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Acute assessment > A-E for specific emergencies > Flashcards

A-E for specific emergencies Flashcards

1
Q

Initial management of ACS

A

MONAC

  • Morphine - 10mg in 10mL slowly IV (+ metoclopramide IV)
  • Oxygen - if outside 94-98% target
  • Nitrates - sublingual GTN/2sprays
  • Aspirin - 200mg PI loading dose (then 74mg OD)
  • Clopidogrel: 300-600mg PO loading dose (then 75mg OD) ; if undergoing PCI, preferred if prasugrel (1 dose of 60mg PO, then 10mg OD)

+ refer to cardiology for reperfusion if indicated

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2
Q

Indications for PCI

A
  • emergency: STEMI (any amount of ST elevation/ new LBBB)

- urgent: NSTEMI; unstable angina

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3
Q

Short term management ACS for

(1) ST elevation
(2) non-ST elevation
(3) all

A

(1) reperfusion therapy - PCI
(2) stabilize medically and admit for cardio review - high risk (raised troponin/persistent pain/ST depression/diabetics) = semi-elective/urgent
(3)
- ACS-specific LMWH 5/7 + hospital protocol for VTE prophylaxis
- admit 4-7 days (testing cardiac enzymes + investigation +/- reperfusion)
- start some of the long term meds - B-blocker (reduces myocardial demand); ACEi btw 6-24hrs after an MI or LVF (prevents cardiac remodelling)
- correct eletrolytes

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4
Q

ACS-specific LMWH

A
  • subcut fondaparinux 2.5mg OD or
  • enoxaparin 1mg/kh

if PCI planned <24hrs (in a STEMI) unfractionated heparin)

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5
Q

Findings - ACS

A
  • ECG - ST elevation/new LBBB, inverted T waves, Q waves
  • Troponin - increased (in unstable angina is N)
  • CXR - normal +/- HF
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6
Q

Definitive test - ACS

A

coronary angiography - see occlusion

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7
Q

Classical history - ACS

A
  • crushing central chest pain
  • radiation to neck/left arm
  • A/w nausea/SOB/sweating
  • CVD risk factors
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8
Q

Signs - tension pneumothorax

A
  • Resp distress - incr WOB
  • tachycardia, hypotension, hypoxia
  • tracheal deviation to OPPOSITE side
  • incr percussion note + absent breath sounds on affected side
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9
Q

Initial management - tension pneumothorax

A

Needle thoracostomy
- Confirm side
- Sterility
- 14-16G (orange/grey) IV cannula + 10mL syringe
- second intercostal space; mid clavicular line at 90degrees, anove 3rd rib
- once air is aspirated, advance cannula (tube not needle) + secure with tape
= now a simple pneumothorax

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10
Q

Definitive management pneumothorax

A

chest drain

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11
Q

Classical history - pneumothorax

A
  • sudden onset pleuritic chest pain
  • may be SOB
  • risk factors = Marfan’s appearance, COPD/asthma
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12
Q

Signs - simple pneumothorax

A

ispilateral

  • reduced chest expansion
  • absent breath sounds
  • hyperresonance
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13
Q

management simple pneumothorax

A 
1ry 
- <2cm - CXR monitoring
- > 2cm or Sx - aspirate
2ry 
- <1cm - observe 24hrs
- 1-2cm - aspirate
- >2cm or Sx - chest drain
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14
Q

Classic presentation - arrhythmia

A
  • fall after transient arrhythmia
  • +/- palpitations or ‘feeling strange’ prior to collapse
  • cardiac PMH or FHX of sudden death
  • during exercise or when supine
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15
Q

Initial management - arrhythmia

A
  • no pulse: cardiac arrests ALS algorithm
  • any adverse signs +
    tachy -> synchronised DC cardioversion
    brady -> atropine +/- pacing
  • no adverse signs - according to type of arrhytmia

all

  • apply defibrillator’s 3-lead cardiac monitoring
  • treat reversible causes (electrolyte abnormalities)
  • Review 12 lead ECG to find cause
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16
Q

Adverse signs in arrhythmias

A
  • shock (SBP<90)
  • Syncope
  • Myocardial ischaemia (chest pain)
  • Heart failure
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17
Q

