Acute Care Flashcards
(180 cards)
1
Q
head position if doing suction/if there is vomit/blood
A
lateral
2
Q
intubation if GCS is what
A
< 8
3
Q
how do you measure the size of an oropharyngeal airway
A
incisor teeth to angle of mandible
4
Q
should you always give oxygen in ABCDE
A
all critically ill patients should receive oxygen
5
Q
what are the oxygen sats for people with COPD
A
if acutely unwell 15L non-rebreather mask, can titrate later on to achieve 88-92 via 2-4L venturi
6
Q
B) action: anaphylaxis
A
adrenaline
7
Q
B) action: short of breath
A
sit them up
oxygen
8
Q
B) action: opiate overdose
A
naloxone
9
Q
B) action: tension pneumothorax
A
needle decompression in 2ICS MCL followed by chest drain in 5ICS MAL
10
Q
C) action: fluid challenge
A
500ml bolus 0.9% saline STAT
11
Q
C) action: fluid challenge in HF
A
250ml initially
12
Q
what do you do if someone responds fully to fluid challenge
A
continue with maintenance fluids
13
Q
what do you do if someone responds to fluid challenge but BP falls again
A
give more fluids / another fluid challenge
14
Q
what does it mean if someone doesnt respond to a fluid challenge
A
they are either volume overloaded or volume deplete
15
Q
action: patient is hypotensive and fluid overloaded
A
inotropes
16
Q
action: patient is hypotensive despite fluid resuscitation
A
vasopressors
17
Q
action: circulatory shock venous access
A
2 wide bore IV cannula - take bloods including group and save/cross match plus fluid challenge of 1000ml crystalloid STAT
18
Q
major haemorrhage and cardiac arrest number
A
2222
19
Q
action: ACS
A
12 lead ECG and immediate drug treatment
20
Q
what is assessed in disability
A
AVPU GCS blood glucose pupils pain temperature
21
Q
action: hypoglycaemia
A
100ml 10% dextrose
22
Q
GCS: eye opening score 1-4
A
Opens spontaneously.
Opens to command.
Opens to pain.
No response.
23
Q
GCS: verbal response score 1-5
A
Orientated and talking. Confused and disoriented Inappropriate words Incomprehensible sounds No verbal response
24
Q
motor response 1-6
A
Obeys commands. Localizes to pain. Flexion & withdrawal to pain. Abnormal flexion to pain. Extension to pain. No response.
25
how is pain administered in GCS
supra orbital notch
26
what is abnormal flexion in GCS
decorticate posturing (core- hands at chest)
27
what is the BP and HR in cushings triad
hypertension
| bradycardia
28
skull base fracture signs: anterior fossa
panda eyes - bilateral periorbital bruising
29
skull base fracture signs: middle fossa
battle sign - mastoid bruising behind ear
30
how else might a skull base fracture of middle fossa present
SNHL
facial nerve palsy
(temporal bone)
31
sudden onset
| worst headache ever
sub arachnoid haemorrhage
32
where is the pain of a SAH usually focused
occiput
33
1st line IX of SAH
CT brain
34
2nd line IX of SAH
lumbar puncture
35
what is a positive LP result of a SAH
xanthochromic CSF (turns yellow)
36
when should a LP be performed post SAH
at least 12 hours post-presentation
37
what investigation can help find cause of SAH
CT intracranial angiogram
38
treatment SAH
IV saline
nimodipine
neurosurgery/IVRs - endovascular coiling, aneurysm clipping
39
how long do poeple with SAH get nimodipine
21 days
40
4 complications of SAH
re-bleed
delayed ischaemic neurological deficits (3-12 days later)
hydrocephalus
hyponatraemia
41
what is seen on CT of SAH
acute blood (bright) in the basal cisterns, sulci and ventricles
42
```
relatively minor trauma
fluctuating consciousness
dull headache
confusion/sleepy
FND
```
subdural haemorrhage
43
2 RFs for SDH
alcoholism
| age
44
CT scan for SDH
- acute
- chronic
crescent shaped haematoma
acute - bright
chronic - dark
45
what can be given as epilepsy prophylaxis after SDH
7 days phenytoin
46
tx SDH if expanding mass with FND
burr hole craniotomy
47
head injury followed by a lucid period then loss of consciousness again
increasingly severe headache associated with sudden decline in level of consciousness
EDH
48
will a recent head injury be apparant in EDH
yes
49
what artery is likely damaged in an extradural haemorrhage
middle meningeal artery
50
what would a fixed dilated pupil in EDH imply
brain herniation
51
CT scan of EDH
lens shaped (biconvex) haematoma
52
is EDH restricted by the suture lines
