Acute Care Flashcards
(96 cards)
1
Q
Adrenaline Dose in anaphylaxis
A
0.5ml of 1:1000 IM
2
Q
Adrenaline Dose in Cardiac Arrest
A
1mg or 10 ml of 1:10,000 IV
1ml of 1:1000 IV
3
Q
What is the Fluid replacement formulae?
A
30ml/kg/hr
4
Q
What is the formulae for K+ Na+ Cl- replacement?
A
K+ Na+ Cl-
1mmol/kg/hr
5
Q
When is IV magnesium given?
A
If Mg levels <0.4 or signs of tetany.
6
Q
When is Oral Mg used?
A
If >0.4
7
Q
What is a side effect of oral Mg?
A
Diarrhoea
8
Q
What is a usual infusion of IV Mg
A
40mmol over 24 hours
9
Q
Causes of Hypomagnesia
A
PPI Diarrhoea Chronic alcoholism Diuretics TPN Hypokalaemia Hypercalcaemia
10
Q
How does Hypomagnesia present
A
Parasthesia, Tetany, Seizures, Arrythmia, reduced PTH
11
Q
When is IV Calcium Gluconate used?
A
If K+ over 6.5 or ECG changes
12
Q
What is the initial fluid resus volume?
A
500ml 0.9% saline
13
Q
If someone is in an acute confusional state what is used?
A
Oral or IM haloperidol
NEVER BDZ as will worsen confusion
14
Q
In an ABG what is the normal anion gap?
A
8 to 14 if not using K+
10-18 if using K+
15
Q
What causes an elevated anion gap?
A
Excess exogenous or organic acid.
16
Q
Causes of a Metabolic Acidosis with a raised Anion Gap
A
Methanol Uraemia DKA Paraldehyde Isoniazide Lactic Acidosis Ethyelen Glycol Salicylate Poisoning - Aspirin
17
Q
What fractures are associated most with Compartment syndrome?
A
Supracondylar
Tibial Shaft
18
Q
If a patient presents with a paracetamol overdose when they took all of them at once within an hour of arrival and A + E. What is the initial management?
A
Activated Charcoal
19
Q
What are indications for Acetylcysteine use in a paracetamol overdose?
A
Patient staggered the dose over longer than an hour, or doubt over duration
Levels >100mg/l at 4 hours or 15mg/l at 24 hours
20
Q
How is Acetylcysteine infused?
A
Over 1 hour
21
Q
What are the indications for a liver transplant in a paracetamol overdose?
A
PTT > 100 seconds
Creatinine > 300
Grade III or IV encephalopathy
22
Q
What is the preferred fluid used in burn resuscitation?
A
Hartmans (crystalloid) > Coloid
23
Q
What is the formulae for Resuscitation fluid in burns and how is this applied?
A
4ml x % burn x kg
50% in first 8 hours
50% in last 16 hours
24
Q
What is the maintenance fluid in burns?
A
0.5ml x % burn x kg
25
Signs of DKA
```
Blood Glucose >11
Ketone >3
pH <7.3
Bicarbonate <15
Raised Anion Gap
+/- pseudohyponatraemia
```
26
An STEMI presents in A + E what is given?
Aspirin + Ticagrelor + 5000 units of Heparin
27
Patient OD - Increased HR, Warm, Dilated Pupils, Dry
AntiCholinergic Medication
28
Patient OD - Pinpoint Pupils, Increased Bowel Sounds, Sweaty
Cholinergic - Mushrooms, Pilocarpine
29
Patient OD - Bradychardia, Reduced RR, Cold, Pinpoint pupils, Absent bowel sounds, Dry
Opiod
30
Patient OD - Tachychardia, Increased RR, Dilated Pupils, Hot , Inceased Bowel sounds, Sweaty
Sympathomimetics - Cocaine Ecstasy etc
31
How do you differentiate Opiod from BDZ overdose?
BDZ pupils aren't affected.