Initial management - sinus tachycardia

A

1- treat cause

2- if necessary = beta blocker or rate-limiting Ca2+ channel blocker (verapamil)

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18
Q

Initial management - First onset AF

A

Life-threatening haemodynamic instability: emergency electric cardioversion
Non-life-threatening haem instability
- <48hrs rate or rhythm control
- > 48hrs/unknown/risk factors (>65 + IHD/no sx) - rate control (b-blocker or verapamil IV)

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19
Q

Pharmacological cardioversion

A

IV amiodarone hydrochloride

  • 1st - 5mg/kg over 20-120mins / ECG monitoring
  • max 1.2g/day
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20
Q

Define ‘paroxysmal’ SVTs

A

= narrow complex tachy + regular (no/abnormal P waves)

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21
Q

Initial management - ‘Paroxysmal’ SVT

1st - 3rd line

A

1st - vagal manoevres
2nd - IV adenosine 6mg (if asthma use CCB)
3rd - B blocker

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22
Q

Define - Atrial fibrillation

A

irregular with no P waves

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23
Q

Define - Atrial flutter

A

regular with sawtooth baseline

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24
Q

Initial management - atrial fibrillation or flutter

A

1- treat cause
2a - if >65yr + IHD/no Sx/not suitable for cardioversion => b-blocker or rate-limiting CCB (digoxin if sedentary)
2b - if not above + clear onset <48hrs => electrical DC cardioversion or pharmacological (flecanide or amiodarone if structural heart disease)
3- reduce thromboemoblic risk if not cardioverted - LMWH/warfarin

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25
Q

ECG features of VT

A
  • rapid HR >100
  • regular
  • uniform QRS in each lead
  • V broad QRS >160ms
  • AV dissociation (P and QRS at different rates)
    = looks like mostly up and down waves u
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26
Q

ECG Features of polymorphic VT (Torsade de pointes)

A

VT with varying amplitude

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27
Q

ECG features of broad complex tachy of supraventricular origin

A
  • Mimics VT
  • pre-existing BBB/WPW
  • more likely if irregular QRS
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28
Q

Define - sustained VT

A

> 30 secs

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29
Q

Initial treatment - Sustained VT

A

pharmacological cardioversion

= amiodarone

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30
Q

Initial treatment polymorphic VT / torsades de pointes

A

magnesium sulphate

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31
Q

Initial management - broad complex tachycardia of supraventricular origin

A

not sure if SVT origin or VT = treat as VT (amiodarone
1a - SVT or AF w/ BBB = treat as AF (treat cause, rate control if old, rhythm control if young - amioderone)
1b - SVT or AF with pre-excitation syndrome = amiodarone

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32
Q

Causes - Bradycardia`

A

AV hear block
Sinus brady
- extrinsic = drugs (B-blockers, ditialis), neural syndromes (carotid sinus hypersensitivity, vaso-vagal syncope), hypothermia, hypothyroid
- intrinsic = ischaemia/infarct of SA node; fibrosis of artium and SA node

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33
Q

Adverse signs or risk of asystole in bradycardia

A
  • Mobitz II (unpredictable dropping QRS)
  • Complete heart block (no connection btw P and QRS) + broad QRS
  • Ventricular pauses > 3 secs
  • Recent asystole
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34
Q

management of bradycardia

A

1- treat cause
2- haemodynamic instability/.risk of asystole - atropine; if continues get transvenous pacing (interim - further atropine + transcutaneous pacing)
3- haemodynamically stable+ no risk of asystole - observe
4- permanent pacing = Mobitz type II, 3rd degree HB

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35
Q

Adenosine
a- indication
b- Dose + route

A

a- reverting to sinus rhythm in paroxysmal supraventricular tachycardia
b. 6mg IV blous flushed quickly, followed by another 12mg x 2

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36
Q

Amiodarone

a. indication
b. dose + route
c. total dose/day

A

a. pharmacological cardioversion in structural heart disease - in SVT, V fib, VT
b. (cardioversion_ 300mg IV over 20-60min
c. 1.2g over 24hrs

