- Dopamine alongside vasopressors are the mainstays of treatment

sirs is >/=2 of the following - Heart rate >90 bmp - Respiratory rate >20/min - Temperature >38℃ or 12 000/mm3 or 10% immature neutrophils

clasp Ixs and txs Flashcards by lana yassin

Subdural haemorraghe ixs

CT scan mainstay of investigation

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Subarachnoid haemorraghe ixs

CT cerebral angiogram - (to identify an anyeursm)

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Spinal cord compression ix

immediate MRI

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what are the reversible causes of cardiac arrest

4 H’s and 4 T’s
Hypoxia, Hypovalemia, Hypo/hyperkalemia/metabolic, Hypothermia

Thrombosis, Tamponade (cardiac), Toxins, Tension pneumothorax

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hypovalaemic shock tx

fluids and electrolytes

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cardiogenic shock tx

inotropics by beta or dopaminergic stimulation- dobutamine, adrenaline, dopamine, dopexamine

intra-aortic baloon pump if pharmacological tx not working

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what is obstructive shock and causes

physical obstruction to filling of the heart → reduced preload and cardiac output

tamponade, PE, tension penumothorax

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obstructive shock tx

PE - DOAC + thrombolysis (thrombolysis used in pe when there is haemodynamic instability)
Cardiac tamponade - pericardial drainage
Tension pneumothorax - decompression and chest drainage

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distributive shock, what is it and subtypes

significant reduction in SVR beyond the compensatory limits of increased cardiac output
Generally initial high cardiac output but insufficient to maintain forward perfusion
main subtypes:
- Septic - bacterial endotoxin mediated capillary dysfunction
- Anaphylactic - mast cell release of histamnergic vasodilators- (tx adrenaline as vasoconstricts and stabilises mast cell)
- Neurogenic - loss of thoracic sympathetic outflow following spinal injury (= loss of sympathetic tone= bradychardia due to unopposed vagal tone)

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neurogenic shock tx

Dopamine alongside vasopressors are the mainstays of treatment

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what are shockable and non shockable cardiac arrest rythms

shockable:
vfib
pulseless ventricular tachycardia

non shockable
pulseless electrical activity
asystole

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sepsis vs septic shock
(define septic shock)

septic shock is sepsis but assoc with cellular/metabolic dysfunction.
septic shock = sepsis + persistant hypotension lactate>/= 2

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SIRS defined

sirs is >/=2 of the following

Heart rate >90 bmp
Respiratory rate >20/min
Temperature >38℃ or <36℃
WCC >12 000/mm3 or <4 000/mm3 or >10% immature neutrophils

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what antibiotics inc risk of c.difficile

the 4 cs

co-amoxiclav, cephlasporins (eg. ceftriaxone), clindamycin, ciprofloxacin (quinolones)

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where are anaerobes found

mouth, teeth throat, sinuses and lower bowel

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Gram positive found where in the body

skin and mucous membranes

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Gram negative found

GI tract

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(types of allergy) which occurs sooner- immediate onset reaction (type 1) or accelerated/immediate reaction

accelerated occurs later- within 1-6 hours of last dose.

immediate (type 1) within 1 hour

both IgE mediated

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what in penillicin is responsible for allergic reaction

B-lactam ring

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How is sepsis monitored/defined

Early news warning score
Score of 5 or more with known/suspected infection= sepsis till proven otherwise
Or can be less than 5 but concerning features eg. Non blanching rash

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Adjust news score up if

Clinical/carer concern
Deterioration,surgically remidiable sepsis
Neutropenia
Blood gas/ lab evidence organ dysfunction/lactate

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Staph a test

First gram stain
Then rapid PCR- also tells u if its mrsa

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When does PCR not work

Study These Flashcards

On dirty samples eg urine, stool

Gram pos cocci in pairs or chains ix

Study These Flashcards

Agglutination aasay (serological test antibodies antigens)

How to testbfor weird bacteria species

MALDI-TOF

Bacteria testing order

Bloods>(1-5days)> positive alert + gram stain> culture results and maldi tof> discs etc

Important causes if gram negative sepsis

E. Coli, neiserria meningitis, psuedomonas aerginusa

Mechanisms of abx resistance (5)

-change target cell -reduced uptake - pump which spits bacteria back out - inactivating enzymes -decrease cell membrane permeability

Malaria ix

Thick and thin smear

c.difficile tx

ORAL vancomycin if cant take orally then NG tube etc- has to go into stomach if life threatening add IV metronidazole if recurrs within 12 weeks- oral fidaxomin

what additional test must be carried out for c.difficile

abdo x-ray- check for toxic megacolon

what does coagulese negative staph usually indicate in a culture

usually a contaminant suspect pathogenic if presence of ICED (implantable Cardiac electronic Device) or prosthetics etc.

symptom of anaerobic pneumonia

pleural infection

pneumonia treatment

amoxicillin------IV co-amoxiclav + doxy depending on severity (<2 CURB65= mild, >3=severe) all get pneumococcal and influenza vaccine

additional tests for pneumonia

HIV test Chest x-ray at 6 weeks

ICED infection tx

1st line: IV vancomycin

staph A bacteraemia ixs

48 hourly blood culture until negative transthoracic echo

staph A tx

flucox if allergic: vancomycin (IV is septic etc)

Which drugs have a b lactam ring

Penicillins Cephalosporins Carbapenams Aztreonam

Sepsis 6 o Oxygen- when given and targets

Start is sats <92- take this with a pinch of salt, if unwell just give as unlikely to do harm Aim: 94-98

Sepsis 6 targets in hypercapniac patients Who is at risk for this

Target 88-92 ABG- pco high indicates hypercapnic pt. Ppm at risk: COPD, end stage lung disease etc

What are you testing for when taking blood cultures for sepsis 6

Check for infection + fbc u&es, LFTs, CRP, clotting, lactate

How are fluids given in sepsis 6.and what type of fluid

20mls/kg in divided doses, crystalloid Consider pt history eg. Hf Can use lactate to guide response Do not give dextrose- does not restore circulating volume

What is pharmacokinetics

What the body does to the drug - absorption & bioavailability -distribution -excretion -

new score of 1-4 when should initial treatment be started by

<6h (6h cut off for max time)

news of 5-6 when is max time for starting initial tx

<3hrs

news score of >/=7 what is the max time for starting initial treatment

<1hr

What mutation causes marfans

Fibrillin

What mutation causes marfans

Fibrillin

What is a mendelian disorder

Disease predominantly caused by a change in a single gene (High penetrance)

What mutation causes loeys dietz syndrome

Mutation in TBR1 or TBR2

animal bites antbiotic tx

co-amoxiclav

what contraindicates trimethoprim

methotrexate

bacteriuria tx in asymptomatic Catheterised patients:

no treatment! the longer catheter is in situ the greater the likliehood of developing bacteriuria. only treat if symptomatic if symptomatic 7 day course of abx not 3

cavitating lesion pneumonia- what organism

staph a hameophillus type A

Lyme disease tx

Doxcy- 3 weeks

jirovecci pneumonia tx

co - trimaxazole

clasp Ixs and txs Flashcards

(57 cards)