yes
53
is a SDH restricted by the suture lines
no
54
when is a CT indicated in terms of GCS
GCS < 13 on initial assessment or < 15 at 2 hours later
55
dx treatment of raised ICP
mannitol
56
tear drop sign on facial xray
blow out fracture
57
how many back blows and abdominal thrusts in choking person
5 back blows then 5 abdominal thrusts
| continue cycle if unsuccessful
58
what 3 drugs are given in anaphylaxis
adrenaline
hydrocortisone
chlorphenamine
59
dose: adrenaline in anaphylaxis in adult or child over 12
500mcg
60
dose: adrenaline anaphylaxis child 6-12
300 mcg
61
dose: adrenaline anaphylaxis child < 6
150 mcg
62
adult anaphylaxis protocol
adrenaline 0.5mg IM
| hydrocortisone 200mg slow IV, chlorphenamine 10mg slow IV
63
how much can adrenaline be repeated
every 5 mins up to 3 times
| use a different site each time
64
what do you do if colloid fluids are running in anaphylaxis
stop - may be cause of reaction
65
fluids in anaphylaxis
2 large bore IV cannula IV 500ml crystalloid over 15mins or 1L STAT if hypotensive
66
how long do you observe post adrenaline in anaphylaxis
6 hours
67
how long should prednisolone be continued after anaphylaxis
3-5 days 30-40mg PO
68
should chlorphenamine be continued in anaphylaxis
4mg/6hr if itching
69
what specific blood should be taken in anaphylaxis
serum tryptase
70
tx bradycardia
500mcg atropine IV
71
how many times can atropine be repeated
up to 6 times (3mg in total)
72
unstable tachycardia
DC cardioversion up to 3 times
73
2nd line unstable tachycardia
amiodarone 300mg IV over 10-20 mins
| followed by 900mg over 24 hours
74
tx stable broad complex tachycardia
loading dose amiodarone followed by 24 hour infusion
75
2nd line stable broad complex tachycardia
lidocaine
76
polymorphic VT (TdP)
IV Mag Sulf
77
tx stable narrow complex tachy 1st line
vagal manoeuvres
78
2nd line tx stable narrow complex tachy
IV adenosine
79
2nd line tx stable narrow complex tachy
| asthmatics
IV verapamil
80
tx acute AF if haemodynamically unstable
emergency cardioversion (rhythm control) DCCV
81
1st line chemical cardioversion in AF if structural heart disease
amiodarone
82
1st line chemical cardioversion in AF if no structural heart disease
flecainide
83
tx stable AF if onset is < 48 hours
rate or rhythm control
84
tx stable AF if onset is > 48 hours
rate control
85
1st line rate control in AF
BB or CCB (diltiazem)
86
2nd line rate control in AF
digoxin (e.g. if heart failure)
87
dose IV adenosine in 2nd line stable narrow complex tachycardia
6mg IV bolus
88
4 H causes of cardiac arrest
hypoxia
hypovolaemia
hypothermia
hypo-metabolic/hyperkalaemia
89
4T causes of cardiac arrest
toxin
thrombosis
tamponade
tension pneumothorax
90
should you call resus team before starting CPR
yes
91
compressions
- number
- depth
- rate
- per breaths
30
5-6 cm
100-120
30:2
92
shockable rhythms
VF
| pulseless VT
93
what can be done if no defib
precordial thump
94
what do you do if someone has a cardiac arrest while on a monitor that was showing VF or pulseless VT
3 shocks before CPR
95
what 2 drugs are used in cardiac arrest
adrenaline
| amiodarone
96
what is the dosage of adrenaline in cardiac arrest
1mg
97
when should adrenaline be given in cardiac arrest for non-shockable rhythms
ASAP
98
when should adrenaline be given in cardiac arrest for shockable rhythms
1mg after 3 shocks
| repeat 1mg every 3-5 mins
99
when should amiodarone be given in cardiac arrest for shockable rhythms
300mg after 3 shocks
| 150mg after 5 shocks
100
how are drugs delivered in cardiac arrest
1st line IV
| 2nd line IO
101
what drug can be given in cardiac arrest if PE suspected
alteplase
102
airway position in cardiac arrest in children under 1
head in neutral position
103
how is paediatric ALS started
5 rescue breaths then 15 compressions
104
compression depth in < 1 year old
2 fingers
105
compression depth in infant
4cm
106
rescue breaths : compressions in a paediatric cycle
15 compressions:2 breaths
107
what kind of shock:
o Chest pain, palpitations.
o Cold, clammy peripheries.
cardiogenic
108
what kind of shock:
o Cold, clammy peripheries.
o Distended neck veins.
o Raised JVP.
obstructive
109
```
what kind of shock:
o Cool, cold peripheries.
o Dry mucous membranes.
o Thready pulse.
o Low JVP.
