FINALS > ACUTE > Flashcards

ACUTE Flashcards

(66 cards)

Start Studying
1
Q

In broad terms, how should respiratory failure be managed?

A
  1. A –> E assessment
  2. O2
  3. Determine the cause: investigate
    Treat according to cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How should oxygen therapy be escalated in a hypoxic patient?

A
  1. High-flow O2 (15L) via non-rebreathing mask (70% FiO2)
  2. NIV (CPAP or BiPAP)
  3. Intubation & mechanical ventilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What investigations should be done to determine the cause of respiratory failure?

A

• Bloods: FBC, U&E, blood cultures, coagulation screen, CRP
• ABG
• CXR
ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What type of NIV should be used in type I respiratory failure? Why?

A

CPAP.

There is inadequate oxygenation. Alveoli need to be kept open/fluid pushed out of the lung.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What type of NIV should be used in type II respiratory failure? Why?

A

BiPAP.

There is inadequate ventilation. Alveoli need to be stretched open during inspiration and kept open during expiration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the definition of respiratory failure?

A

PaO2 < 8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is V/Q mismatch?

A

Ventilation perfusion mismatch or V/Q defects are defects in the total lung ventilation/perfusion ratio.
One or more areas of the lung receive oxygen but no blood flow, or they receive blood flow but no oxygen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Name three causes of V/Q mismatch.

A

• Alveolar collapse
• Fluid build-up
- Bronchoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the two types of respiratory failure?

A

Type I - low O2, normal or low CO2

Type II - low O2, high CO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the pathophysiology of type I RF.

A

Inadequate oxygenation (hypoperfusion) due to:

1. Alveolar collapse e.g. pneumonia
2. Fluid in the alveoli e.g. heart failure

Ventilation is preserved - CO2 is normal or low –> V/Q mismatch.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the pathophysiology of type II RF.

A

Inadequate ventilation (hypoperfusion AND hypoventilation) due to:

1. Obstruction: COPD, asthma, muscular dystrophy

CO2 is high. No V/Q mismatch.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When might pulse oximetry be misleading?

A 
CO poisoning
Poor peripheral perfusion/shock
Hypothermia
Nail varnish
Excessive movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Name some causes of acute dyspnoea.

A 
Respiratory:
	• Asthma/COPD
	• Pneumonia
	• Pleural effusion
	• Pneumothorax
Cardiac:
	• Pulmonary oedema
	• MI
	• PE (see PE/DVT)
	• Arrhythmias 
Trauma:
	• Aspiration/FB
	• Flail chest
	• Haemothorax
	• Drowning
Other:
	• Hypovolaemia or fever
	• Hyperventilation syndrome
Respiratory compensation for metabolic acidosis e.g. DKA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How might a patient present with pulmonary oedema?

A 
• Tachypnoea
• Tachycardia
• Frothy pink sputum
• ^JVP
• Basal crackles or wheeze
Signs of reduced CO: sweaty, cool and pale
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name some features of pulmonary oedema on a CXR.

A 
• Cardiomegaly
• Kerley A, B or C lines
• Fluid in interlobar fissures
• Pleural effusions
Bat wing hilar shadows
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What can cause non-cardiogenic pulmonary oedema?

A

ARDS (sepsis, trauma, pancreatitis), IV fluid overload, drowning, altitude, smoke inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment for pulmonary oedema?

A

PODMAN

  1. Position
  2. Oxygen
  3. Diuretics
  4. Morphine
  5. Anti-emetic
  6. Nitrates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is primary and secondary hyperventilation? How should they be managed?

A

Primary = psychogenic:

  • Patient may be agitated or distress
  • Exclude serious secondary causes and reassure

Secondary = due to compensation:

  • Identify cause: metabolic acidosis, poisoning, pain, hypovolaemia
  • Treat the cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What will the ABG show in a patient who is hyperventilating?

A

^O2.
CO2 is low as it’s ‘blown off’.
pH >7.45

Respiratory alkalosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does hyperventilation lead to perioral and peripheral paraesthesia?

A

Hypocalcaemia.

H+ and Ca+ bind to albumin. In alkalosis, H+ dissociate from albumin and Ca+ are taken up.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the definition of shock?

A

Acute circulatory failure with inadequate tissue perfusion and cellular hypoxia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the first signs of shock (compensated)?

A

^HR

Pallor
Anxiety
Sweating
Tachypnoea
>CRT
Narrow pulse pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the late signs of shock?

A

Hypotension
Bradycardia
Arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the four types of shock?

