Acute and Critical Care Flashcards
(171 cards)
1
Q
What is the threshold for immediate treatment of hyperkalaemia (with and without ECG changes)?
A
Serum potassium
- Greater than 6mmol/L with ECG changes
Greater than 6.5mmol/L without ECG changes
2
Q
Cardiogenic causes of pulmonary oedema
A
Heart failure Myocarditis Tamponade Pulmonary embolism Valve disease NSAIDs, ACEi
3
Q
Non-Cardiogenic causes of pulmonary oedema
A
AKI Renal artery stenosis Sepsis Altitude Liver failure Acute respiratory distress syndrome Head Injury
4
Q
Symptoms of acute pulmonary oedema
A
SOB ± orthopnoea S3 sound Gallop rhythm Wheeze Pink frothy sputum Fine crackles Sweaty
5
Q
Common infective organisms in COPD exacerbations
A
H. influenzae Strep pneumoniae Staph aureus Rhinovirus Influenzae
6
Q
ECG findings in PE
A
Right Axis Deviation RBBB Tachycardia S1Q3T3 - Large S Wave in Lead 1 - Q wave in Lead 3 - Inverted T wave in Lead 3
7
Q
PE Management (normal)
A
LMW Heparin or Fondaparinux
Aim for INR >2
Continue warfarin or NOAC for 3 months
8
Q
Thrombolysis in PE
A
10mg IV Alteplase then 90mg infusion over 2 hours
9
Q
PE Management in renal impairment
A
Unfractionated heparin
10
Q
What score on the Two-Level Well’s Score suggests a PE is likely?
A
4 or more
less than 4 is PE unlikely
11
Q
Management if PE likely on Two-Level Well’s Score
A
Offer CTPA, or immediate AC if CTPA not available immediately
V/Q SPECT scan if CTPA not suitable/ allergy to contrast media
12
Q
Management if PE unlikely on Two-Level Well’s Score
A
Offer a D-Dimer
If positive, investigate as PE likely
13
Q
Antibiotic management of mild Community acquired pneumonia
A
Amoxicillin
14
Q
Antibiotic management of moderate CAP
A
Amoxicillin + Clarithromycin
15
Q
Antibiotic management of severe CAP
A
Co-Amoxiclav/ Cephalosporin + Clarithromycin
16
Q
Antibiotic management of HAP
A
Aminoglycoside IV + Antipseudomonal penicillin/ cephalosporin
17
Q
Common CAP organisms
A
Strep pneumoniae
Haemophilus influenzae
Mycoplasma pneumoniae
Staph aureus
18
Q
Common organisms in HAP
A
Gram negative enterobacteria S. aureus Pseudomonas aureginosa Klebsiella Clostridium
19
Q
Symptoms of a silent MI
A
Syncope Pulmonary oedema/ SOB Epigastric pain Vomiting Acute confusion Feeling of impending doom Common in Elderly and diabetics
20
Q
ECG changes in NSTEMI
A
ST depression
T wave inversion
No changes
21
Q
Hyperacute changes in a STEMI
A
Tall T waves
22
Q
Changes seen in a STEMI after hours (and the criteria for pPCI)?
A
ST elevation in 2 consanguineous leads - 2mm in chest leads - 1mm in limb leads New LBBB No evidence of a pathological Q wave
23
Q
Latent ECG changes in a STEMI
A
T wave inversion
24
Q
Contraindications to fibrinolysis
A
Previous intracranial haemorrhage Ischaemic stroke in last 6 months Cerebral malignancy Recent trauma or surgery in 3 weeks GI bleed in previous month Bleeding disorder Aortic dissection
25
Classification of Aortic Dissection
Type A- Affects the ascending aorta
| Type B- affects other portion of aorta
26
Signs and symptoms of aortic dissection
Central retrosternal chest pain
- 'Ripping'
- Radiates to back
- Worst at onset then gradually improves
Hemiplegia/ diplegia if carotid involvement
Limb ischaemia
Angina
Pulse deficit
27
Best imaging type for Aortic dissection
MRI
28
Management of aortic dissection
BP aim for 100-120 mmHg
Cross match 10 units of blood
Surgical (stents, grafts, arch replacement)
TEVAR for type B
29
Irregular features/ unstable in tachycardia warranting 3x DC shock followed by Amiodarone?
```
Hypotension/ shock
Syncope
HR >200BPM
MI
Heart failure
Impaired consciousness
```
30
Examples of focal Narrow complex tachycardias
Sinus Tachycardia (underlying cause)
Atrial tachycardia
Junctional tachycardia
Multifocal atrial tachycardia
31
Condition in which Multifocal atrial tachycardias are common?
COPD
32
Examples of Re-entrant Narrow Complex Tachycardias
Atrial Flutter
Atrial Fibrillation
AV Node re-entry tachycardia
Atrio-Ventricular Re-entrant tachycardia
33
Management of Narrow complex tachycardia with IRREGULAR Rhythm
(Treat as Atrial Fibrillation)
Rate control with beta blocker or Diltiazem
± Digoxin or amiodarone if heart failure
LMW Heparin until full assessment of emboli risk ahs been made
34
Management of Narrow complex tachycardia with REGULAR rhythm
Vagal manoeuvres e.g. Valsalva, Carotid sinus massage
Adenosine 6mg rapid IV bolus
Followed by 2x12mg IV boluses if unsuccessful
35
Types of Broad complex tachycardia
```
Monomorphic (most common)
Fascicular tachycardia
RV outflow tract tachycardia
Polymorphic tachycardia
Torsade de pointes tachycardia
```
36
Management of Broad complex tachycardia with REGULAR rhythm
Amiodarone 300mg IV then 900mg/24h infusion
37
Management of Broad complex tachycardia with IRREGULAR rhythm
Depends on cause
| - Torsade de pointes --> MgSO4 infusion 2g over 10 mins
38
Causes of bradyarrythmia/ complete heart block
Drugs (CCBs, Beta blockers, Digoxin)
Lenegre's/ Lev's disease
Severe hyperkalaemia
39
Management of bradyarrythmia with adverse features
Atropine 500mcg infusion every 3-5 minutes up to a maximum of 3mg
Percutaneous pacing/ pacemaker more definitive
40
Causes of VF
```
MI
Cardiomyopathy
aortic stenosis/ dissection
myocarditis
tamponade
trauma
Brudaga syndrome
Tension pneumothorax
PE
Primary pulmonary hypertension
QT Prolonging drugs
Seizures
Stroke
Hyperkalaemia
Sepsis
Drowning
Electrical shocks
```
41
Management of Ventricular Fibrillation
NON-Synchronised DC shock
42
Infective causes of pericarditis
Viral (Coxsackie virus, Echovirus, EBV, influenza, HIV)
| Bacterial (staph, H. influenzae, TB, meningococcus, Rheumatic fever)
43
Other causes of pericarditis
```
Sarcoidosis
SLE
RA
Vasculitis
Myxoedema
Uraemia
Dressler's syndrome
Radiotherapy
```
44
ECG findings of pericarditis
```
ST elevation (saddle-shaped)
T wave inversion
```
45
Management of pericarditis
Ibuprofen or Naproxen 250mg QDS
Colchicine if symptoms persist for 14 days
Treat underlying cause ± steroids
46
AAA criteria for diagnosis
Dilation of the aorta of over 50% (usually 3cm original size)
47
Risk factors for AAA
```
Male (3x)
Over 65
Smoking
Hypertension
COPD
Alcohol
Infective (Brucellosis, Salmonellosis, TB, HIV)
Behcet's Disease
Takayasu's Disease
Marfan's Syndrome
Ehlers-Danlos Syndrome
```
48
Criteria for surgical repair of AAA
Over 5.5cm in size
May be an open repair or endovascular (EVAR)
49
What percentage of appendicitis have perforated at presentation?
30%
50
What is Rovsing's Sign in Appendicitis?
Pain is greater in the RIF when pressing the LIF
51
What is the Cope Sign in appendicitis?
Indicates a low appendix
Pain on flexion and internal rotation of the right hip
52
What indicates a retroperitoneal appendix?
Tenderness on the right on PR
RUQ and flank pain
53
Choice of antibiotics for Appendicitis?