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37
Q

Atropine

a. indication
b. dose + route + frequency
c. max dose

A

a. reverting to sinus from bradycardia
b. 500mcg IV + repreat every 3-5min
c. max 3mg needed

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38
Q

Magnesium sulphate

a. indication
b. dose + route
c. max

A

a. Torsades de pointes - VT with varying amplitudes
b. 2g IV over 10-15mins
c. repeated once if necessary

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39
Q

equipment set up in arrhythmias

A
  • 3-lead cardiac monitoring (Ride Your Green Bike) = Red on right shoulder, Yellow on left shoulder, Green on ASIS, Black not on defib machines
  • defib pads - Right - longitudinally on left sternal edge; left - longitufinally on left paraspinal muscles (in line w/ each other)
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40
Q

defib settings in broad complex tacgt ir AF

A
  • synchronised mode
  • 150J -> 200J –> 200 J
  • biphasic
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41
Q

defib settings in narrow complex tachy of afib

A
  • synchronised mode
  • 70J –> 120J –> 200J
  • biphasic
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42
Q

Classify - Life threatening asthma

A

33, 92 CHEST

  • PEFR <33% predicted/baseline
  • <92% sats
  • Cyanosis
  • Hypotension
  • Exhaustion
  • Silent chest
  • Tachycardia
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43
Q

Classify - Severe asthma

A
  • PEFR 33-50% predicted/baseline
  • can’t complete sentences
  • RR >25
  • HR> 110
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44
Q

Initial management - ashtma attack

A 
O SHIT ME!
Oxygen - oxygen driven nebs
Salbutamol - 2.5-5mg NEB
Hydrocortisone 100mg IV (or pred 40mg PO)
Ipratropium - 500mcg NEB
Theophylline- aminophylline infusion 1g in 1L saline 0.5ml/kg/h
Magnesium sulphate - 2g IV over 10 mins
Escalate care (intubation/ventilation)
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45
Q

Describe - back to back nebs in asthma

A

5-10mg/ hr salbutamol neb

ipratropium 4-6 hrly

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46
Q

When to escalate asthma attack

A

if not responding to nebulized treatment (needing any IV)

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47
Q

Initial management COPD

A
  • O SHIT ME as per asthma but O2 in 24-28% venturi mask
  • ABG after 15 mins O2 ot determine further ventilation
  • consider NIV
  • antibiotics as per guidance (i.e doxycycline 10mmg OD)
  • 5/7 prednisolone 30mg
  • chest physio
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48
Q

Investigations to order - asthma attack/COPD exac

A
  • ABG
  • CXR
  • Bloods - regular incl potassium monitoring
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49
Q

Examination findings - peritonitis

A
  • no movement w/ respiration
  • guarding
  • firm, peritonitic abdomen
  • rebound tenderness
  • severe pain to light palpation
  • percussion tenderness
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50
Q

Differentials - peritonitis

A
  • perforated viscus - peptic ulcer, colonic tumour, gallbladder, appendix, spleen, ectopic
  • AAA
  • spontaneous bacterial peritonitis
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51
Q

Clinical history - peritonitis

A

Severe generalised abdominal pain

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52
Q

Investigations to order - peritonitis

A
  • erect CXR - look for pneumoperitoneum (perf)

- urgen CT abdo/pelvis

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53
Q

Initial management - peritonitis

A
  • 2 wide bore IV cannula
  • fluid resus
  • NBM
  • Urgent laparotomy and repair
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54
Q

Clinical history - AAA

A
  • severe generalised abdo pain
  • back pain
  • reduced GCS/collapse
  • elderly
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55
Q

Examination findings - AAA

A
  • hypotension
  • peritonitis
  • expansile mass
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56
Q

Management - AAA

A
  • super urgent vasc referral and surgery

- only CT is stable

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57
Q

clinical history renal colic

A
  • spasms/loin to groin pain
  • nausea and vomiting
  • cannot lie still
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58
Q

examination findings - renal colic

A
  • SNT abdo

- renal angle tenderness

59
Q

Investigations to order - renal colic

A
  • CT KUB
60
Q

Differentials to appendicitis

A
  • Meckel’s diverticulum (left over umbilical cord gets infected)
  • Chron’s
  • mesenteric adenitis
  • ovarian pathology - rupture/torsion/haemorrhage
  • ectopic pregnancy
61
Q

clinical history - appendicitis

A
  • young patient
  • periumbilical pain moves to RIF
  • anorexia
62
Q

examination findings - appendicitis

A
  • Tender RIF
  • worse tenderness at McBurney’s point
  • Guarding/local peritonitis
  • Rosving’s +ve
63
Q