```
hypovolaemic
110
what kind of shock:
o Fever.
o Warm flushed peripheries with increased capillary refill.
o Bounding pulse.
distributive
111
what kind of shock:
| PE, tension pneumothorax, cardiac tamponade
obstructive
112
what kind of shock:
sepsis
anaphylaxis
neurogenic
distributive
113
septic shock treatment
BUFALO
| + vasopressors
114
when is the earliest serum paracetamol levels can be checked in overdose
4 hours post consumption
115
s/s paracetamol overdose
```
LFT - coagulation problems - raised TT or INR
N+V
abdominal pain
hypoglycaemia
jaundice
encephalopathy
```
116
tx paracetamol overdose
acetylcysteine (parvolex)
117
tx paracetamol overdose if presenting within 1 hour
acivated charcoal, wait 4 hours, send paracetamol level
118
how quickly is acetylcysteine infused
1 hour
119
how is it decided when acetylcysteine given in paracetamol dose
deciding using treatment line (amount ingested and time since) - if on or above line
if staggered overdose
if doubt over ingestion time
120
opioid overdose symptoms
Pin point pupils.
Respiratory depression
Reduced LOC - drowsiness, coma.
jerky movements
121
tx opioid overdose
naloxone 400mcg bolus (800mcg if IM)
122
tx benzo overdose
flumenazil
123
benzo overdose s/s
ataxia
dysarthria
reduced consciousness
124
tx aspirin overdose
supportive care + fluids + bicarbonate influsion
125
s/s aspirin overdose
```
Tinnitus.
Vomiting.
Dehydration.
Hyperventilation to combat metabolic acidosis
Hypokalaemia
Raised anion gap
```
126
tx BB overdose
glucagon
127
tx carbon monoxide poisoning
oxygen
128
anaesthetics: when to stop: ACEI
day before surgery
129
anaesthetics: when to stop: warfarin
5 days before surgery
130
anaesthetics: when to stop: LMWH
24 hours before surgery
131
anaesthetics: when to stop: antiplatelet
7 days before surgery
132
how are high risk patients bridged before surgery when asked to stop warfarin for 5 days
heparin
133
example of high risk patients that would be bridged with heparin before surgery
AF
VTE within 3 months
mechanical heart valve / multiple valve replacements
134
what is given if INR is > 1.5 on day of surgery
vitamin K
135
how is warfarin restarted after surgery
if no major bleeding restart on day of procedure and cover with heparin and check INR in 48 hours
136
induction agent example - 2
propofol, thiopental
137
muscle relaxant used in anaesthetics
Rocuronium, Vecuronium, Suxamethonium
138
reversal of muscle relaxant used in anaesthetics
neostigmine
139
drug used to make patient drowsy in anaesthetics prior to procedure
midazolam
140
opiate used in surgery by anaesthetics
fentanyl
141
tx bradycardia in GA
atropine IV 500mcg
142
tx hypotension in GA
ephedrine
| metaraminol
143
tx malignant hypertension in GA
IV dantrolene and active cooling
144
3 body parts adrenline cant be used with lidocaine
fingers
nose
ears
145
calculation of anion gap
Na + K
-
Cl + HCO3
(+ minus the -)
146
normal anion gap metabolic acidosis
* Gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
* Renal tubular acidosis
* Drugs: e.g. acetazolamide
* Ammonium chloride injection
* Addison's disease
147
raised anion gap metabolic acidosis
* Lactate: shock, hypoxia
* Ketones: diabetic ketoacidosis, alcohol
* Urate: renal failure
* Acid poisoning: salicylates, methanol
148
metabolic alkalosis
* Vomiting / aspiration (e.g. Peptic ulcer leading to pyloric stenosis, nasogastric suction)
* Diuretics
* Liquorice, carbenoxolone
* Hypokalaemia
* Primary hyperaldosteronism
* Cushing's syndrome
* Bartter's syndrome
* Congenital adrenal hyperplasia
149
resp acidosis
* COPD
* Decompensation in other respiratory conditions e.g. Life-threatening asthma / pulmonary oedema
* Sedative drugs: benzodiazepines, opiate overdose
