DTP's and CPG's Flashcards
(115 cards)
1
Q
What are the indications for Aspirin?
A
- Suspected ACS
- Acute cardiogenic pulmonary oedema (cardiogenic APO)
2
Q
What are the contraindications for Aspirin?
A
- Allergy / adverse drug reaction to aspirin or any NSAID
- Chest pain associated with psychostimulant overdose
- Bleeding or clotting disorders
- Current GI bleeding OR peptic ulcers
- less than 18 years
3
Q
What are the precautions for Aspirin?
A
- Possible AAA or any other condition that may require surgery
- Pregnancy
- History of GI bleeding or peptic ulcers
- Concurrent anticoagulant therapy eg warfarin
4
Q
What can be the side effects of Aspirin?
A
- Epigastric pain / discomfort
- Nausea / vomiting
- Gastritis
- GI bleeding
- NSAID induced bronchospasm
5
Q
What is the adult dosage for Aspirin?
A
300mg - chewed, followed by small sip of water
6
Q
What is the max daily dosage of Aspirin?
A
450 mg
7
Q
What drug class is Aspirin?
A
Antiplatelet
8
Q
Aspirin Pharmacology
A
Aspirin inhibits platelet aggregation by irreversibly inhibiting cyclo-oxygenase, reducing the synthesis of thromboxane A2 (an inducer of platelet aggregation) for the life of the platelet. This actions forms the basis of preventing platelets from aggregating to exposed collagen fibres at the site of vascular injury
9
Q
What drug class is Droperidol?
A
Antipsychotic
10
Q
What are the indications for Droperidol?
A
Acute behavioural disturbances (with a SAT Score >2)
11
Q
What are the contraindications for Droperidol?
A
Absolute:
- Allergy / adverse drug reaction
- Parkinson’s disease
- Known Lewy body dementia
- Previous dystonic reaction to droperidol
- < 8 years
Relative: (requires consult line)
- suspected sepsis
12
Q
What are the side effects of Droperidol?
A
Vasodilation / hypotension
Extrapyramidal effects eg dystonic reactions (rare)
13
Q
What is the presentation of Droperidol?
A
Vial 10mg/2mL
14
Q
What is the IM & IV Adult dosage of Droperidol for a patient aged 13-15 years? Does it require a consult?
A
0.1 - 0.2 mg.kg
Single max dose 10mg
May be repeated once at 15 min
Total max dose 20mg
It requires a consult and approval
15
Q
What is the IM & IV Adult dosage of Droperidol for a patient over 65 years? Does it require a consult?
A
5mg
May be repeated once at 15min
Total max dose 10mg
Consult and approval is required
16
Q
What is the IM & IV Adult Droperidol dosage for a patient aged 16 to < 65 years? Does it require a consult?
A
10mg
May be repeated once at 15 min
Totak max dose 20mg
No consult required
17
Q
What are the precautions for Droperidol?
A
Hypoperfused state
Concurrent use of CNS depressants
18
Q
What drug class is Ondansetron?
A
Anti-emetic – 5-HT3 antagonist
19
Q
What is the pharmacology of Ondansetron, how does it work?
A
Ondansetron is a serotonin 5-HT3 receptor antagonist. It works by blocking the action of serotonin, a natural substance that may cause nausea and vomiting.
20
Q
What are the indications of Ondansetron?
A
Significant nausea / vomiting
21
Q
What are the contraindications of Ondansetron?
A
Absolute:
- allergy / adverse drug reaction
- Congenital long QT syndrome
- Current apomorphine therapy (used in severe Parkinson’s)
- < 2 years
Relative:
- First trimester pregnancy (may only be administered for extreme and uncontrolled hyperemesis)
22
Q
What can the adverse effects of Ondansetron be? Common and Rare
A
Common
- headache
- constipation
Rare
- hypersensitivity reactions (including anaphylaxis)
- ECG changes
23
Q
What is Ondansetron’s Presentation?
A
Ampoule - 4mg/2mL
Oral tablet - 4mg
24
Q
What is the adult dosage of Ondansetron PO or IM?
A
4-8mg
Total max dose 8mg
Must not be given within 8 hours of previous administration
25
What is the Adult dosage of Ondansetron IV?
4-8mg
Slow push over 2-3 minutes
Total max 8mg
Must not be given within 8 hours of previous administration
26
What is the PO paediatric dosage of Ondansetron for a patient over 5 years?
