PACES AID

Management for Hyperkalemia
First- clinical examination + ECG
1. IV calcium gluconate (10-30mL of 10% solution)
2. Inhaled β2-adrenoceptor agonist (Salbutamol)
3. IV glucose (50 mL of 50% solution) and insulin (5 IU Actrapid)

4. IV sodium bicarbonate ( If acidosis present)
5. IV furosemide and normal saline (If renal function stable)
TO REMOVE K from body
6. Ion-exchange resin (e.g. Resonium) orally or rectally

7. Dialysis

Diltiazem and verapamil are 2 options for rate control strategy for AF
but there are contraindications where these 2 drugs should not be used
Contraindications
1. LVF with pulmonary congestion
2. Severe bradycardia
3. 2nd or 3rd degree heart block
4. Severe hypotension
5. Severe AS
6. CCF
7. Cardiogenic shock
8. Sick sinus syndrome
9. People taking ivabradine also
10. Pregnant women
11. WPW syndrome ( for verapamil)
12. Acute MI complicated by bradycardia, hypotension, or failure (for verapamil)

Can be used With caution
1. People at risk of developing intestinal obstruction
2. Renal or hepatic insufficiency and elderly people
3. People with 1st degree heart block

( ref: NICE- CKS)

3 month preparatory course for PACES
contact for registration
Good luck!

Causes of acute stroke in young patients with preferred investigation
# # # # # # # #
Cerebral infarct
Cardiac embolism-- Echocardiography (including transoesophageal)
Premature atherosclerosis -- Serum lipids
Arterial dissection -- MRI, CTA
Reversible cerebral vasoconstriction syndromes -- MRI, CTA
Thrombophilia -- Protein C, protein S, antithrombin III, Factor V Leiden, prothrombin
Homocystinuria -- Urinary amino acids, Methionine loading test
Antiphospholipid antibody syndrome -- Anticardiolipin antibodies/ lupus anticoagulant
Systemic lupus erythematosus -- ANA
Vasculitis (e.g. primary angiitis of the central nervous system) --- ESR, CRP, ANCA
CADASIL- MRI brain, Genetic analysis, Skin biopsy
CARASIL -- MRI brain , Genetic analysis, Skin biopsy
Mitochondrial cytopathy -- Serum lactate, White cell mitochondrial DNA, Muscle biopsy, Mitochondrial molecular genetics
Fabry’s disease -- Alpha-galactosidase levels
Sickle cell disease -- Sickle cell studies
Neurovascular syphilis -- Syphilis serology
Primary intracerebral haemorrhage
AVM --- MRI/MRA
Drug misuse --- Drug screen (amphetamine, co***ne)
Coagulopathy --- PT and APTT, Platelet count
Subarachnoid haemorrhage
Saccular (‘berry’) aneurysm --- MRI/MRA
AVM --- MRI/MRA
Vertebral dissection --- MRI/MRA