Define McBurney’s point

A

point lying 1/3 of distance laterally from right ASIS to umbilicus

64
Q

Define - Rosving’s sign

A

pain on RIF when palpating LIF

65
Q

Investigations - appendicitis

A

USS abdo/pelvis to rule out gynae differentials

66
Q

Initial management - appendicitis

A
  • IV access
  • Fluid resus
  • pain relief
  • NBM
  • urgent laparoscopy/appendicectomy
67
Q

Clinical presentation - biliary colic

A
  • intermittent RUQ pain

- exacerbated by fatty food

68
Q

clinical presentation - cholecystitis

A
  • continuous RUQ
  • Murphy’s +ve
  • tender + guarding RUQ
69
Q

Murphy’s sign

A

pain in inspiration when you palpation the right subcostal area
= inflamed gallbladder touches hand)

70
Q

clinical presentation - common bile duct stones

A
  • jaundice

- RUQ pain

71
Q

clinical presentation - cholangitis

A
  • jaundice
  • fever/rigors
  • RUQ pain
72
Q

clinical presentation - acute pancreatitis

A
  • severe epigastric/umbilical pain
  • radiates to back
  • relieved by sitting forwards
  • vomiting
73
Q

examination findings - acute pancreatitis

A
  • epigastric tenderness
  • tachycardia
  • fever
  • shock
  • Grey Turner’s and Collen’s sign (periumbilical and C-shaped flank bruising)
74
Q

Clinical presentation - Peptic ulcer

A
  • epigastric pain

- related to meals

75
Q

Investigations - pancreatitis

A
  • bloods - routine + amylase/lipase + triglycerides + immunoglobulins
  • USS to exclude gallstones
  • CT abdo if >diagnosis
  • Apache II/Glasgow score – ABG + serum calcium
76
Q

Clinical presentation - diverticulitis

A
  • Elderly
  • LIF pain
  • pyrexia
77
Q

exam findings - diverticulitis

A
  • tender LIF
  • guarding/local peritonitis
  • PR - confirm no CA / abscesses
78
Q

investigation - diverticulitis

A
  • bloods - routine
  • urine dip
  • flexible sigmoidoscopy
79
Q

initial management - acute pancreatitis

A
  • supportive - fluids (lot sof IV crystalloids bc 3rd space sequestration) + pain
  • NBM +/- NG tube
  • stop causative meds
  • no abx unless proven infection
  • treat cause
  • ITU + O2 may be required
80
Q

initial management - biliary colic

A
  • supportive

- OPT cholecystectomy

81
Q

Initial management - cholecystisis

A
  • abx - ciprofloxacin

- cholecystectomy (4wk)

82
Q

initial management - common bile duct stome

A
  • continuous IV (prevent hepato-renal syndrome

- ERCP stone removal

83
Q

Initial management cholangitis

A
  • IV abx - cipro/tazocin

- treat cause

84
Q

initial management - peptic ulcer

A
  • H.pylori eradication if cause
  • PPI (after stool sample collection) - omeprazole PO / pantoprazole IV
  • gastroscopy + biopsy
85
Q

initial management diverticulitis

A
  • NBM

- bowel antibiotics - ceftriaxzone + metronidazole

86
Q

clinical presentation - bowel obstruction

A
  • vomiting
  • abdo pain
  • no bowel movements/flatus
87
Q

examination findings - bowel obstruction

A
  • distended
  • tender
  • tinkling bowel sounds
88
Q

investigations - bowel obstruction

A
  • abdo xray

- if confirmed - CT abdo/pelvis

89
Q

Initial management - bowel obstruction

A
  • Supportive - fluids + pain
  • NBM
  • wide bore NG tube - free drainage
  • Laparoscopy/laparotomy (depending on cause)
90
Q