32
If you have a patient who has OD who's bloods show and Acidotic Picture and ECG shows Tachychardia or Arrhythmias what is the most important management?
IV Sodium Bicarbonate - Increase contractility and reduce arrhythmia risk by reducing acidosis.
Magnesium Sulphate if prolonged QRS
33
If and overdosed patient presents with seizures what is the treatment?
BDZ can still be used. Phenytoin should be avoided
34
What is the management plan of someone presenting with a Sympathomimetic OD?
```
BDZ - Sedation
Ketamine - Sedation if needed quickly
Check CK - Rhabdo is common
U+Es - Rhabdo and dehydration
ECG - Vasospasm is common finding
```
35
If a patient in DKA had a BP <90 what is their fluid resus?
500ml NaCl in 5 mins
36
If a patient in DKA has a BP >90 what is their fluid resuscitation?
1L NaCl over 1 hour
37
A patient who has received Naloxone is looking to be discharged. What are the guidelines on their discharge?
Patent Airway without naloxone for 6 hours
38
Management of Hypovolaemic Hyponatraemia
Normal Isotonic Saline
39
Hypovolaemic Hyponatramia - Isotonic Saline Increase Na
Likely Diagnosis is correct
40
Hypovolaemic Hyponatraemia - Isotonic Saline causes a decrease in Na+
SIADH is likely cause
41
Management of Euvolemic Hyponatraemia
Fluid Restriction - 500m - 1000ml a day
| Vaptans used
42
Management of Hypervolaemic Hyponatraemia
Fluid Restriction -> 500ml-1000ml
Vaptans
Loop Diuretics
43
What can be used with care in Acute Hyponatraemia?
Hypertonic 3% saline
44
Too rapid Hyponatraemia correction can lead to
Central Pontine Myelinolysis 'locked in syndrome'
45
Too rapid correction of Hypernatraemia
Cerebral Oedema
46
ABG in Salicylate Poisoning
Initial Respiratory Alkalosis due to stimulation of CNS
| Later Metabolic acidosis with +ve anion gap
47
Example of a Salicylate
Aspirin
48
Signs of Salicylate Poisoning
Hyperventilations
| Tinnitus
49
Management of Salicylate Poisoning
Urinary Alkalinisation
IV Sodium Bicarbonate
Haemodialysis
50
Indications for Haemodialysis is Salicylate Poisoning.
Serum level >700
Pulmonary Oedema
Seizures
51
What is first line for the management of Neuropathic pain?
Amitriptyline
Pregablin
Duloxetine
Gabapentin
52
What is second line in neuropathic pain?
Try another 1st line drug monotherapy.
53
What is capsaicin useful for?
Small areas of localised neuropathic pain.
54
ECG signs of hypothermia
J waves
| Prolonged PR QT and QRS
55
What is the adrenaline dose used in anaphylaxis in a child under 6 months?
100 - 150mcg
| 0.1 - 0.15ml 1 in 1000
56
What is the adrenaline dose used in 6 months to 6 years in anaphylaxis?
150mcg
| 0.15ml 1 in 1000
57
What is the adrenaline dose in a 6 - 12 year old in anaphylaxis?
300mcg
| 0.3ml 1 in 1000
58
When can someone be discharged from hospital after two hours post anaphylaxis?
No symptoms remain
required a single IM
Auto-injector and trained to use it
59
When is someone discharged after 6 hours post anaphylaxis?
2 IM doses needed
| Previous biphasic reaction
60
When is someone discharged after 12 hours post anaphylactic episode?
Over 2 IM doses needed
Severe asthma
Late at night
Live in a remote area with poor access.
61
Paediatric BLS
Look for breathing -> 5 rescue breaths -> Pulse -> 15:2 CPR
62
What should be administered in hyponatraemia causing seizures or coma?
