I’m entering a few months prep for the UK and Ireland exit exam in Emergency Medicine: the FRCEM. I’ll be adding lots of little notes on pearls I’ve learned along the way. A lot of my revision is based around the Handbook of EM as a curriculum guide and review of contemporary, mainly UK guidelines. I also focus on the areas that I’m a bit sketchy on. With that in mind I hope they’re useful.
You can find more things on the FRCEM on this site here
Name some causes of hyper Ca
- Malignancies
- myeloma
- breast
- renal
- lung
- of note 20% of hyperCa with malignancy has no bone mets
- even in those with bone mets the commonest mechanism of hyper Ca is known as Humoral hypercalcaemia and from the tumour producing “parathyroid hormone related peptide” (ref)
- hyperparathyroidism
- paraneoplastic syndromes
- sarcoid
- addisson’s
- dehydration
- drugs
- lithium
- thiazides
- prolonged cuff time when measuring
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What are the ECG changes?
- QT shortening (of note in hypocalcaemia the QT gets longer but that’s about the only ECG change
- J waves (osborne waves) can happen
- eventually can have ventricular arrhthmia
- widening of the QRS
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Management
- fluids/rehydration
- bisphosphonates
- calcitonin
- diruetics (not without its critics)
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