A
  1. Hypovolaemic
  2. Cardiogenic
  3. Distributive
  4. Obstructive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How can you classify the pathological processes of shock? (think like a plumber)
There is a problem with: 1. Fluid - hypovolaemia 2. Pump - obstructive, cardiogenic 3. Pipes - distributive
26
What is the general approach to treating shock?
1. A-->E (+call for help) 2. O2 3. Treat underlying cause
27
Generally, what are the three treatment options in shock?
1. Fluid 2. Vasopressor 3. Inotrope
28
What is a passive leg raise (PLR)? Why is it used?
Lie the patient flat, raise legs to 45 degrees. Mimics fluid bolus by increasing venous return. Used to predict whether a patient will respond to a fluid bolus.
29
How can you classify the types of hypovolaemic shock?
1. Blood loss e.g. trauma, GI bleed, AAA, ectopic pregnancy. | 2. Fluid loss e.g. burns, vomiting, pancreatitis and sepsis.
30
What is the management of hypovolaemic shock?
Fluids or blood
31
How is blood loss classified in haemorrhagic shock?
Class I = <15% Class II = 15-30% Class III = 31-40% Class IV = >40%
32
What 5 parameters are used in the classification of haemorrhagic shock?
``` Blood loss % Heart rate Blood pressure Mental status Fluid requirements ```
33
How is heart rate classified in haemorrhagic shock?
Class I = 60-100 Class II = 100-120 Class III = 120-140 Class IV = >140
34
How is mental state classified in haemorrhagic shock?
Class I = slight anxious Class II = Mildly anxious Class III = anxious, confused Class IV = Confused, lethargic
35
What is the most likely cause of shock in trauma? Which other causes should be considered?
Haemorrhagic Also consider: neurogenic (spinal cord injury), obstructive (tension PTX, cardiac tamponade)
36
What is the definition of cardiogenic shock?
Relative or absolute reduction in cardiac output due to a primary cardiac disorder Circulatory collapse occurs as a result of pump failure
37
What signs might be seen in a patient with cardiogenic shock?
Raised JVP | Cardiac arrythmia
38
Name some causes of cardiogenic shock.
Ischaemia - ACS Heart failure Arrythmias cardiomyopathy
39
What are the aims of treatment in cardiogenic shock?
Increase cardiac output Improve myocardial perfusion Decrease cardiac workload
40
What is the management of cardiogenic shock?
Inotrope = dobutamine (5-20mcg/kg/min) + fluids (slowly) + norepinephrine (vasoconstriction)
41
Give some examples of distributive shock.
``` Sepsis Anaphylaxis Neurogenic shock Drug/toxin Addisonian crisis ```
42
What is the pathophysiology of distributive shock?
Problem with peripheral vascular vasodilation
43
What is the management of distributive shock?
Vasopressors
44
What is the definition of septic shock?
an infection that triggers a particular Systemic Inflammatory Response Syndrome (SIRS).
45
How does a patient present with septic shock?
^temp ^HR ^RR Low BP
46
Describe the pathophysiology of distributive shock due to spinal cord injury.
Interruption of the autonomic nervous system. Decreased sympathetic tone/increased parasympathetic tone = decrease in peripheral vascular resistance. Decreased cardiac output, bradycardia.
47
How might a patient present with neurogenic shock secondary to spinal cord injury?
Sinus bradycardia Low BP Flushed peripheries
48
What is obstructive shock?
Extracardiac obstruction to blood flow.
49
Give three causes of obstructive shock.
Massive PE Cardiac tamponade Tension pneumothorax
50
What is the management of obstructive shock?
Remove the obstruction e.g. pericardiocentesis/anticoagulation
51
What is the management of a small PTX? <1cm
Admit O2 Reassess in 24 hours
52
What is the management of PTX 1-2cm?
Aspiration should be attempted (needle thoracocentesis)
53
What is the management of a PTX >2cm?
Chest drain insertion
54
What is the management of a PTX >2cm?
Chest drain insertion
55
How do you assess for a c-spine injury?
Canadian C-spine rules | needs to be GCS 15 to give a good history
56
When do you need imaging in a suspected C-spine injury?
Can't move neck 45 degrees to the left or right | Neck pain
57
When should you order a CT head following head injury?
``` GCS 13 or less Fall in GCS Basal skull fracture signs Suspected open/depressed skull fracture Seizures Focal neurological deficit >1 episode of vomiting ```
58
How should you manage a seizure?
A --> E O2 Remove dangerous objects IV access/bloods --> 4mg IV lorazepam (can use rectal diazepam if no IV access)
59
What can cause seizures in known epileptics?
Infection Electrolyte disturbance Non-compliance Alcohol withdrawal
60
What are the sepsis red flags?
61
What is the definition of sepsis? And septic shock?
62
Which score can be used to rule out a PE?
PERC (if >50 then automatically scores 1) >0 = investigate for PE
63
How should the Well's score be interpreted?
``` <4 = d-dimer >4 = CTPA + treat ```
64
What is a massive PE? How is it managed?
Systolic <90 | Thrombolyse
65
How do you quantify asthma exacerbations?
Moderate Severe Life-threatening
66
What are the causes of SAH?
70% berry aneurysm 20% AVM 10% no lesion

FINALS (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions