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Flashcards in Acute Care Deck (67)
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1

Red flags for headaches

FINE JVPP
• F - Focal neurological deficit
• I - Injury
• N - Neck stiffness
• E - Early morning headache
• J - Jaw claudication
• V - Vomiting or Visual disturbance
• P - Photophobia or Pregnancy

2

Thunderclap headache

Subarach

3

Unilateral headache + eye pain

cluster

4

Worse in morning and bending forward

raised icp

5

headahce + scalp tenderness in over 50s

Giant cell arteritis

6

Ix of headaches

BOXES - Bloods:
• FBC, CRP, U&E
• ESR
• Blood culture if pyrexia
• Meningococcal PCR

Special test:
• LP
CT head

7

S&S of temporal arteritis

• Headache
• Rapid onset <1 mth
• Jaw claudication
• Visual disturbances
• Tender palpable temporal artery
Systemic symptoms

8

Ix of temporal arteritis and tx

Ix:
• ESR - >50mm/hr
• Temporal artery biopsy - skip lesions

Tx:
• Prednisolone 250-1000mg IV if visual sx
• Urgent opthalmology review if visual symptoms

9

Differentials of SOB

1. PE
2. Pneumothorax
3. Asthma/COPD
4. Pneumonia
5. Acute HF
6. ACS

10

Ix for SOB

BOXES

Bloods:
• FBC, U&E, CRP
• D-Dimer to rule out PE
• Blood culture if pyrexic
• ABG

Orifice tests:
• Sputum

X-rays:
• CXR

ECG

Special:
• CTPA for PE

11

asthma emergency tx

O - Oxygen high flow non rebreath 15L
S - Salbutamol nebs 5mg
H - Hydrocortisone 100mg IV
I - Ipratropium 500mcg Neb
T - Theophylline: aminophylline infusion 1g in 1L saline 0.5ml/kg/h
M - Magnesium sulphate 2g IV over 20 mins
E - Escalate care with intubation and ventilation

12

COPD emergency tx

O - Oxygen 24-28% venturi mask
S - salbutamol nebs 5mg
H - Hydrocortisone 100mg IV
I - Ipratropium 500mcg nebs
T - Theophylline: aminophylline infusion 1g in 1L saline 0.5ml/kg/h

ABG

13

Decompensated HF tx

Management:
1. Sit pt upright
2. 100% oxygen non rebreath mask
3. IV access and ECG. Treat arrhythmias
4. Investigations whilst continuing treatment
5. Diamorphine IV 1.25-5mg
6. Furosemide 40-80mg IV
7. GTN spray 2 puffs. DON’T GIVE IF HEMOCOMPROMISED
8. If systolic >100mmHg, nitrate infusion eg isosorbide dinitrate
9. If pt worsening, consider CPAP

Consider discontinuation of beta blockers in short term.

14

Anaphylaxis tx

Tx:
• IM adrenaline 0.5mg repeat every 5 mins up to 3 times
• 15L oxygen
• 5mg salb nebs
• IV fluid challenge
• Hydrocortisone 200mg IV
• Chlorphenamine 10mg IV

15

Choking adult tx

Tx:
1. Ask pt to cough - if they can, encourage to cough and monitor
2. If they cant - 5 back blows and then 5 abdo thrusts. Keep going until pt becomes unconscious
3. Unconscious pt:
a. Begin CPR - even if carotid pulse present
b. Call for help and ambulance

16

IHD RFs

IHD RFs - HOPEFULS:
H - HTN
O - Obesity
P - PVD
E - Elevated LDL
F - FHx
U - Up glucose (DM)
L - Low HDLL
S - Smoking, Sex (male), Sedentary

17

Chest pain differentials acute

3Ps, 2As
1. ACS
2. PE
3. Aortic dissection
4. Pnuemothorax
5. Pneumonia

18

Chest pain ix

BOXES - Bloods - trop, FBC, WBC, CRP
CXR
ECG
CTPA (PE), CT angio (aortic dissection)

19

Give wells score criteria. When do you anticoagulate?

Don’t Die, Tell The Team To Calculate Criteria:
D - DVT
D - Diagnosis most likely PE
T - Tachycardia
TT - Three days immobility
T - Thromboembolism in past
C - Coughing up blood
C - Cancer

2 or more anticoagulate

20

Acute STEMI tx

STEMI Management:
1. Use ECG monitor
2. Bloods for FBC, U&E, glucose, lipids, cardiac enzymes
3. Assess PCI or fibrinolysis contraindications
4. Aspirin 300mg PO + prasugrel (if no contra) + LMWH
5. Morphine 5-10mg IV + metoclopramide 10mg IV
6. Is PCI available within 120 mins?
a. Yes - pci
b. No- Fibrinolysis (tPA) with rescue PCI if not successful

Acute Treatment (MONA):
• M - Morphine + metoclopramide
• O - Oxygen (if O2 <94%)
• N - Nitrates (if hemocompromised DO NOT USE)
• A - Antiplatelets (aspirin + prasugrel)

21

Post MI prevention and depression tx

Post MI prevention:
• Lifelong therapy of:
○ Aspirin
○ Antiplatelet eg clopidogrel
○ Beta blocker
○ ACEi
○ Statin
• Lifestyle advice:
○ Mediterranean diet
○ Exercise - until slight breathlessness
○ Sex 4 weeks post uncomplicated MI.
• Depression:
○ Treat with sertraline

22

Contraindications to PCI for MI

Contraindications to PCI:
• Due to antiplatelets
• High risk of bleeding
• Allergy
• Uncontrolled HT
• Stroke
• Bleeding disorders

23

PE tx - how long treatment?

Anticoagulant:
• Enoxaparin used until the diagnosis confirmed
• Then switch to warfarin after INR in target range. There will be drug overlap.

Length of anticoag:
• If PE precipitated by known event - 3 to 6 months
• If due to unknown event - 6 months minimum.
• If due to malignancy - 6 month anticoag

24

S&S of tension pneumo. tx

Examination:
• Pt looks ill
• Mediastinal shift
• Haemodynamic instability as tension compresses mediastinum

ABCDE + immediate large bore cannula 2nd ICS MCL

25

S&S of aortic dissection

S&S:
• Tearing pain, sudden onset
• Radiates into back
• Hypertension
• Blood pressure difference between arms greater than 20 mmHg
• Neurological deficits

26

Ix for aortic dissection

Investigations:
• CXR - widened mediastinum, abnormal aortic knob, tracheal and oesophageal deviation
• CT angiography of thoracic aorta
• MRI angiography

27

RFs for aortic dissection

RFs:
• Hypertension
• Trauma
• Collagen deficiency - marfans, ehlers danlos
• Turners and noonans syndrome
• Pregnancy

28

Severity scoring of pneumonia and what score means?

Severity assessed with CURB-65:
• Confusion = 1
• Urea > 7 = 1
• Respiratory rate > 30 breaths per minute= 1
• Systolic blood pressure < 90 mmHg / Diastolic < 60 mmHg = 1
• Age > 65 = 1

Score >2 admit to hospital.
Score >4 (30% mortality) consider ICU.

29

Define HAP

onset of sx 48 hrs post admission

30

Organisms causing community acquired pneumonia

1) strep pneumoniae
2) H influenzae
3) staph aureus