4mg single dose
27
What is the PO paediatric dosage of Ondansetron for a patient aged 2-4 years?
2mg single dose
28
What is the IM paediatric dosage of Ondansetron for a patients older than 2 years?
100 microg / kg (rounded to nearest 5kg)
Single dose - must not exceed 4mg
15-20kg - 2mg - 1ml
20-25kg - 2.5mg - 1.25ml
25-30kg - 3mg - 1.5ml
30-35kg - 3.5mg - 1.75ml
>35kg - 4mg - 2ml
29
What is the paediatric dosage of IV Ondansetron for patients over 2 years?
100 microg/kg
Slow push over 2-3min
Single dose, not to exceed 4mg
30
Can an IV cannula be inserted for the sole purpose of ondansetron administration?
NO
31
A patient is having an active seizure, what is the treatment?
- Protect the patient from injury
- Reversible causes
- Oxygen
- IPPV
- Midazolam (5mg IM / 200microg/kg for Paediatric)
- Levetiracetam
32
A patient has just stopped actively seizing, what is the treatment?
- reversible causes
- oxygen
- posturing
- PNES
33
What is a Focal Seizure?
Seizure activity that does not impair awareness or responsiveness
34
What is a Generalised seizure? What are the 5 types?
A generalised seizure is where abnormal neuronal activity rapidly engages both hemispheres of the cerebral cortex.
- Absence: brief ALOC with no post-ictal
- Atonic: Sudden loss of muscle tone resulting in a fall
- Tonic: sudden increased muscle tone that most often occurs in clusters during sleep
- Myoclonic: brief sudden jerking action of a muscle
- Tonic Clonic: abrupt LOC that is concurrent with involuntary muscular contractions (tonic phase) followed by symmetrical jerking movements (clonic phase)
35
What is status epilepticus?
Seizure activity lasting 5+ min or recurrent seizure activity where the patient does not recover to a GCS of 15 prior to another seizure
36
What are seizure triggers in epilepsy?
- Lack of sleep & stress
- sudden stopping or changing medications
- fever / infection
- diarrhoea, vomiting & dehydration
- alcohol / drug use
- menstruation
- photosensitivity
- extreme temperatures, mainly heat
- electrolyte disturbances
37
What are the indications for Morphine?
- Significant pain
- Sedation
- Autonomic dysreflexia (systolic BP >160)
Morphine is preferred narcotic except for: allergy/adverse reaction, haemodynamic instability, suspected kidney failure, NAS narcotic administration is preferred treatment, suspected ACS
38
What are the contraindications for Morphine?
- Allergy/adverse drug reaction
- Kidney disease (renal failure)
39
What are the precautions for Morphine?
- Hypotension
- Respiratory tract burns
- Respiratory depression/failure
- Known addiction to narcotics
- Concurrent MAOI therapy
- Cardiac chest pain
40
What are the side effects of Morphine?
- Bradycardia
- Drowsiness
- Hypotension
- Nausea/vomiting
- Pinpoint pupils
- Respiratory depression
41
What is the adult IM dosage of Morphine?
>70 yrs / cachectic or frail
2.5-5 mg
Repeated up to 5 mg every 10 min
Max dose 10 mg
<70 yrs
2.5-10 mg
Repeated at up to 5 mg every 10 min
Max dose 20 mg
42
What is the adult IV dosage of Morphine?
>70 yrs / cachectic or frail
2.5-5 mg
Repeated up to 2.5 mg every 10 min
Max dose 10 mg
<70 yrs
2.5-5 mg
Repeated at up to 5 mg every 10 min
Max dose 20 mg
43
What is the paediatric IM dosage for Morphine?
>1 year
100-200 microg / kg
Single max dose 5mg. total max dose 200 microg/kg
44
What is the paediatric IV dosage for Morphine?
>1 year
100 microg / kg
Single max dose 2.5mg
Repeated at 50 microg/kg at 5 min intervals
Total max dose 200 microg/kg
45
What is the presentation of Morphine?
Ampoule 10mg/1ml
46
What is the pharmacology of Morphine? What effects does it have on the body?
A narcotic analgesic that acts on the CNS by building with opioid receptors, altering processes affecting pain perception and emotional response to pain. It also combines to cause respiratory depression, vasodilation, decreasing in the gag reflex and slows AV node conduction
47
You arrive to a 65YOM who presents with shortness of breath, a low grade fever, a cough and substernal chest pain. Hx - Knee surgery 4 weeks ago - there is unilateral swelling, redness, localised warmth and tenderness. What is his primary diagnosis and treatment?