Cefuroxime and Metronidazole pre-operatively
54
Biliary Colic presentation
RUQ pain radiating interscapularly
Nausea and vomiting
Intermittent jaundice
Lasts 15 mins to 24 hours
55
Biliary colic investigations
USS scan
Bloods unremarkable
ERCP/ CT/ MRI scans
56
Acute Cholecystitis presentation
```
RUQ pain radiating interscapularly
Fever
Local Peritonism (Murphy's Sign- pain when pressing right costal margin)
```
Nausea and vomiting
Intermittent jaundice
57
Acute cholecystitis investigation findings
USS scan
Bloods- mildly deranged LFTs, raised WCC/CRP
ERCP/ CT/ MRI scans
58
Cholangitis presentation
CHARCOT'S TRIAD
RUQ pain radiating interscapularly
Fever
Jaundice
Local Peritonism (Murphy's Sign- pain when pressing right costal margin)
59
Cholangitis investigations findings
USS scan
Bloods- Raised WCC, CRP, ALP, GGT, Bilirubin
ERCP/ CT/ MRI scans
60
Risk factors for paralytic ileus
```
Surgery
Pancreatitis
Spinal injury
Hypokalaemia
Hyponatraemia
Uraemia
Peritoneal sepsis
Drugs (TCAs)
```
61
AXR findings in small bowel obstruction
Distended loops of small bowel
Valvukae conniventes completely cross the lumen
62
AXR findings in large bowel obstruction
Haustra do not cross the bowel lumen
Coffee bean sign in sigmoid volvulus
63
Most common location of a diverticulum in adults
Sigmoid colon
64
Presentation of diverticulitis
LLQ colicky pain relieved on defaecation
Tenderness and peritonism
Fever
Sudden painless bleeding
65
Cullen's sign in pancreatitis
Periumbilical bruising
66
Grey-Turner's Sign in pancreatitis
Flank bruising
67
Serum enzyme measurements in pancreatitis
Amylase (usually increases 3x/ 1000u/mL; but may be normal even in severe disease)
Lipase (more sensitive and specific)
68
GET SMASHED acronym for causes of Pancreatitis
Gallstones
ETOH
Trauma
```
Steroids
Mumps
Auto-immune
Scorpion Venom
Hyperlipidaemia, Hypothermia, hypocalcaemia
ERCP and emboli
Drugs
```
And pregnancy or cancer!
69
Glasgow Prognostic Score for pancreatitis
A score of 3 or more (1 point for each) would prompt immediate ITU/ HDU referral
```
PaO2: <8KPa
Age 55+
Neutrophilia (WCC >15x10^9/L)
Calcium (<2mmol/L)
Renal function (Urea 16mmol/L +)
Enzymes (raised AST, LDH)
Albumin ( <32g/L)
Sugar (BM 10+)
```
70
Where are most peptic ulcers located?
Duodenal (80%)
71
ALARMS symptoms in dyspepsia- indications for an Upper GI endoscopy
Over 55 and new dyspepsia fro 4-6 weeks, with:
- Anaemia
- Loss of weight
- Anorexia
- Recent onset/ progressive symptoms
- Melaena/ haematemesis
- Swallowing difficulties
72
Use of the Rockall score in Upper GI bleeding
Aims to identify patients at risk of adverse events following acute upper GI bleeding. Should be interpreted with a NEWS score
Under 3: Good prognosis
8+: High risk of mortality
73
Domains of the Rockall score
```
Age
Shock
Co-Morbidities
Diagnosis
Stigmata of haemorrhage on endoscopy
```
74
Presentations of Renal colic
Typical: Loin to groin spasms and inability to lie still; nausea and vomiting
Upper obstruction- pain between rib 12 and lateral lumbar muscles
Mid Ureteric obstruction- mimics appendicitis/ diverticulitis
Lower ureteric obstruction- bladder irritability, genital pain
75
Treatment of an uncomplicated lower UTI
Nitrofurantoin 50mg/6h PO or Trimethoprim 200mg/12h PO
3 day course for women
7 day course for men
76
Treatment of Pyelonephritis
- Oral Ciprofloxacin 7-10 days IV followed by oral switch
| - Cefalexin, Co-Amoxiclav are alternatives
77
Indications for inpatient treatment for Pyelonephritis
Dehydrated/ unable to tolerate oral fluids
Pregnant
High risk of complication development e.g. patients with structural renal disease
Diabetes or immunosuppression
78
Indications for early brain imaging in stroke
```
Indications for thrombolysis/ early anticoagulation
Patient on anticoagulation treatment
Known bleeding tendency
Reduced GCS (<13)
Unexplained progressive or fluctuating symptoms
Papilloedema
Neck stiffness
Fever
Severe headache at stroke onset
```
79
Contra-Indications for Thrombolysis in stroke
```
U18
recent stroke/trauma/surgery/MI/GI bleed
INR>1.7 on Warfarin
Pregnancy
Diabetes
liver disease
cancer
```
80
Bamford stroke classification of a LACS
One of:
Pure sensory stroke
Pure motor stroke
Senori-motor stroke
Ataxic hemiparesis
81
Bamford stroke classification of a POCS
Cranial nerve palsy and a contralateral motor/sensory deficit
Bilateral motor/sensory deficit
Conjugate eye movement disorder (e.g. horizontal gaze palsy)
Cerebellar dysfunction (e.g. vertigo, nystagmus, ataxia)
Isolated homonymous hemianopia
82
Bamford Stroke classification of a TACS/ PACS
```
Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)
```
All 3 for TACS
2/3 for PACS
83
Blood sugar control target in acute stroke
4-11mmol/L
84
What percentage of strokes are preceded by TIAs?