Clinical presentation - ectopic pregnancy

A
  • incr iliac fossa/pelvic pain
  • abt 6 weeks pregnant - recent
  • may have spotting
91
Q

examination findings - ectopic pregnancy

A
  • tenderness R/LIF
  • guarding
  • adnexal tenderness
  • cervical excitation
92
Q

Investigations - ectopic pregnancy

A
  • serum bHCG - trend
  • transvaginal USS
  • vaginal swabs
93
Q

initial management - ectopic pregnancy

A
  • 2 wide bore IV cannulae
  • supportive - fluid + pain
  • medical = if uncomplicated = methotrexate
  • surgical = laparoscopy
94
Q

Confirming diagnosis of DKA

A
  • Glucose >11mmol/L / known diabetes
  • pH <7.3 or HCO3 <15
  • Capillary ketones >3mmol/L or ++ urinary ketones
95
Q

Fluid management in DKA

A
  • priority is to hydrate - initial 1st L of saline asap
  • titre K replacement based on VBG
  • insulin - 0.1unit/kg/hr (max 15units/hr) from fast acting insulin (actrapid) in 50mL saline
  • when cap glucose is <14 give 10% IV glucose
96
Q

principles in treatment of DKA

A
  • rehydrate and replace
  • continue/start long acting insulin + return to normal insulin when acid-base + ketones fully corrected and eating and drinking
  • NG tube (prevent aspiration)
  • LMWH prophylaxis
97
Q

confirming diagnosis HHS

A
  • glucose >11mmol/L (usually 30)
  • osmolarity >320
  • absence of significant ketosis
98
Q

management HHS

A
  • rehydrate - 9L/24hrs
  • insulin - withhold for 1hr, if glucose not decr then infuse at 0.05units/kg/hr
  • investigate cause
  • stop metformin
99
Q

management hyperglycaemia (not DKA or HHS)

A
  • rehydrate
  • STAT dose novorpaid or actrapid insulin - T1 (1 unit, aim BM <12) T2 (0.1unit/kg aim BM <14)
  • investigate cause
  • adjust insulin/recheck glucose
100
Q

Management - hypoglycaemia (unconscious)

A
  • 150mL 10% glucose ; 75mL 20% glucose IV STAT
  • glucagon 1mg IM if no IV access ( repeat only 1-2x)
  • re-check BM
  • give long acting carb to swallow when possible
101
Q

Management - hypoglycaemia (conscious w/out swallow)

A
  • 1.5-2 tubes glucose gel around teeth
  • recheck BM
  • long acting carb to swallow when possible
102
Q

Management - hypoglycaemia (conscious + swallow)

A
  • 15-30g fast acting carbs (7-5 glucose tablets/150mL fruit juice/lucozade)
  • long acting cab (buiscuits/toast)
103
Q

Causes hyperglycaemia

A
  • DKA or HHS
  • Sepsis
  • Steroids
  • missed hypoglycaemics/insulin
  • pancreatitis
  • dehydration
  • meal/feeds
104
Q

causes of hypoglycaemia

A
  • not enough going in - poor oral intake/ vomiting
  • too much going out - insulin excess/sulfonylureas; decr renal function thus decr drug excretion; alcohol; abrupt steroid dicontinuation
105
Q

Initial management - CAP

A
  • Oxygen - 15L non-re-breath mask (or 24-28% venturi if retainer)
  • antibiotics
  • IV fluids
  • antipyretic
  • VTE
106
Q

Elements of CURB 65

A 
C - new onset confusion
U - urea >7mmol/L
R - resp rate >30/min
B - systolic BP <90, diastolic <60
65 - age
107
Q

causes of acute confusion

A
  • infection
  • metabolic abnormalities - hypoglycaemia, hyponatraemia, hypercalcaemia
  • drugs - opiates, corticosteroids, benzodiazepines
  • alcohol withdrawal
  • surgery
  • intracranial pathology (subdural haematoma)
108
Q

why perform ECG in an infectious presentation?

