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4MB Medicine Aaron > Acute Care > Flashcards

Acute Care Flashcards

1
Q

What assessments and interventions would you make for someone’s Airway?

A

Look (obstruction, breathing, resp muscles, cyanosis)
Listen (stridor, snoring, gurgling)
Intervene: head-tilt, chin-lift, jaw-thrust

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2
Q

What assessments and interventions would you make for someone’s Breathing?

A

Look (chest movement, rate, depth, cyanosis)
Listen (breath sounds bilaterally)
Feel (air movement, trachea)
O2 sats
Intervene: high-flow O2, ventilatory support

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3
Q

What assessments and interventions would you make for someone’s Circulation?

A

Pulse, blood pressure, cap refill, JVP

Intervene: 2x IV access, fluids, blood samples, ECG

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4
Q

What assessments and interventions would you make for someone’s Disability?

A

AVPU, glucose, GCS, pupil reation and size

Intervene: glucose

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5
Q

What assessments and interventions would you make for someone’s Exposure?

A

Temperature, injury, rashes

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6
Q

What is the minute volume (in regards to respiration) comprised of?

A

Tidal volume x Respiratory Rate

Alveolar ventilation + Dead space ventilation

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7
Q

A healthy lung would have ventilation:perfusion (V:Q) ratio of 1. What would the V:Q ratio be in a shunt?

A

Q would be higher than V, signifying wasted perfusion

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8
Q

A healthy lung would have ventilation:perfusion (V:Q) ratio of 1. What would the V:Q ratio be if there is dead space?

A

V would be higher than Q, signifying wasted ventilation

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9
Q

Why does CO2 retention suggest low alveolar ventilation?

A

Due to physiological dead space, alveoli aren’t perfused and there is an overall decrease in alveolar ventilation, which impedes CO2 elimination

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10
Q

What is the consequence of alveolar hypoventilation and increase in alveolar CO2?

A

Hypoxia

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11
Q

Opioid analgesia is the commonest cause of hypercapnia secondary to reduced hypoxic drive. True/False?

A

True

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12
Q

What is hypoxic drive of respiration?

A

Due to chronic hypercapnia, body relies on O2 levels to control breathing - if high O2 levels detected, respiratory drive/effort will be decrease
This is why caution should be taken when giving high-flow O2 to COPD patients

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13
Q

What is cardiogenic shock?

A

Reduction in cardiac output due to reduced stroke volume due to reduced contractility
Essentially, “pump failure”

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14
Q

What is obstructive shock?

A

Mechanical obstruction of flow causes hypoperfusion

Caused by impaired filling or emptying of heart

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15
Q

What is hypovolaemic shock?

A

Inadequate circulating volume causes hypoperfusion

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16
Q

What is distributive shock?

A

Peripheral vasodilation causes reduced vascular resistance and thus fall in blood pressure
Results in inappropriate distribution of blood flow

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17
Q

List clinical features of tricyclic antidepressant/amphetamine
poisoning

A 
Dilated pupils
Divergent squint
Tachycardia
Hyper-reflexia
Extensor plantar response
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18
Q

List clinical features of barbiturates/BZD/opioid poisoning

A 
Coma
Hypotension
Respiratory depression
Pin-point pupils
Hypo-reflexia
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19
Q

List clinical features of salicylate poisoning

A 
Tinnitus, deafness
Hyperventilation
Sweating
Nausea
Tachycardia
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20
Q

What are the most useful investigations in poisoned patients?

A 
Paracetamol levels
Salicylate levels
Blood glucose
ABG's
Urea and electrolytes
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21
Q

What is the antidote for beta-blocker poisoning?

A

Glucagon

Atropine

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22
Q

What is the antidote for carbon monoxide poisoning?

A

Oxygen

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23
Q

What is the antidote for iron poisoning?

A

Desferrioxamine

24
Q

What is the antidote for opioid poisoning?

A

Naloxone

25
Q

What is the antidote for paracetamol poisoning?

A

Acetylcysteine

Methionine

26
Q

What is the antidote for sulfonylurea poisoning?

A

Glucose

Octreotide

27
Q

What is the antidote for warfarin poisoning?

