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Acute Care Flashcards

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1
Q

4 Hs

A

Hypoxia Hypovolaemia Hyper/hypo kalaemia, calcaemia (metabolic) hypothermia

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2
Q

4 Ts

A

Thrombosis (coronary/pulmonary) Tension pneumothorax Tamponade (cardiac) Toxins

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3
Q

Non Shockable rhythms

A

asystole PULSELESS electrical activity (except VT)

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4
Q

Shockable rhythms

A

VF pulseless VT

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5
Q

What do you give if non-shockable rhythm?

A

Adrenaline 1mg IV

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6
Q

What dose amiodarone given after 3 shocks?

A

300mg

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7
Q

What do you do if spontaneous movement/breathing efforts return during CPR

A

Check for pulse (carotid)

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8
Q

Treatment of tension pneumothorax

A

wide bore needle decompression (wide bore/grey cannula) 2nd intercostal space mid-clavicular line Then insert chest drain 5th intercostal space mid-axillary line (but can also decompress here)

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9
Q

What constitutes to hyperkalaemia?

A

K+ > 6.5 mmol/l

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10
Q

What constitutes to hypokalaemia?

A

K+ < 2.5 mmol/l

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11
Q

Hyperkalaemia ECG Changes

A
  • tall ‘tented’ T waves in precordial leads
  • decreased/flattened P waves and widened QRS (moderate)
  • progressive widening of QRS, axial deviation, BBB (severe)
  • QRS will evertually become so big that may merge with T wave -> sine wave pattern
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12
Q

PE ECG changes

A
  • often no changes
  • S waves in lead I (S dips below baseline)
  • Q waves in lead III (Q dips below baseline)
  • inverted T waves in lead III

S1, Q3, T3

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13
Q

Type 1 respiritory failure definition and example causes

A

->Hypoxic

usually cause by processes resulting in direct damage to lungs/interuption of blood flow e.g. pneumonia, ARDS, pumonary oedema, fibrosis, PE

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14
Q

Type 2 respiritory failure and example causes

A

-> hypercapnia (+/- hypoxia)

caused by things which limit air flow into the lungs e.g. coma, neuromuscular disorders, COPD, asthma, pneumothorax and restrictive aspect of pulmonary fibrosis

