simon Management of non ketotic hyperglycaemia eg sick day rules and advice re giving corrections-married a diabetic but easy to forget. Good to mention LADA (late onset diabetes) as is new since I was in med school, what to do about pumps and long acting insulin... @_diabetes101 ?

@heli_med_james @TheResusRoom @laing_simon 15th Feb will be my first day in clinical practice as an ACP! 😃 Think I’ll leave the DKAs to the grown ups for now ..

@heli_med_james @TheResusRoom @laing_simon Hypotensive / shocked DKA: How fast and how much fluid can you give? Protocol 2x500ml bolus' for shocked patients... after that, just the normal regime (which doesnt talk about what to do if the initial bolus doesn't fix the hypotension). How much fluid to cause cerebral oedema?

@heli_med_james @TheResusRoom @laing_simon Also, DKA are usually hyperkalaemic. Most dont treat the hyperkalaemia (ie. Ca, salbutamol, dex / actrapid) they just fix the DKA. Others do treat hyperkalaemia. Which is right?

@heli_med_james @TheResusRoom @laing_simon Euglycemic DKA!

@heli_med_james @TheResusRoom @laing_simon DKA mimics and how to spot them? The validity of standard DKA protocols for euglycaemic DKA (e.g. due to SGLT2 inhibitors) and how to best modify them?

@heli_med_james @TheResusRoom @laing_simon Paediatric DKA: why does starting insulin early increase the risk of cerebral oedema? Adult DKA: what are the risks of rapid correction and what causes them?