Primary diagnosis: Pulmonary Embolism
Treatment: Oxygen, 12 lead ECG, IV fluid 250-500ml, adrenaline, differential diagnosis
48
What is a Pulmonary Embolism?
A pulmonary embolism is a blood clot that develops in a blood vessel (often in the leg) and then travels to a lung artery where it suddenly block blood flow.
49
What causes cardiac instability in pulmonary embolisms?
Cardiac instability is caused by right ventricular failure due to a massive PE with resultant shock
50
What are the common clinical features of a PE?
Dyspnoea - SOB
Tachypnoea - Shallow rapid breathing
Pleuritic or substernal chest pain
Syncope or near-syncope
Cough
Haemoptysis - coughing blood
Low grade fever
Jugular venous distension
Cyanosis
Sinus tachycardia
shock or hypotension
Signs of DVT: unilateral swelling, redness, localised warmth, tenderness, all often in lower limbs
Signs of right ventricular dysfunction:
S1-Q3-T3
RBBB
51
What puts a patient at risk of a PE?
History of a DVT or PE
Prolonged immobilisation
Recent surgery, trauma or hospitalisation
Oral contraceptive use
Hormone replacement therapy
Cancer
Pregnancy - Postpartum - C-sections
52
What are differential diagnoses for a PE?
AMI
Pneumonia
Pericarditis
CHF
Pleurisy
Pneumothorax
Pericardial tamponade
53
Why must you be careful when administering fluid to a patient with a PE?
IV fluid boluses should be administered judiciously as aggressive fluid resuscitation may cause further overstretching of an already expanded and failing right ventricle
54
What is croup? What is its clinical features?
Croup is a common viral inflammatory illness causing narrowing of the subglottic airway.
It is characterised by a seal like barking cough, inspiratory stridor and hoarseness of voice with or without respiratory distress.
Predominately affects children aged 6-36 months.
Durations is usually 2-5 days - symptoms worsen at night (often )
55
What are the 5 criteria for the Westley Croup Score?
And what are the 3 scoring catergories?
Level of consciousness - disorientated, normal
Cyanosis - at rest, with agitation, none
Stridor - at rest, with agitation, none
Air entry - markedly decreased, decreased, normal
Chest wall retractions - severe, moderate, mild, none
Scoring: mild (<2), moderate (3-7), severe (>8)
56
What is the treatment for Croup: mild (<2) / moderate (3-7) / severe (>8)?
Mild: Dexamethasone PO
Moderate: Dexamethasone PO, consider Adrenaline NEB
Severe: Dexamethasone PO, Adrenaline NEB
57
What are the paediatric dosages for Dexamethasone 6 months to 6 years?
0.3mg/kg rounded to nearest 0.5ml - total max dose 0.6mg/kg (or 12 mg)
5-10kg = 0.5ml
10-15kg = 1.0ml
15+ kg = 1.5ml
58
What is the presentation of Dexamethasone?
Vial - 8mg/2ml
59
What are the contraindications of dexamethasone?
- allergy or adverse drug reaction
- children less than 6 months or older than 6 years
- steroid administration within 4 hours
60
What drug class is dexamethasone?
Corticosteroid
61
What is the treatment for a burn?
- Active cooling with running water for at-least 20 min, max 60 min
- Protect against hypothermia (cool the burn, warm the patient)
- Early airway assessment & management
- Oxygen
- IPPV
- Analgesia
- IV fluid (15ml/hr x TBSA nearest 10%) (consult for paed)
- Cover with cling wrap
- Burn aid dressing if: paediatric <5%, adult <10%
No burn aid dressing if circumferential or if require management in a dedicated burns unit
62
What are burns requiring management in a dedicated burns unit?
- Partial thickness burn > 20% all ages or 10% in patients younger than 10 or older than 50
- Full thickness burns more than 5%
- Burns involving face, eyes, ears, hands, feet, genitalia, buttocks, perineum or overlying a major joint
- All inhalation burn
- All significant electrical burns
- Burns in people with significant co-morbidities (heart failure)
63
What are the clinical features of asthma?
Wheeze
Dyspnoea - SOB
Chest tightness or cough
Tachypnoea - rapid shallow breathing
Tachycardia
Accessory muscle usage
Cyanosis (late sign)
64
What is Asthma?
Asthma is an obstructive respiratory disease characterised by chronic airway inflammation, bronchial hyper-responsiveness and intermittent airway narrowing.
