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Year 3 ICSM COPY > Acute Care and Trauma > Flashcards

Acute Care and Trauma Flashcards

1
Q

Define ARDS

A

A syndrome of acute and persistent lung inflammation with increased vascular permeability

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2
Q

What is a pulmonary infiltrate?

A

A substance, thicker than air (eg pus/blood) lingering in the parenchyma.

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3
Q

Recall the characteristics of ARDS

A

A - Absence of raised capillary wedge pressure
R - Reduced blood oxygen (hypoxaemia)
D - Double-sided infiltrates (bilateral infiltrates)
S - sudden onset (acute)

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4
Q

Explain the aetiology of ARDS

A

Severe insult to lungs
Inflammatory mediators released
Capillary permeability increases
Results in pulmonary oedema, reduced gas exchange and reduced lung compliance.
(Injury, inflammation, increased permeability)

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5
Q

Recall some causes of ARDS

A 
TOAST crumbs and apple PIPs can make you choke - 
Transfusion
Overdose of drugs
Aspiration
Sepsis
Transplantation

Pneumonia
Injury/burns
Pancreatitis

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6
Q

Recall the pathological stages of ARDS

A

Exudative
Proliferative
Fibrotic

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7
Q

Recall the signs of ARDS

A 
Think SMURF: fast, blue, noisy:
Cyanosis 
Tachypnoea
Tachycardia
Widespread crepitations
Hypoxia refractory to oxygen treatment 
(Usually bilateral)
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8
Q

Identify appropriate investigations for ARDS

A

Bloods
Imaging = CXR to look for bilateral infiltrates
ECG - to look for mitral valve dysfunction (=valve beneath LA: dysfx –> build up of pressure in lungs)
PAC to check PCWP (pressure in left atrium)

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9
Q

Recall the presenting symptoms of ARDS

A 
Cough Sometimes Decreases Respiratory Function - 
Cough
Symptoms of cause
Dyspnoea
Respiratory distress
Functional deterioration
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10
Q

Why does alcohol withdrawal cause symptoms?

A

Chronic EtOH consumption –> suppressed glutamate activity –> increased sensitivity of body to glutamate to compensate
When alcohol consumption stops, suppression of Glu reduced but sensitivity still increased –> more Glu activity –> excitatory symptoms

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11
Q

Recall the presenting symptoms of alcohol withdrawal

A

HAD A PINT
Headache
Anxiety
Depression

Anorexia

Palpitations
Insomnia
Nausea
Tremor

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12
Q

What is the acute confusional state caused by alcohol withdrawal called?

A

Delirium tremens

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13
Q

Recall the features of delirium tremens

A

Sweating
Hallucinations
Tremor

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14
Q

What is the management plan for alcohol withdrawal

A 
*ABCDE*
Amobarbital
B1 vitamin (thiamine)
Chloro-
Diaz-
Epoxide
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15
Q

What is the reason for fatality in alcohol withdrawal?

A

Seizures (generalised tonic-clonic)

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16
Q

Distinguish immunogenic and non-immunogenic anaphylactic shock

A

Immunogenic involves IgE and immune complexes, non-immunogenic = mast cell/basophil degranulation without Ig involvement

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17
Q

Recall some symptoms of anaphylaxis

A

Symptoms of anaphylaxis will make the patient SOB:
Skin (rash, pruritis)
Oedema (lips, face)
Breathing (short, wheezing)

18
Q

Recall the signs of anaphylaxis

A 
URTICARIA:
Urticaria
Reduced BP
Tachypnoea
Infected conjunctiva
Cyanosis
Audible wheeze
Rhinitis
Increased heart rate
Airway swelling
19
Q

Recall an appropriate management plan for anaphylaxis

A 
Oxygen Can Help Anaphylaxis:
Oxygen
Chloropheniramine
Hydrocortisone
Adrenaline (IM)
20
Q

Recall the pathophysiology of aspirin overdose

A 
Really High Aspirin Consumption Does Harm Always
Resp centre stimulation
Hyperventilation
Alkalosis (respiratory)
Compensation by kidneys: urine bicarb and K+ increased
Dehydration
Hypokalaemia
Acidosis (metabolic)
21
Q

Recall the presenting symptoms of aspirin overdose

A 
OVERDOSE
Over-
Ventillation
Ears ringing
Red-faced
Dizziness
Overtired
Sweating
Epileptic-looking
22
Q

Recall the signs of aspirin OD on physical examination

A

Fever
Tachycardia
Hyperventillation
Epigastric tenderness

23
Q

Recall the appropriate investigations for aspirin OD

A

Bloods (including salicylate and ABG to show acidosis/alkalosis)
ECG (to look for hypokalaemia)

24
Q

Recall the 3 severities of burns injury and the approx healing time for each of these

A

Superficial - 7 days
Deep - 21 days
Full thickness - requires skin graft

25
Q

What is it important to check for in burns injury that you might forget?

A

Inhalational njury

26
Q

What investigations should be done in an electrical burn case?

A

CK
ECG
Urine myoglobin

27
Q

Which is the most commonly injured artery in extradural haemorrhage?

A

Middle meningeal artery

28
Q

Recall the characteristic progression of extradural haemorrhage

A

Temporary loss of consciousness –> lucid phase –> deterioration of GCS

29
Q

Recall the signs of extradural haemorrhage

A 
Mnemonic: Sudden damage can result in haemorrhage
Scalp trauma
Deteriorating GCS
Raised
ICP
Headache
30
Q

What is indicative of extradural haemorrhage on CT?

A

Shift in midline that shows raised ICP

31
Q

Define multi-organ dysfunction syndrome

A

Affects 2 or more organ systems and is induced by variety of insults including sepsis

32
Q

How is MODS measured?

A

It is scored 1-4

33
Q

Summarise the 4 MODS scores

A

1: Mild respiratory alkalosis and hyperglycaemia
2: Hypoxia + tachypnoea, liver dysfunction
3: Acid-base disturbance, azotaemia, coagulation abnormalities (due to liver dysfunction)
4: Lactic acidosis, ischaemic colitis, vasopressor dependent

34
Q

What is the main investigation in MODS

A

ABG - need to asses where they are in the alkalosis –> acidosis spectrum

35
Q

Recall the symptoms of opiate overdose

A 
Mnemonic: Codeine Never Softens Anyone's Crap
Constipation
Nausea
Sedation
Anorexia
Cravings
36
Q

Recall the signs of opiate overdose

A

Pinpoint pupils
Tachycardia with hypotension
Respiratory depression

37
Q

What drug is used to combat opiate overdose?

A

Naloxone

38
Q

What is the result of paracetamol overdose?

A

Hepatic necrosis

39
Q

After how many hours does paracetamol overdose begin to really show symptoms

A

24 hours

40
Q

What are the symptoms of paracetamol OD?

A

RUQ pain and jaundice, develops into jaundice and encephalopathy

41
Q

Recall the necessary investigations in paracetamol OD (think about liver fx)

A 
FBC
U&E, LFT
Clotting
Glucose
ABG
Salicylate

Year 3 ICSM COPY (17 decks)

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