Medical Flashcards
When should NIV be considered in COPD
Within 60 mins in all pt’s with eCOPD and a persistent resp acidosis (pH<7.35 and PaCO2>6.5) or RR>23 in whom medical rx is unsuccessful
Absolute contraindications for NIV
Severe facial deformity
Facial burns
Fixed upper airway obstruction
PNX Chest drain insertion
If pnx >2cm at the hilum OR SOB!
Reticulated and erythematous rash over the legs in elderly patients who are otherwise well.
Erythema ab igne - secondary to chronic exposure to infrared radiation usually from heat sources
What must be present to diagnose DKA?
D - BM >11 or known DM
K - Ketones >3 in blood or 2+ or more urine
A - HCO3<15 or pH<7.3
Reversal agent for Dabigatran
It is a direct thrombin inhibitor and is reversed by Idarucizumab
What are the relative NIV contraindications (5)
PH <7.15
PH<7.25 and other adverse feature
GCS<8
Confusion/agitation
Cognitive impairment
What are the initial settings for NIV setup?
EPAP 3 (or higher if known OSA)
IPAP 15 (20 if pH<7.25)
Uptitrate over 10-30 mins.
Do not exceed 30/8 without expert review
What is the reversal agent for riavroxaban/apixaban?
They are both factor Xa inhibitors and are reversed by andexanet Alfa
How do you perform an LSBP?
- Take BP after lying for at least 5 mins
- Take BP within 1 min of standing
3 take BP after three mins of standing
What’s is a positive postural drop? (3)
- A systolic drop of 20mmHg or more (with or without st)
- A drop in SBP below 90 (with or without st)
- A diastolic drop of 10 or more with st
Features of life threatening asthma
SpO2 <92%
PEFR<33% of predicted/best
Cyanosis/confusion
Hypotension
Exhaustion/poor resp effort
Silent chest
Tachy arrhythmia
What are the features of acute chest syndrome in sickle cell ds.? (4)
Abnormal resp signs/st
Chest pain
Fever
Hypoxia
- sats 95% and below
- escalating oxygen requirement
What are the complications seen with acute painful sickle cell episodes? (5)
Acute stroke
Aplastic crisis
Infections
Osteomyelitis
Splenic sequestration
Explain the findings on a HINTS exam that would suggest a central cause?
- HI normal in central (positive = peripheral)
- Nystagmus - vertical, rotational, or bidirectional horizontal in central. (Unidirectional horizontal in P)
- Vertical skew correction in Central
What is a complication if inferior myocardial infarcts?
Complete HB
- the RCA supplies the AV node
What is the Dix-Hallpike test and what does it tell you?
Turn head 45 degrees and lay the pt backwards with neck extension. Look for onset of nystagmus and st of vertigo.
If +ve - indicates BPPV
So perform epley manoeuvre
What are the causes of methaemaglobinaemia?
Congenital
Medications: chloroquine, prilocaine (LA’s), metoclopramide, nitrites
Low sats with normal PaO2. Chocolate blood. Cyanosis and sn of reduced O2 delivery.
Why is levopromazine recommended in EoL care?
It is an anti-emetic with analgesic and sedative properties.
What can trigger ocular gyros crises/extrapyramidal SE?
Metoclopramide, haloperidol, neuroleptics/anti-psychotics
Rx. With procyclidine
What is the MOA for Heparin?
Anti-thrombins. They bind thrombin 3, preventing activation for clotting factor X to Xa