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1

Sepsis 6

1. Administer high flow oxygen.
2. Take blood cultures
3. Give broad spectrum antibiotics
4. Give intravenous fluid challenges
5. Measure serum lactate and haemoglobin
Measure accurate hourly urine output

2

Red flag sepsis symptoms

• Systolic BP <90mm or >40mmhg fall from baseline
• MABP <65mmHg
• HR >130 bpm
• RR >25 per min
AVPU = V, P, or U

3

Meningitis signs

non blanching rash, photosensitivity, stiff neck

4

How to reverse warfarin

1. Stop warfarin
2. IV Vit K - Takes 4-6h to work
3. FFP - only if human prothrombin complex unavailable
Human prothrombin complex - reversal in 1 hr eg Bereplex. Give with Vit K

5

Anaphylaxis tx. how to inject adrenaline?

adrenaline - 500mcg
hydrocortisone - 200mg
chlorphenamine - 10mg

adrenaline can be repeated every 5 mins if necessary. Anterolateral aspect of middle third of thigh

6

Emergency dialysis indications

• Severe pH disturbance
• Resistant pulmonary oedema
Resistant hyperkalaemia

7

Causes of metabolic acidosis normal and raised anion gap

○ Normal - GI loss, renal tubular acidosis, drugs, addisons
Raised - lactate (shock, hypoxia, metformin), ketones (DKA), urate (renal failure), acid poisoning (salicylates, methanol)

8

Can you take blood from cnanula?

CANT TAKE BLOOD FROM CANNULA AFTER FLUSHING

9

Causes of neutrophilia

bacteria, inflammation, necrosis, steroids, malignancy

10

Causes of neutropenia

chemo, viral

11

Lymphocytsisus cayses

viral, TB,

12

Eosinophilia causes

allergy, parasites

13

pancytopenia causes

sepsis

14

Hemolysis markers

• Bilirubin
• Haptoglobin (decrease as it mops up Hb)
Red cell spherocytes

15

What Hb level do you give transfusion for?

below 80

16

Iron deficiency anemia markers

Target cells
Iron molecule carriers:
• Carried by transferrin in blood - goes up if iron deficient
• Stored in body as ferritin and hemosiderin - goes down if deficient

17

Causes of macrocytic anemia

Macrocytic:
• B12 deficiency
• Folate deficiency
Alcohol

18

Causes of microcytic anaemia

TAILS
• Thalassaemia
• Anaemia of chronic disease
• Iron deficiency
• Lead
Sideroblastic anemia

19

Causes of normocytic anaemia

• Hemolytic (LDH, reticulocytes)
Bleeding
Pregnancy (physiological)

20

How to know if there is mixed anaemia?

MCV could be normal as its average
check RDW

21

Causes of hyponatraemia

• Hyponatremia + decrease vol - fluid loss - GI, burns, diuretics
• Hyponatremia + normal vol - SIADH (syndrome of inappropriate ADH)
Hyponatremia + increase vol - Heart, liver, kidney failure

22

Causes of hypernatraemia

• Dehydration
• IV fluids
Diabetes insipidus

23

Tx of hyperkalaemia

• Treat underlying cause
• Stabilise cardiac membrane - IV Calcium gluconate
• Short term K+ shift to intracellular - Combined insulin/dextrose infusion, + Salbutamol nebs
Long term removal of K - Calcium resonium, loop diuretics

24

Causes of hyperkalaemia

• K sparing diuretics
• Think Kidney damage
Rhabdomyolysis

25

Hypokalaemia causes

Causes with hypertension:
• Cushings
• Conns syndrome (primary hyperaldosteronism)
Liddles syndrome

Causes without hypertension:
• Diuretics
• GI loss
Renal tubular acidosis

26

tx of hypokalaemai

• Oral K+ supplement if mild
If severe give IV K+ SLOWLY

27

Bone profile of osteoporosis

All normal

28

Bone profile of osteomalacia

Low calcium and P
High ALP

29

Bone profile of pagets

Ca + P normal
Raised ALP

30

COPD exacerbation abx?

amox