A

Vitamin K
Clotting factors
FFP

28
Q

List risk factors/drugs that can precipitate paracetamol poisoning

A 
Alcoholics
Malnutrition
(drugs that induce hepatic enzymes)
Anticonvulsants
Rifampicin
St John's wort
29
Q

List clinical features of paracetamol poisoning

A 
Nausea, vomiting
Abdo pain
Tenderness over liver
Jaundice
Coma, hepatic encephalopathy (much later)
30
Q

Liver function tests are usually normal in paracetamol poisoning until 18 hours after overdose. True/False?

A

True

31
Q

Which test is the most sensitive lab evidence of liver damage from paracetamol poisoning after 24 hours?

A

Prolonged INR

32
Q

List side effects of acetylcysteine/Parvolex

A 
Erythema, urticaria around infusion site
Generalised rash, itch
Nausea
Angioedema
Bronchospasms
Hypo/hyper tension
33
Q

What should be given if skin/allergic reactions occur with Parvolex?

A

IV chlorphenamine

34
Q

How is paracetamol poisoning managed within 4 hours of ingestion?

A

Activated charcoal if within 1 hour

IV acetylcysteine/oral methionine if not

35
Q

List indications for urgent CT scan following a head injury

A 
GCS less than 13
GCS of 13 or 14 after 2 hours
Suspected open/depressed fracture
Any sign of basal skull fracture
Post-traumatic seizure
Focal neurological deficit
Post-traumatic amnesia of over 30 mins
Persistent vomiting
Coagulopathy
Significant mechanism of injury
36
Q

What is the GCS made up of?

A 
Eye response (4)
Verbal response (5)
Motor response (6)
37
Q

List the eye response components of the GCS

A

1- no eye opening
2- eye opens to pain
3- eye opens to voice
4- spontaneous eye opening

38
Q

List the verbal response components of the GCS

A 
1- no vocal response
2- incomprehensible speech
3- inappropriate speech
4- confused speech
5- orientated/normal speech
39
Q

List the motor response components of the GCS

A 
1- no motor response
2- extends to pain
3- flexes to pain
4- withdraws from pain
5- localises pain
6- obeys commands
40
Q

What is the triple airway maneuvre?

A

Head tilt
Chin lift
Jaw thrust

41
Q

How do you size up an oropharyngeal (Guedel) airway?

A

Distance from angle of jaw to corner of patient’s mouth

42
Q

List the main airway adjuncts used

A

Guedel airway
Nasopharyngeal airway
Bag-valve mask

43
Q

What is the daily maintenance requirement of H2O?

A

1.5 ml / kg / h

Roughly 2-3L a day

44
Q

What is the daily maintenance requirement of Na?

A

1-2 mmol / kg / day

45
Q

What is the daily maintenance requirement of K?

A

0.5 - 1 mmol / kg / day

46
Q

Urine output should be greater than ___ ml/kg/h

A

Urine output should be greater than 0.5 ml/kg/h

47
Q

List the Na, Cl, K, HCO3 and glucose concentrations in normal plasma

A 
Na: 135-145
Cl: 100-110
K: 3.5-5
HCO3: 22-26
Glucose: 3.5-7.8
48
Q

List the Na, Cl, K, HCO3 and glucose concentrations in normal saline 0.9%

A 
Na: 154
Cl: 154
K: nil
HCO3: nil
Glucose: nil
49
Q

List the Na, Cl, K, HCO3 and glucose concentrations in Hartmann’s solution

A 
Na: 131
Cl: 111
K: 5
HCO3: 29
Glucose: nil
50
Q

List the Na, Cl, K, HCO3 and glucose concentrations in dextrose-saline

A 
Na: 30
Cl: 30
K: nil
HCO3: nil
Glucose: 40g
51
Q

Which type of fluid is good for replacing plasma loss?

A

Hartmann’s solution

52
Q

How do you calculate someone’s fluid requirements?

A

Overall requirement = maintenance requirement + replacement of losses
Calculate requirements over 24 hours

53
Q

List causes of extracellular fluid loss

A 
Diarrhoea and vomiting
NG aspirates
Stoma
Burns
Pancreatitis
54
Q

What is typically used to replace extracellular fluid losses?

A

Hartmann’s

55
Q

Which type of fluid is typically given for normal maintenance fluids?

A

Dextrose-saline

56
Q

What fluid would you prescribe for an acutely hypotensive patient in whom cause is uncertain?

A

250-500ml saline over 5 mins, then reassess

4MB Medicine Aaron (4 decks)

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