Defined by the presence of both respiratory symptoms (wheeze, dyspnoea, chest tightness or cough) and excessive variation in lung function.
65
What can cause an exacerbation of asthma?
- Allergen or irritant exposure
- Exercise
- respiratory infections
- Poor compliance with prescribed medications
- Extreme weather events ('thunderstorm asthma')
66
What are some pertinent questions for a patient having an asthma attack?
- Previous asthma history
- age of onset
- frequency and severity of symptoms
- number of previous hospital presentations <1yr
- previous ICU admissions)
- Asthma triggers,
- Cause of current episode
- Onset of symptoms
- Current prescribed medications
- Concomitant medical conditions
67
What are the clinical features of COPD?
- SOB on exertion
- Cough and sputum production
- Chest tightness
- Wheeze
- Malnutrition and obesity are common
- Older aged group
Advanced:
- Dynamic chest hyperinflation
- Soft breath sounds, prolonged expiratory phase
- Hypoxia and hypercapnia
Acute Exacerbation:
- change in baseline dyspnoea, cough or sputum - typically due to respiratory infection
- difficulty in speaking, anxiety, tachypnoea, tachycardia, cyanosis
- Accessory muscle use, tracheal tub, intercostal recessions, paradoxical abdominal wall motion
68
What are some differential diagnoses for COPD?
- Heart Failure and cardiogenic APO
- IHD and AMI
- PE
- Pneumothorax (abrupt onset)
- Pleural effusion, pneumonia and lobar atelectasis
- Upper airway obstruction
- Anaphylaxis
69
Clinical treatment of COPD
- Minimise patient exertion
- Patient reassurance
- Oxygen (maintain SpO2 at 88-92%)
- Salbutamol - NEB 5mg single
- Ipratropium Bromide - NEB 500 microg - repeat at 20 min - max 1.5mg
- Hydrocortisone - 100mg IV or IM
- Adrenaline - 500 microg IM repeat every 5 min
- IPPV (+/- PEEP)
70
What are the 3 disease processes associated with COPD?
- Chronic Bronchitis (daily sputum production for at least 3 months or two or more consecutive years)
- Emphysema (alveolar dilation and destruction)
- Chronic Asthma
71
What does Salbutamol do?
Acts as a bronchodilator
72
What are the indications for salbutamol?
- Bronchospasm
- Suspected hyperkalaemia (with QRS widening and/or AV dissociation)
73
What are the contraindications for Salbutamol?
Allergy/adverse reactions
<1 years
74
What are the precautions for Salbutamol?
Acute pulmonary oedema (APO)
Ischaemic heart disease
75
What are the side effects of Salbutamol?
- anxiety
- tachyarrhythmias
- tremors
- hypokalaemia and metabolic acidiosis
76
What is the adult dosage of Salbutamol for an adult patient with bronchospasm>
MDI - 12 inhalations repeated at 10 min
NEB - 5mg repeated PRN no max dose
77
What is the paediatric dosage of Salbutamol for bronchospasm?
MDI - 1-5 years 6 inhalation OR 6+ 12 inhalations
NEB at 8L/min (6L for COPD patients)
1-5 years - 2.5mg repeat PRN no max
>6 years - 5mg repeat PRN no max
78
Outline what a GCS is and its components
GCS is the assessment of a patients conscious state
EYE OPENING (4):
4 spontaneous
3 reacts to speech
2 reacts to pain
1 no response
BEST VERBAL RESPONSE (5)
5 orientated
4 confused
3 inappropriate words
2 incomprehensible
1 no response
BEST MOTOR RESPONSE (6)
6 obeys commands
5 localised to pain
4 withdraws from pain
3 flexion response
2 extension response
1 no response
79
What are the 4 areas in a perfusion status assessment?
Skin
Blood Pressure
Pulse
Consciousness
Patient can have:
adequate perfusion, borderline perfusion, inadequate perfusion, grossly inadequate perfusion, no perfusion
80
Secondary Surveys: Pain assessment and History
OPQRST & SAMPLE
Onset
Provocation
Quality
Radiation
Severity
Timing
Signs/symptoms
Allergies
Medications
Past medical Hx
Last meal
Events prior
81
What is the mnemonic to guide clinical handover?