15%
85
Management of a TIA with an ABCD2 score of 4+
Immediate Aspirin 300mg OD
± Clopidogrel or Dipyridamole
24 Hour referral for TIA clinic (MRI, Carotid USS)
Don't drive for 1 month
86
Management of a TIA with an ABCD2 score of less than 3
Immediate Aspirin 300mg OD
Specialist referral within 1 week
87
Symptoms that may precede a Vasovagal Syncope
Nausea
Pallor
Sweating
Closing of visual fields
88
Rule of 15s for Syncope
```
Pulmonary Embolism
Aortic Dissection
ACS
Ectopic Pregnancy
Subarachnoid Haemorrhage
Ruptured AAA
```
89
Prevention of syncope
Lying down/ squatting if warning symptoms
Tilt training
Isometric counterpressure manoeuvres (leg crossing or arm tensing)
Cardiac pacing
Avoid alcohol and stop drugs
Increase oral fluid intake
90
Empirical antibiotic treatment of meningitis in 3 months - 50 years
IV Cefotaxime/ Ceftriaxone
91
Empirical antibiotic treatment of meningitis in 50+ years
IV Cefotaxime/ Ceftriaxone + Amoxicillin
92
Whipple's Triad of Hypoglycaemia
1. Plasma Hypoglycaemia (< 3 mmol/L; or 4mmol/L in hospital patients)
2. Symptoms attributable to low blood sugar
3. Resolution of symptoms with correction of hypoglycaemia
93
Most common site of an intracranial venous thrombosis
Sagittal sinus (50% cases)
94
Blood glucose level in DKA
11mmol/L +
95
Ketonaemia in DKA
3mmol/L in blood
Ketones 2++ in urine
Ketonuria does not always = ketoacidosis
96
Acidosis in DKA
Venous pH <7.3
OR
Venous Bicarbonate < 15mmol/L
97
Insulin infusion rate in DKA
0.1 units/kg/hour
(1 unit/mL)
Initially 50ml made up of Insulin Actrapid
98
Initial Fluid in DKA if BP >90
1L Saline
99
When is glucose added to IV fluids in DKA
10% Glucose at 125ml/hr is added when BM is < 14 mmol/L
100
How to estimate serum osmolality
2Na + Glucose + Urea
101
Investigations if DVT Wells Score 2+
Proximal Leg Vein USS within 4 hours
If negative, D-Dimer
102
Investigations if DVT Wells Score 1 or less
D-Dimer test
If positive, Proximal Leg Vein USS
103
Duration of warfarin treatment after a DVT
3-6 months, particularly if unprovoked
104
6P's of Acute Limb Ischaemia
```
Pale
Pulseless
Pain
Paraesthesia
Paralysis
Perishingly cold
```
105
What ABPI indicates critical limb ischaemia
Less than 0.5
106
Which metabolite of paracetamol is Hepatotoxic
NAPQI (5%)
107
Which enzyme normally converts the toxic metabolite of Paracetamol to a conjugate excretable in urine?
Glutathione
Body has an 8 hour supply of Glutathione
108
How is N-Acetylcysteine administered as a treatment for Paracetamol OD?
Infused over 1 hour in 5% glucose. Must be commenced within 8 hours
109
SEs of N-Acetylcysteine
Erythema, urticaria, angioedema, bronchospasm
110
Alternative to N-Acetylcysteine
Methionine
111
Anticholinergic SEs of TCA (or Atropine) OD
Dry mouth, urinary retention, dilated pupils, agitation
112
Overdose with which drug may require treatment of arrhythmias with Sodium Bicarbonate
TCAs
113
Most common cause of Cellulitis (organism)
Strep pyogenes
114
What may suggest a diagnosis of septic arthritis from blood tests?