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15
Q

GCS motor response 6

A

Obeying commands

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16
Q

GCS motor response 5

A

localising to pain

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17
Q

GCS motor response 4

A

withdrawing to pain

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18
Q

GCS motor response 3

A

flexor response to pain

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19
Q

GCS motor response 2

A

extensor respose to pain

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20
Q

GCS motor response 1

A

no response to pain

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21
Q

GCS verbal response 5

A

orientated to time, place and person

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22
Q

GCS verbal response 4

A

confused conversation

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23
Q

GCS verbal response 3

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A

innapropriate speech

24
Q

GCS verbal response 2

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A

incomprehensible sounds

25
GCS verbal response 1
none
26
GCS eye opening 4
spontaneous eye opening
27
GCS eye opening 3
in response to speech
28
GCS eye opening 2
in response to pain
29
GCS eye opening 1
none
30
Below what GCS is airway protection needed?
8 (some sources say 7)
31
Sepsis 6 bundle
O2 IV fluid IV Abx Lactate urine output blood cultures (preferably before abx)
32
initial emergency of anaphylaxis
O2/secure airway Adrenaline IM 0.5mg -repeat every 5 mins, guided by BP, pulse resp. function
33
additional treatment for anaphylaxis
- chlorophenamine (antihistamine) 10mg IV - hydrocortisone 200mg IV - if wheeze present, also treat for asthma - admit to ICU if hypotensive, normal ward if not. Measure serum tryptase
34
when may IV adrenaline be used in anyphalaxis
when there is no pulse (if insufficienct circulation then IM will be useless)
35
STEMI emergency treatment
Aspirin 300mg CLopidogrel 600mg (i.e. 2x antiplatet) 5000 units Heparin IV +PCI!
36
NSEMI emergency treatment
Morphine 5-10mg IV O2 GTN aspirin 300mg rising troponins or risk factors/already poor cardiac function/high GRACE score -\> second antiplatelet e.g. ticagrelor, IV nitrate, bisoprolol, cardio review/ angiography lower GRACE score, low/no toponins -\> send home, outpatient appt. for further Ix above may be candidates for cabbage or coronary stenting
37
emergency management of pulmonary oedema
- O2 - ensure to monitor ECG - diamorphine 1.25-5mg IV (caution in COPD, liver failure) - furosemide 40-80mg IV - GTN (unless BP low) consider CPAP
38
Investigations for suspected pulmonary oedema
- CXR (fluid, kerley B lines etc.) - ECG (rule out MI, monitor for arrythmias) - U&E, troponins, ABG - echo - BNP (hight negative predictive value)
39
common causes of broad complex tachycardia
- Hypokalaemia - Hypomagnesaemia
40
useful drug for ventricular tachycardia
amiodarone 200mg IV
41
good drug for supraventricular tachycardias
Adenosine 6mg IV (first try vagal manouvres before drugs)
42
good drug for bradycardias
atropine 500mcg IV | (only give if adverse sighs e.g. shock)
43
Emergency treatment of asthma
O2 salbutamol 5mg nebs (not will need to turn flow of O2 down to about 6 to give this) Ipratropium 0.5mg Hydrocortisone 100mg IV OR pred 40-50mg PO repeat nebs ever 15-30 mins, consider MgSO4
44
PEF in sever asthma attack
33-50% predicted -unable to complete sentences in one breath
45
PEF in sever asthma attach
\<33% of predicted/best arrythmias, hypotension, exhaustion, confusion, coma
46
Acute exacebation of COPD emergency management
salbutamol 5mg neb, ipratropium 500mcg neb O2 (venturi mask) ajust according to ABGs Hydrocortisone 200mg IV or pred 30mg OD if evidence of infection give Abx if not responding/need to blow off lots of excess CO2 consider Bipap or resp. stimulants
47
When is a chest drain NOT needed in pneumothorax?
when rim of air on CXR \<2cm of CXR or over 2cm but sucessfully aspirated
48
PE emergency management
IV LMWH/fondaparinux
49
When would you do rapid sequence induction?
- patient who needs to be intubated but is not fasted like in elective surgery - useful in emergency setting as likely contents in stomach which pose risk to airway - patient with low/lowering GCS who needs airway protection (if gag reflex still present may push up intracranial pressure)
50
Drugs commonly used in rapid sequence induction
- thiopentone or Etomidate, sometimes propafol but not ideal due to vasodilatory effects (induction) - ruconium (muscle relaxant/paralysis) - fentanyl (pain) note other drugs will be needed to aintain anaesthesia
51
What is the function of cricoid pressure?
prevents gastric contents coming up when attempting to intubate patient
52
Info needed around paracetamol overdose
- how many tablets - what strength - form of tablet (combination tablet) - how long ago - patients weight - Note get LFTs and paracetmol level (if over 1h) sent off quickly
53
drug used in treatment of paracetamol overdose when do you decide to use it?
acetyl cysteine - treatment threshold based off blood paracetamol levels and how long its been since tablet ingestion - if been less than 1h since ingestion consider activated charcoal
54
Older man with back/loin pain differentials
mechanical disc tear renal calculi AAA -\> USS
55
Where can you look up management for overdose of any drug?
toxbase
56
management of opioid overdose
- supportive - naloxine -\>TENTATIVELY otherwise push patients into withdrawal and can become agressive or worsen outcomes -also note short half life of naloxone, patients may slip back into resp. depression
57
what is Rosving's sign?
palpation of the LLQ increases pain felt in the RLQ -sign of appendicitis

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