IMIST AMBO
I - Identification (name & age)
M - Mechanism/ Medical Complaint
I - Injuries/Relative info to complaint
S - Signs (vitals)
T - Treatment and trends
A - Allergies
M - Medications
B - Background (medical Hx)
O - Other issues (characteristics of the scene, social situation, advanced healthcare directive, cultural/religious considerations, belongings or valuables)
82
What comprises a respiratory assessment?
CAPERRSSS
C - conscious states (GCS)
A - appearance
P - pulse rate
E - effort of breathing
R - rate of breathing
R - rhythm of breathing
S - sounds
S - speech
S - skin
83
What comprises a neurological assessment?
Orientation to time, place, person
GSC
Pupils
Motor function
Sensory function
84
Define Hypoglycaemia and its clinical features
Hypoglycaemia is a BGL <4.0 mol/L. Glucose orally/intravenously is the recommended treatment.
Autonomic features:
Diaphoresis, hunger, tingling around mouth, tremor, tachycardia, pallor, palpitations and anxiety
Neurological features:
ALOC, lethargy, change in behaviour, headache, visual disturbance, slurred speech, dizziness, seizures, coma
85
What is the treatment for a hypoglycaemic patient?
- Oral glucose if patient can swallow safely
Unable to have oral glucose
- IV glucose 10%
If unable to gain IV access:
- consider glucagon
86
What is the dosage of glucose 10% for a hypoglycaemic patient?
Glucose 10% presentation: 250ml
Adult IV:
15g (150ml)
repeated at 10g (100ml) boluses every 5 min until BGL >4.0
Paediatric IV:
0.25g/kg (2.5ml/kg)
repeated at 0.1g/kg (1ml/kg) every 5 min until BGL >4.0
87
What is the dosage of glucose gel for a hypoglycaemic patient?
Glucose Gel presentation: 15g tube
Adult & Paediatric:
PO 15g
repeated once at 15 min if BGL <4.0
max dose 30g
Contraindications
- unconscious
- difficulty swallowing
- <2 years
88
What is the dosage of Glucagon in a hypoglycaemic patient? Unable to self administer oral glucose
Glucagon presentation: Vial (powder and solvent) 1mg
Adult IM: 1mg single dose
reconstitute 1mg glucagon with 1ml water for injection in a 3ml syringe to achieve 1mg/1ml
Paediatric IM:
>25kg = 1mg single dose
<25kg = 05.mg (same process as 1mg, but decant 0.5ml of solution to achieve 0.5mg/0.5ml)
89
What BGL recording is considered hyperglycaemia?
BGL >10 mol/L
90
What is the treatment for a hyperglycaemic patient?
Assess dehydration and perfusion status
Consider:
- IV access
- IV fluid
- Oxygen
- Diabetes Service Referral
91
What is a normal fasting blood glucose target for a person without diabetes?
3.9-5.6 mmol/L
92
In the diabetic patient, what can hyperglycaemia present as?
- Diabetic Ketoacidosis (DKA)
- Hypersomolar Hyperglycaemia syndrome
93
What is Diabetic Ketoacidosis? What are the 3 things it is characterised by?
DKA is a life threatening complication usually seen in patients with type 1 diabetes, which is characterised by:
- hyperglycaemia
- ketosis
- metabolic acidosis
94
What are the clinical features of Diabetic Ketoacidosis DKA and Hyperosmolar Hyperglycaemic Syndrome HHS? What are the difference in their clinical features?
Neurological:
- lethargy
- ALOC
- Seizure
- Coma
Cardiovascular
- hypotension & tachycardia (signs of hypovolaemia)
- pale, cool and clammy OR flushed, hot and febrile
Differences:
- DKA >10 mmol/L
- HHS >40 mmol/L & Kussmaul respiration (rapid deep breathing at consistent pace)
95
What are shockable rhythms?
VT (Pulseless Ventricular Tachycardia) - a brand complex tachycardia
VF (Ventricular Fibrillation) - irregular deflections with no discernible P waves, QRS complexes or T waves
96
What are non-shockable ECG rhythms?
PEA (Pulseless Electrical Activity) - organised electrical activity on the ECG with no resulting detectable cardiac output (no palpable pulse)
Asystole - flat line
97
What is an Acute Aortic Dissection?
Separation of the aortic wall layers from either the abdominal aortic or thoracic arctic aneurysm.
It occurs when the innermost later of the aorta tears, resulting in separation of the vessel layers and creation of a false lumen in the aortic wall. This can occur as a result of degeneration through ageing, diseases associated with weakness of connective tissues (Marfans syndrome) or pathological processes.