Polymorphonuclear cells >75%
115
Antibiotics for tonsillitis
```
Penicillin V (Phenoxymethylbenicillin) 10 days
or clarithromcyin
```
Centor 3+
116
Most common position of leg in hip fracture
External rotation
Adduction
Shortening of leg
117
Common XR finding in hip fracture
Loss of shenton's Line (arc around femur and pubic tubercle)
118
Ligaments affected in medial ankle sprain
Deltoid Ligament
119
Ligaments affected in lateral ankle sprain
Calcaneofibular ligament
Anterior talofibular ligament
Anterior/ Posterior Inferior talofibular ligaments
120
Ligaments affected in syndesmotic ankle sprain
Interosseus and lower tibiofibular ligaments
121
Grading of ankle sprains
- Grade 1- Stretched ligament with microscopic tearing
- Grade 2- Ligament stretched with partial tearing
- Grade 3- Ligament is completely ruptured, severe swelling
122
Colle's versus Smith's Fractures
Colle's: Distal radius fragment displaced dorsally
Smith's: Distal radius fragment displaced ventrally
123
XR Findings in anterior shoulder dislocation
Humeral head under coracoid process (AP)
| Head anterior to glenoid process
124
XR Findings in posterior shoulder dislocation
Lightbulb sign
| Humeral head posterior to glenoid process
125
Drugs which may cause acute urinary retention
```
Anticholinergics
Opioids
Benzodiazepines
NSAIDs
CCBs
Detrusor relaxants
Alcohol
Antihistamines
```
126
Reversible causes of VF (4H's, 4T's)
Hypoxia
Hyper/hypokalaemia
Hypovolaemia
Hypothermia
Tamponade
Tension Pneumothorax
Thromboembolism
Toxin
127
Reasons to consider admission for acute AF
Pulse above 150
BP <90
Chest pain/ LOC/ acute SOB
Stroke/ TIA/ Acute HF
128
How often is Adrenaline given in cardiac arrest
After 3 shocks
Then every 3-5 minutes
129
How often is Amiodarone given in cardiac arrest/ ALS
After 3 shocks
Another after 5
130
How many posterior ribs on a CXR can indicate hyperinflation?
7
131
What is the San Francisco Syncope Rule?
Predicts adverse outcomes for patients presenting with syncope at 7 days. Any of the following classes the patient as high risk:
- Congestive Heart Failure History
- Haematocrit <30%
- ECG Abnormalities
- SOB
- Systolic BP <90 at triage
132
Serious causes of ventilation compromise in trauma
```
Airway Obstruction
Tension Pneumothorax
Open Pneumothorax
Massive Haemothorax
Flail Chest
Cardiac Tamponade
```
133
On the floor and four more
Visible blood loss, plus:
- Chest
- Abdomen
- Pelvic cavity
- Long Bones
134
Most common type of shock in trauma
Haemorrhagic
135
Cushing response to raised ICP
Bradycardia
Hypertension
Irregular respiration
136
Brainstem testing in DBD
```
Absent pupillary light reflexes
Absent corneal light reflex
No cranial/ limb response to pain
Absent vestibulo-cochlear reflexes
Absent gag/ cough reflex
Apnoea test
```
137
Criteria of diagnosis for ARDS
Clinical symptoms
- Acute onset
- Pulmonary oedema- bilateral infiltrates on CXR
- PCWP < 19mmHg (demonstrates non-cardiogenic)
- Refactory hypoxaemia (pO2:FiO2 <200mmHg)
138
Key settings of control on a mechanical ventilator
```
Tidal volume/ RR
Inspiratory flow
I:E ratio
FiO2
PEEP
```
139
Ventilating below what FiO2 reduces risk of oxygen toxicity
0.5
140
Key indications for Non-Invasive Ventilation
COPD with respiratory acidosis pH 7.25-7.35*
type II respiratory failure secondary to chest wall deformity, neuromuscular disease or obstructive sleep apnoea
cardiogenic pulmonary oedema unresponsive to CPAP
weaning from tracheal intubation
141
Minimal daily requirements: H20
25-30 ml/kg/day
142
Minimal daily requirements: Sodium
1-2 mmol/kg/day
143
Minimal daily requirements: Potassium
0.5-1 mmol/kg/day
144
Minimal daily requirements: Glucose
50-100 g to prevent starvation ketosis
| - does not cover nutritional requirements
145