A
  • differential for new onset confusion

- infection can cause arrhythmias (AF)

109
Q

Initial management - pulmonary embolus

A
  • oxygen
  • LMWH +/- warfarin while awaiting CTPA - fondaparinux 10mg SC STAT
  • analgesia - paracetamol
  • haemodynamically unstable = may be thrombolysis + senior
110
Q

Findings - PE

A
  • ABG - mild = N; medium/large = resp alkalosis (low PaCO2 hyperventilation, low PaI2); massive = metabolic acidosis (hypoacaemia + anaeropbic metabolism)
    = D-dimer -raised
  • CXR, N / pleural effusions
  • ECG - sinus tachy; RV strain (T wave inversion V1-4 + RBBB); uncommon S1Q3T3
  • CTPA
111
Q

Gold standard diagnosis - PE

A

CTPA

112
Q

Score for PE risk

  • name
  • main components
A

Revised Geneva Score - points for stasis + hypercoagulability + signs (unilat limb pain and tenderness, haemoptysis, mild raised HR

113
Q

How to use Geneva Score

A
  • > 10 pts - high –> CTPA
  • low/intermediate –> D-dimer
  • D-dimer +ve –> CTPA
  • D-dimer -ve –> not PE
114
Q

Definitive management - PE

A

anticoagulation

  • bridge w/ heparing/fondaparinux (longer term anticoag started when INR 2)
  • warfarin (except if cancer - LMWH)
  • anticoagulation clinic
115
Q

Initial treatment - Acute Pulmonary Oedema

A

POD MAN
Position - sat up
Oxygen
Diuretic (furosemide) + fluid restriction
Morphine
Anti-emetic
Nitrates (GTN infusion of SBP >110 in crashing PO)

treat cause

116
Q

Possible complication + management - Acute pulmonary oedema

A
  • hypoxic despite interventions –> CPAP

- cardiogenic shock (hypotension + overload) –> dobutamine (an inotrope)+/0 balloon pump in ICU

117
Q

Causes + definitive management - Acute pulmonary oedema

A
  • Aortic/mitral regurgitation –> valvuloplasty
  • MI –> PCI
  • arrhythmia - rhythm/rate/caridoversion
  • hypertensive crisis –> antihypertensives
  • tamponade –> pericardiocentesis
118
Q

Investigations - Acute Pulmonary Oedema

A
  • ECG - ?LV failure due to ACS
  • CXR
  • Echocardiogram
  • BNP
119
Q

Fluid management in acute pulmonary oedema

A
  • strict fluid balance charting –> catheterise
  • fluid restriction
  • diuretic
  • serial weights
120
Q

Investigations - Acute HPB complications

A
  • Bloods - FBC, U&Es, LFTs, CRP, coag screen, glucose, blood cultures if infection
  • CXR
  • Urine dip and MSU
  • Abdo USS
  • Ascitic tap (if present)
121
Q

Signs - Decompensation of Chronic Liver Disease

A
  • jaundice
  • ascites
  • encephalopathy
122
Q

Causes - Decompensation of Chronic Liver Disease

A
  • Spontaneous Bacterial Peritonitis / sepsis
  • dehydration/AKI
  • UGI bleed
  • constipation
  • portal vein thrombosis
  • drugs
  • liver ischaemia
  • HCC
123
Q

Initial management - Decompensation of Chronic Liver Disease

A
  • treat cause (i.e - constipation - lactulose/enema)
  • avoid sedatives
  • ICU required
124
Q

Presentation - Hepato-renal failure

A

worsening renal function in advanced chornic liver disease w/out explanation + not responding to fluids

125
Q

Management - hepato-renal syndrome

A
  • fluid balance monirtoring + daily weights
  • suspend nephrotoxic drugs
  • 5% human albumin solution boluses
    arterial vasconstrictors - terlipressin
126
Q

Presentation - spontaneous bacterial peritonitis

A

Sepsis/signs of infection in pt w/ ascites

127
Q

Management - spontaneous bacterial peritonitis

A
  • ascitic tap
  • IV antibiotics
  • 20% human albumin solution
128
Q

Management - alcohol withdrawal

A
  • pabrinex

- chlordiazepoxide - avoid DT

129
Q

initial management - seizure

A
  • maintain airway
  • Oxygen - 15L non-rebreather
  • recovery position
  • if possible - secure IV access and begin investigations
130
Q