The false lumen can extend either distally or proximally along the aorta and result in obstruction of adjacent arteries.
Rupture of the aorta into the pericardium, pleural or peritoneal cavities is the most common cause of death during the acute early phase.
98
What are the clinical features of an acute aortic dissection?
- Sudden acute chest pain that is excruciating at onset, often described as sharp/ripping/tearing in quality
- Pain is linked to location of the dissection:
Anterior (ascending aorta)
Neck/jaw (arch)
Interscapular (descending aorta)
Lumbar/abdominal (subdiaphragmatic)
- Pulse deficits
- BP differences (>20 mm Hg)
- Altered sensations in extremities - numbness, tingling or pain
- Paraplegia
- Pallor, vomiting, diaphoresis
99
What is the treatment for a AAA?
Oxygen
IV access
Analgesia
Antiemetic
IV fluids
Blood
100
What is the treatment for acute coronary syndrome symptoms?
12 lead ECG
Oxygen
GTN
Aspirin
Antiemetic (ondansetron)
Fentanyl
12 lead consistent with STEMI? yes
pPCI Referral
101
What are the dimensions of a large box and a small box on an ECG strip?
Large box - 5mm = 0.2 sec
Small box - 1mm = 0.04 sec
102
What are the normal characteristics on an ECG for a:
P wave
PR interval
QRS complex
QT interval
ST segment
T wave
P wave - upright and rounded, between 05-2.5mm tall, less than 0.1 seconds duration
PR interval - between 0.12-0.20 seconds duration
QRS complex - less than 25mm tall, between 0.06-0.12 seconds duration
QT interval - between 0.35-0.45 seconds duration
ST segment - normally 0.08 seconds duration
T wave - prominent, rounded, between 0.1-0.25 seconds duration
103
What is a way to figure out the rate on an ECG?
300 / number of large squares between QRS complexes
104
What does a long PR interval indicate?
1st degree heart block
105
An ECG strip has non-conducted p waves (extra P waves with no QRS complex following/a skipped beat), what does it indicate?
AV Block - 2nd degree heart block
106
What does a third degree / complete heart block look like on an ECG?
The QRS complexes are being conducted at their own rate and are totally independent of the P waves
107
What are the two types of second degree heart blocks characteristics (mobitz I and mobitz II)?
Mobitz I - progressive prolongation of the PR interval resulting in a dropped beat (the PR interval gets longer until a beat is finally dropped of skipped)
Mobitz II - PR interval is unchanged, but there is a random skipped beat
108
What does ST depression indicate and what does ST elevation indicate?
ST depression = Ischaemia
ST elevation = infarction
109
What does atrial flutter look like on an ECG?
and
What does atrial fibrillation look like on an ECG?
Atrial Flutter
- Atrial rate of ~300bpm, but not sinus
- Sawtooth P waves
Atrial Fibrillation
- Sinus rate of ~350-600bpm
- Irregular QRS complexes
- Disorganised atrial electrical activity between QRS complexes
- No P waves
- Absence of an isoelectric baseline
110
What is the clinical treatment for a Stroke?
- Oxygen
- Antiemetic (Ondansetron)
- Analgesia
- IV fluids
- where possible position semi reclined (45 degree head up) to maximise the balance between cerebral perfusion and minimising cerebral oedema
111
What is the time frame required for IV thrombolysis?
What is the time frame required for Endovascular clot retrieval ECR?
IV thrombolysis - within 9 hours
ECR - within 24 hours
112
What is Acute Pulmonary Oedema (APO)?
APO refers to the buildup of fluid in the alveoli and lung interstitial that has extravasated out of the pulmonary circulation. As fluid accumulates it impairs gas exchange and decreases lung compliance, producing dyspnoea and hypoxia.
113
What are the clinical features of APO?
- Sudden onset of SOB, feels like drowning
- Profuse diaphoresis
- Crackles, usually heard at bases first and progress to apices when worsens
- cough
- Pink, frothy sputum
- Tachypnoea and tachycardia
- Hypertension
- Hypotension, indicates severe L ventricular & cardiogenic shock
- Cyanosis
- Raised JVP
114
What is the primary goal of treatment for cardiogenic APO?
Reduce preload and after load with nitrates
115
What is the treatment for cardiogenic APO?
- Oxygen
- Aspirin = 300mg 1 tablet
- GTN = 400 microg, 1 spray every 5 min
- 12 Lead ECG
- CPAP
- IPPV
- PEEP