What volume of blood loss produces a fall in Hb of approximately 10g/dL
500ml
Significant when below 70g/dL; may be higher in elderly/ co-morbidity
146
What is in a Massive Transfusion protocol
1:1:1 Packed RBCs, FFP, Platelets
Up to 10 units
147
Important drugs in renal failure
```
NSAIDs
ACEi and ARBs
Diuretics
Contrast Medium
Penicillins
Metformin
Statins
Gentamicin
```
148
Key indications for RRT
```
Severe fluid excess e.g. Oedema
Stage 3 AKI
Hyperkalaemia
Clearance of nephrotoxics
Rising creatinine or urea
```
149
Appropriate Mannitol dose for raised ICP and SEs
Mannitol 20% solution 0.5g/kg over 20 minutes
The effects only last 2-6 hours so may get a reboound rise in ICP
150
Why are patients hyperventilated in Head Injury
Reduces PaCO2: this causes cerebral vasoconstriction and reduces ICP almost immediately
151
GCS criteria warranting a 1 hour CT Head following a head injury:
GCS <13 on Initial Assessment
| GCS < 15 2 hours after injury
152
1 hour CT head criteria
```
GCS <13 on Initial Assessment
GCS < 15 2 hours after injury
Suspected open/ depressed skull fracture
Sign of basal skull fracture
Post traumatic seizure
Focal neurological deficit
2+ episodes of vomiting
```
153
8 hour CT head criteria
Aged 65+
Clotting/ bleeding disorder
Dangerous mechanism of injury
Retrograde amnesia lasting 30+ minutes
154
Signs of basal skull fracture
Haematotypanium
Panda Eyes
CSF leakage from ear or nose
Battle Sign
155
Minimum monitoring standards for Anaesthesia
```
Cardiac (ECG)
NIBP
SpO2
FiO2
EtCO2
Airway Pressure (Peak Inspiratory Pressure)
```
156
When is temperature monitored in anaesthesia
For procedures lasting longer than 30 mins
157
When is a Peripheral nerve stimulator used to monitor in anaesthesia
When Akinesis (NM blockade) is performed
158
Normal level of Epidural anaesthesia
L3-L4
Can be anywhere between L1 and sacrococcygeal hiatus
159
Normal level of Spinal anaesthesia
L2-S2
Less change of cord damage with a lower level
160
Which type of Regional anaesthesia has a quicker onset of action
Spinal
161
Which vasoactive drug is avoided in obstetric anaesthesia, to reduce the risk of foetal acidosis?
Ephedrine
162
Why should an FiO2 above 0.3 be avoided in neonates
Causes proliferative retinopathy
163
Which local anaesthetics have a slow onset and duration, but a long duration of action?
Bupivicaine and Levobupivicaine
164
Types of LA and their hydrostatic properties
Esters -> Hydrophobic
| Amides -> Hydrophilic
165
When can extubation occur
- When muscle paralysis has worn off
- Troughs in EtCO2 monitoring
- Return of cough reflex
- Nerve stimulator e.g. TOF with no fade
166
How is the size of a nasopharyngeal airway assessed
Against size of patient little finger
167
Criteria to confirm correct ET tube placement
Misting of ET tube
EtCO2 observed on monitor
EQUAL chest expansion
Auscultation of chest (confirm to air entry into stomach)
168
Cormack- Lehane Score above which you would want to use a bougie or stylet for laryngoscopy
Grade 2B+
169
Cormack- Lehane Score above which you would want to use additional devices
Grade 4
170
Angina Chest Pain: NICE definitions
1. constricting discomfort in the front of the chest, or in the neck, shoulders, jaw or arms
2. precipitated by physical exertion
3. relieved by rest or GTN in about 5 minutes
All 3 features: typical angina
2 of the above features: atypical angina
0-1: Non-anginal chest pain
171
Eron Classification of Cellulitis
1: No systemic symptoms, no co-morbidities
2: Co-morbidity that may complicate treatment e.g. peripheral arterial disease, obesity
3: Significant systemic symptoms e.g. acute confusion, tachycardia, tachypnoea, hypotension, OR unstable co-morbidities, OR limb threatening infection
4: Sepsis/ necrotising fasciitis