3% saline IV
63
Major Haemorrhage Protocol
```
SEND OFF TWO PINK TOPPED FOR GROUP AND SAVE
2L of warm IV crystalloid
Tranexamic Acid
2 units of O negative blood
Fully crossmatched blood
```
64
Glucose dose in Hypoglycaemia requiring an IV due to reduced consciousness
100ml 20% glucose IV STAT
65
Naloxone in Respiratory arrest
400mcg bolus
66
Naloxone in over sedation
Titrate to affect
67
In paediatric BLS where do you feel for a pulse?
Brachial or Femoral
68
If thrombolysis has been administered how long should CPR be carried on for?
60-90 minutes
69
Indication for IV sodium bicarbonate in an overdose.
pH - <7.1
QRS >160ms
Arrhythmias
Hypotension
70
In a Beta blocker OD what medication should be use and why?
Glucagon as dobutamine won't work as its receptors and blocked
71
In an acute hypoglycaemic patient with reduced consciousness and no IV access what is used?
Glucagon IM
72
In children or young people what is the fuild resus formula?
20ml/kg over an hour
73
Whats the maximum in
74
Headache , N+V Vertigo Confusion weakness and cherry red flushed skin
Carbon Monoxide poisoning
75
How do you diagnose CO poisoning?
ECG and ABG
| Carboxyhaemaglobin level
76
Describe what different levels of carboxyhaemaglobin tell you.
```
<3% = Non smoker
<10% = smoker
10-30% = symptomatic CO poisoning
>30% = Severe CO toxicity
```
77
What is the management of CO poisoning?
High flow oxygen via non rebreather mask.
78
if someone with a salicylate OD presents within an hour of ingesting what can be given?
activated charcoal
79
What is used in the treatment of Popper related hypoxia?
Methylene Blue
80
Why should a slower infusion rate be considered in a younger patient with a DKA?
They are at an increased risk of cerebral oedema
81
Presents similar to alcohol + metabolic acidosis with anion gap and osmotic gap
Tachychardia + Hypertension
AKI
Ethylene Glycerol Poisoning - Anti Freeze
| Fomepizole is first line over ethanol now
82
Oxygen saturation targets in an acutely unwell patient
94 -98%
COPD - pCO2 normal = 94-98
- hypercapniac - 88-92% on a 28% venturi mask 4l min
83
How is tranexamic acid administered in a major haemorrhage
IV bolus the slow infusion
84
INR cut off for a chest drain insertion.
>1.3
85
Most reliable line for administering long term medication i.e chemotherapy
Hickmans line
86
Haemorrhagic shock - class 1
```
<750 ml loss
<100bpm
Normal BP
>30ml/hr urine
Normal consciousness
```
87
Haemorrhagic shock - Class II
```
750-1000ml
>100bpm
Normal BP
20-30ml urine
Anxious
```
88
Haemorrhagic Shock class III
```
1500-2000ml
>120bpm
BP is reduced
5-15ml urine
Confused
```
89
Haemorrhagic shock class IV
>2000ml
Blood pressure dropped
<5ml urine
Lethargic
90
Management of a N Acetylcysteine anaphylaxis
Stop -> nebulised salbutamol -> restart infusion at a slower dose
Non IgE mediated anaphylactoid reaction - not true anaphylaxis
Urticaria and hives.
91
Managment of an acute haemolytic reaction during a transfusion.
STOP the transfusion
Aggressive fluid resuscitation
Inform lab - send two pinks tops to lab for crossmatch and direct Coombs test
92
What is the first line management in magnesium sulphate induced respiratory depression.
Calcium Gluconate
93
COPD acute exacerbation - oxygen therapy
15l Non rebreather mask - all receive even in known CO2 retainers
- 28% venturi mask at 4L after
94
BLS - resus chest compression guidelines
Neonate - 3:1. 1 or 2 thumbs
Paediatric - 15:2 1 hand
Adult - 30:2 2 hands
95
What electrolyte should be replaced first?
Magnesium as this can cause a resistant hypokalaemia
96
How is someones fluid deficit accounted for in their fluid maintenance.
% dehydration x kg x 10
| Spread out over 24-48 hours in addition to normal fluid maintenance