150
resp alkalosis
* Psychogenic: anxiety leading to hyperventilation
* Hypoxia causing a subsequent hyperventilation: pulmonary embolism, high altitude
* Early salicylate poisoning*
* CNS stimulation: stroke, subarachnoid haemorrhage, encephalitis
* Pregnancy
151
tx status epilepticus
IV lorazepam (can repeat once after 10-20 mins)
primary care
- buccal midazolam
- rectal diazepam
152
tx seizure if benzo fails twice
phenytoin, phenobarbital, levtiracetem or sodium valproate
| GA
153
tx hypoglycaemia orientated and able to swallow
- what to give
- when to recheck BM
- can you repeat
- what to do if BM still low
4-5 glucose tablets
check BM after 10-15 minutes
repeat up to 3 times
if BM still < 4 call for help
154
tx hypoglycaemia confused/disoriented or aggressive
glucogel
recheck BM after 10-15 min
repeat up to 3 times
if ineffective IM glucagon 1mg
155
tx hypoglycaemia unconscious/fitting
IV glucose over 10 mins
- 75ml 20% glucose (or 150ml of 10% glucose)
recheck after 10 minutes
once BM > 4 give 10% glucose infusion at 100ml / hour and restart insulin
156
Tx DKA
IV insulin (0.1 unit/kg/hour)
once glucose is < 15mmol/L start 5% dextrose
LMWH
monitor potassium
157
tx HONK
insulin sliding scale
158
treatment hyperkalaemia rhyme
```
Conor Gets - calcium gluconate
A Really - act rapid
Good - glucose
Score - salbutamol
Conor Really - calcium resonium
Likes Doing - loop diuretic
Drugs - dialysis
```
159
treatment hyperkalaemia - calcium gluconate
10ml calcium gluconate 10% IV
160
treatment hyperkalaemia - insulin and glucose
10 units ActRapid and 50ml 50% glucose IV
161
treatment hyperkalaemia - salbutamol
2.5mg nebulised
162
reversal of warfarin
vitamin K and prothrombin complex concentrate
163
addisonian crisis
IV hydrocortison 100mg stat
| fluid resus - IV saline or dextrose if hypoglycaemia
164
ix acute phase stroke
Non-contrast CT brain
165
presentation 1 week after stroke with mild deficits investigation
MRI
166
tx stroke confirmed ischaemic and presenting within 4.5 hours
thrombolysis + thrombectomy within 6 hours
167
what is given as soon as haemorrhagic stroke ruled out
300mg aspirin
168
what is given if presenting > 4.5 hours of ischaemic stroke
300mg aspirin
169
how long is aspirin continued after stroke
14 days at least
170
what is given immediately in TIA
aspirin 300mg
171
tx acute intracranial venous thrombosus
LMWH
| warfarin for longer term
172
management of acute variceal upper GI bleed rhyme
FKTAB - flirty katharine takes all boys
173
management of acute variceal upper GI bleed
```
FFP
vitamin K
Terlipressin
Antibiotics
Endoscopic banding
```
174
management of acute asthma rhyme
```
O SHIT ME
oxygen
salbutamol
hydrocortisone
ipratropium
theophylline
mag sulf
escalate
```
175
management of acute asthma
sit up and give high flow O2 via non-rebreather 15L mask
salbutamol nebulised 2.5-5mg
40/50mg prednisolone orally or 500mg hydrocortisone IV
- get help -
Ipratropoium bromide (SAMA) via nebulsier is given for life threat and severe, or if patient hasn’t responded to SABA and steroid
IV theophylline
IV Mag sulf 2g over 20 mins
176
management of thyroid storm
IV propranolol
IV dexamethasone
carbimazole
fluids, paracetamol
177
elderly patient on NSAID
raised urea disproportionate to creatinine
shock
upper GI bleed - haemorrhagic shock
178
COPD acute treatment rhyme
```
ISOTAPE
ipratropium
salbutamol
oxygen
theophylline
amoxicillin
prednisolone
escalate
```
179
tx hypercalcaemia
IV saline
following hydration bisphosphonates can be used
calcitonin works quicker than bisphosphonates
furosemide may be used if patient cannot handle aggressive fluid therapy
180
thyroid storm tx
IV propranolol
IV dexamethasone
carbimazol/PTU
Lugol's iodine - later
