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Year 4 Acute Care > Acute Care > Flashcards

Acute Care Flashcards

1
Q

what are teh indications for central venous catheter insertion

A

monitoring of central venous pressure
venous acces for haemodialysis
venous access for cardiac pacing
administration of inotropes, cytotoxic agents or parenetral nutrition

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2
Q

what are teh 4 main sites for central venous catheter insertion

A

internal jugular
subclavian
femoral
antecubital fossa

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3
Q

what is the correct placement of a central venous catheter

A

tip sitting in the right atrium

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4
Q

what is an inotrope

A

a substance that affects the force of muscular contraction either positively or negatively

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5
Q

what is a vasopressor

A

a substance which increases the systemic vascular resistance

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6
Q

what is the lebel of care 0

A

stabel patient on routine ward

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7
Q

what is teh level of care 1

A

at risk of deteriorating

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8
Q

what is the level of care 2

A

HDU - NIV or support for single organ failure

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9
Q

what is teh level of care 3

A

ICU - advanced resp support or multiorgan failure

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10
Q

how do you calculate an anion gap

A

(Na+K) - (Cl + HCO3)

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11
Q

what is the normal anion gap

A

12+/-4

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12
Q

what are the causes of a raised anion gap metabolic acidosis

A

MUDIPLES

methanol ; uraemia; DKA/ alcoholic ketoacidosis; paraldehyde; isoniazide; lactic acidosis; ethylene glycol; salicylate

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13
Q

what are the red flag symptoms to look for in head injury

A

cushings response - hypertension bradycardia and irregular breathing (raised ICP reduced cerebral blood flow)

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14
Q

when do you intubate

A

GCS < 8

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15
Q

How are head injuries grades

A

by GCS
13-15 - MILD
9-12 - Moderate
3-8 - Severe

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16
Q

what are the main signs of a basillar skull fracture?

A 
haemotympanum 
battles sign (back of ear 12 hours post injury) 
racoon eyes (tarsal plate sparing)
17
Q

discuss the main indications for CT

A
  • GCS <12
  • confusion or drowsiness (failure to imporve within 1 hr of admission of 2 hrs of injury )
  • base of skill or depressed skull fracture +/- suspected penetrating injuries
  • decreased LOC / new focal neuro signs
  • GCS 15 but severe and persistent headache or two episodes of vomitting
  • a histoyr of coagulopathy (warfarin etc), loss of consciousness, amnesia or any neurological signs
18
Q

brainstem death requires confirmation by how many doctors

A

two

19
Q

describe mechanical invasive ventillation

A

perfomred via an endotracheal tube or other airway device (commonly a tracheostomy)

20
Q

describe mechanical non invasive ventilation

A

performed via a tight fitting mask (CPAP Or BIPAP)

21
Q

how do you measure the % of burns

A

rule of 9s - (4.5 for front and back of arm each and rest 9 but needs to count front and back)

22
Q

when should hypoglycamia be treated urgently

A

<3.5

23
Q

treat hypoglycaemia

A

100mls 10% glucose IV immediately

24
Q

only restart metformin after surgery if

A

good renal function as has a risk of lactic acidosis

25
Q

in a diabetic on the morning before teh op commence what

A

IV glucose and insulin

26
Q

WHEN AFTER THE OP DO DIABETICS GET CHANGED TO SUBCUT INSULIN

A

when eating normally (but continue IV insulin infusion for the first 60 mins after the first dose of subcut insulin)

27
Q

how should diabetics fast

A

fast till midnight and omit the norning insulin

finger prick before and after procedure

28
Q

what is the sequence of anaestehtci

A 
premeds
induction 
maintenance 
reversal 
recovery
29
Q

post op nausea give

A

ondansetron first line

cyclizine second line

30
Q

what investigation is most important in patients with RA prior to surgery

A

C spine XRAY to check for atlantoaxial subluxation as important for anaesthesia

31
Q

what is given in the shock pack

A

4 units rbcs 4 units 1 pool of platelets

Year 4 Acute Care (18 decks)

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