Clinical Flashcards
(25 cards)
There is a sick patient in Resus. How do you approach this case?
—This is a sick/frail/at risk patients who I am concerned about.
—I would do a rapid assessment of the patient’s stability and decide where the best place will be to stabilise/optimise/resuscitate them whilst simultaneously mobilising team X/Y/Z
—My priorities are…
What is pre-eclampsia?
Multisystem disorder of pregnancy from inadequate trophoblastic invasion
Pre-eclampsia is a disorder of pregnancy defined by:
—New onset BP >140/90 after 20 weeks gestation
Plus one of:
—Proteinuria
—Organ dysfunction
—Placental dysfunction
What is carcinoid syndrome?
Carcinoid syndrome is a rare condition seen in patients with the neuroendocrine carcinoid tumour where the tumour/metastasis is outside of the hepatic portal system.
Its typical features involve: flushing, diarrhoea and bronchospasm as well as R heart disease
You are asked to deal with an emergency. What will you do?
From the information I have, I suspect…
I will call for assistance and assign roles (+/-QRH)
I will apply specific and supportive measures:
—Secure airway
—Control ventilation
—Ensure cardiovascular stability
What is COPD?
Chronic respiratory condition with classical features of cough, dyspnoea, sputum production often in patients with risk factors
Classified using the GOLD criteria
What are some causes for raised temperature under GA?
Sepsis Malignant Hyperthermia Neuroleptic Malignant Syndrome Thyroid storm Ecstasy use Serotonin syndrome
What are the considerations for pre-op assessment for thoracic surgery?
—Post op MI risk
—Thoracosore (uses 9 variables to predict surgical mortality)(Age,Sex,ASA,Performance status, Severity of dyspnoea, Priority of surgery, Extent of resection, Diagnosis (malignant etc), Comorbidity)
—Resp function & post op dyspnoea
What is autism?
Neuropsychiatric disorder: Triad of difficulty with : -imagination -communication -interaction
What is Eisenmenger’s Syndrome?
Communication between the systemic and pulmonary circulation with pulmonary hypertension causing a right-to-left shunt
What is rheumatoid arthritis?
Chronic multisystem autoimmune disease of unknown cause
Results in symmetrical inflammatory polyarthritis with extra-articular features
What is a phaeochromocytoma?
Functionally active, catecholamine-secreting neuroendocrine tumour of chromaffin cells usually in adrenal medulla.
Secrete any combination of noradrenaline/adrenaline/dopamine
What is pyloric stenosis?
Most common surgical condition in <6month old
Hypertrophy of pyloric muscle causing gastric outflow obstruction, vomiting, metabolic alkalosis
What do we mean by conscious sedation?
A level of sedation where the patient remains conscious, retains protective reflexes and can respond to commands but allows sufficient anxiolysis and hypnosis for procedure
What is cerebral palsy?
A group of permanent movement and posture disorders that limit activity due to acquired pathology within the developing brain in the prenatal/neonatal/early infant period.
It is a clinical description based on an assessment of development and not a disease
What are the Echo criteria for Aortic Stenosis?
—Valve area: Mild >1.5cm Moderate 1-1.5cm Severe <1cm Critical <0.6cm
—Mean gradient: Mild <25mmHg Moderate 25-40mmHg Severe 40-50mmHg Critical >50mmHg
—Peak gradient:
Mild <40mmHg
Moderate 40-65mmHg
Severe >65mmHg
—Jet velocity:
Mild <3m/s
Moderate 3-4m/s
Severe >4m/s
What is your technique for an awake fibreoptic intubation?
DAS guidelines: Sedation, Topicalisation, Oxygenation, Perform (meh)
Sedation: Remi, x2 people, anti-sialogogue
Oxygenation: HFNO
Topicalisation:
—Cophenylcaine to nose
—10% lidocaine up to 20 sprays to base of tongue, back of throat, gargle (9mg/kg)
—x3ml of 2% lidocaine for spray as you go to cords etc
Perform: good positioning, ergonomics
2 point check:
—CO2
—view through scope - carina/trachealis
What crises can occur in sickle cell patients?
Vaso-occlusive
Splenic
Bone marrow - either haemolytic or aplastic (parvovirus B19)
What is the triad of tetanus?
—Rigidity
—Muscle spasm
—Autonomic dysfunction
Tetanospasmin inhibits GABA release
Treat with sedation/muscle relaxation (Propofol, Benzos, NMBDs, Mg, clonidine) plus general ICU measures
What do we mean by the term ‘hypotensive anaesthesia’?
When might we use it and how?
Are there any contraindications?
-Reduction of MAP by up to 30% of patient’s normal
-Mainly in ENT (FESS, bimaxilliary osteotomy etc)
-Use of:
—Anaesthetic agents: REMI, TIVA
—Drugs acting on SVR: GTN, SNP, Hydralazine, Alpha blockers
—Drugs acting on CO: Beta blockers, Mg, clonidine
-IHD, HTN (uncontrolled), DM, anaemia, Sickle cell, CVA, renal impairment
What risks calculator tools are there?
ACS NSQIP (elective) Lee’s CRI NELA (emergency); PPOSSUM, VPOSSUM SORT Frailty scores
EuroSCORE II
Thoracoscore
Nottingham Hip Fracture?
What are the components of Lee’s CRI?
High risk surgical procedure IHD CCF CVA Insulin High Cr >177
What is frailty?
A state of increased vulnerability to poor resolution of homeostasis after a stressor event
How does DKA occur?
- In times of low insulin, free fatty acids broken down
- Build up of Acetyl-CoA, which is converted to ketone bodies in the liver
- Ketone bodies are acid in the body, buffered until capacity exceeded and metabolic acidosis occurs
What are some causes of hypoventilation?
Central drive:
—Drugs - opiates, anaesthesia
—Stroke/trauma to brainstem/Resp Centre
—Spinal cord injury (high)
Neuromuscular disorders (weakness):
—Infection - Guillain Barre, botulism, polio
—Muscular dystrophy
—Myasthenia Gravis
Chest wall problems (restrictive):
—Trauma - flail segment
—Kyphoscoliosis
Lung problems: —ARDS —Asthma (airways resistance) —LV failure —Airway obstruction
Other: —Pain —Diaphragmatic splinting —Obesity —?OSA