Investigations - seizure

A
  • cap glucose
  • VBG - lactate/acidosis
  • bloods - FBC, U&E (hypoNa or incr urea, Calcium (hyperCa), clotting
  • special bloods - anti-epileptic drug levels
  • ECG - prolonged QTc
  • Further - CT head; EEG
131
Q

common causes of seizures

A
  • neuro - epilepsy; tumour; meningitis/encephalitis; post-stroke; head trauma; congenital abnormalities; peri-natal hypoxia
  • metabolic: hypoglycaemia, hypoNa, HyperCa, hyperuricaemia
  • drug overdose, alcohol withdrawal, toxins
  • febrile convulsion
  • eclampsia
132
Q

pharmacological seizure management

A
  • 10 mins = 4mg IV lorazapam/10mg IV diazepam; if no IV 10-20mg PR diazepam
  • 20 mins: repeat
  • 30 mins: phenytoin 18mg/kg IV at 50mg/min + ECG monitoring
  • 60mg: GA in ICU
133
Q

causes of post-op pyrexia based on time post surgery

A
  • <2 days atelectasis
  • 2-4 days - pneumonia
  • 4-6 days- anastomotic leak/ infected collections
  • 6-8 days - wound infection
  • 8-10 days - DVT or PE
134
Q

Causes of post-op hypotension (5 categories)

A
  • decr intravascular volume long ops, evaporative fluid losses, third space fluid loss, haemorrhage, poor al intake
  • pump failure/cardiogenic shock - MI due to surgical stress (abt 48hrs postop); consider fluid overload and HF
  • sepsis
  • anaphylaxis
  • sympathetic shock : epidura and high block s(above T) can lose symathetic outflow = vasodilation and cardiogenic shock
135
Q

Clinical signs of hypotension/poor perfusion

A
  • delayed CRT
  • cold peripheries
  • low BP, high HR
136
Q

investigation for organ dysfunction (in shock)

A
  • ABG - lactate and gases
  • assess urine output (N >0.5ml/kg/h)
  • confusion
137
Q

Investigating respiratory complication post-op

A
  • ABG
  • ? infection - bloods, swabs, CXR
  • fluid state - urine output, JVP, clinical hydration
  • clots - assess calves, ecg, consider ddimer and CTPA
138
Q

Respiratory complications post-op + rational (3)

A
  • infection : immobility, poor resp effort due to inadequate pain control + basal atelectasis
  • PE: hypercoagulable state due to surgery +/- underlying pathology (i.e - sepsis)
  • Pulmonary oedema: large fluid shift, hypoalbuminaemia ( + predisposed by cardiac dysfunction)
139
Q

Causes of - Low urine output post-op

A

= <0.5ml/kg/hr

  • pre-renal = volume depletion, inadequate CO
  • renal = nephrotoxic drugs (aminoglicosides, metformin)
  • post-renal = prostatic hypertrophy, raised intra-abdominal pressures compressing ureters
140
Q

Investigations - low urine output post-op

A
  • fluid assessment trend (incl from drains and 3rd space losses into bowels/tissues)
  • medicine review
  • examine catheters
141
Q

Early post-op complications (10)

A
  • fluid depletion
  • electrolyte imbalances
  • local infection (wound/ surgical site)
  • systemic infection (chest/UTI/sepsis)
  • fluid collections
  • atelectasis
  • DVT/PE
  • wound break down/dehiscence
  • anastomotic breakdown
  • bed sores
142
Q

Specific post-op complications for bowel op (6)

A
  • ileus
  • intestinal obstruction
  • anastomotic leaks
  • stoma retraction
  • intra-abdominal collections
  • pre-sacral plexus damage
143
Q

specific post-op complication - thyroidectomy (3)

A
  • airway obstruction 2ry to haemorrhage
  • hypocalcaemia
  • recurrent laryngeal nerve damage (loss of voice)
144
Q

specific post-op complication - cystoscopy/TURP (3)

A
  • UTI
  • TURP syndrome (hyponatraemia)
  • external sphincter damage

Acute assessment (3 decks)

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