EM + CC Flashcards
(33 cards)
What are the indications for a tracheostomy?
- weaning from prolonged mechanical ventilation (reduced dead space and the work of breathing compared to ET tube)
- emergency airway compromise
- in preparation for major head and neck surgery
- neuromuscular disorders (to manage excess trachea-bronchial secretions)
A-E management in a patient with a tracheostomy in urgent resp distress
- call for help (anaesthetist, ENT surgeon) plus have difficult airway trolley nearby
- A-E
- apply humidified oxygen 15L/min via a non-rebreathe mask and over the tracheostomy site.
- remove speaking valve and suction any secretions
remove cuff so patient can breathe around it - change inner cannula
- monitor
What are the 2 different types of nutrition and their key subtypes?
Enteral
- oral
- NG tube
- NJ tube
- PEG
- PEJ
Parenteral (intravenous)
What does PEG/PEJ stand for?
percutaneous endoscopic gastrostomy / jejunostomy
reasons to use an NJ tube rather than NG and vice versa?
NJ: in acute pancreatitis as they bypass the duodenum and pancreatic duct and therefore reduce pancreatic enzyme release that would have exacerbated pancreatic inflammation; good if pt is at risk of lung aspiration as they bypass the stomach.
NG: larger diameter and less likely to block
Considerations when starting parenteral nutrition
- build up gradually
- slow down feed if experiencing diarrhoea or distension
- daily bloods to check for re-feeding syndrome (low K+, phosphate and Mg)
indications for total parenteral nutrition (TPN)
- insufficient intestinal absorption e.g. short bowel syndrome
- bowel rest (e.g. bowel obstruction, intestinal fistula)
complications of TPN
contributes to gut atrophy if prolonged
exacerbates acute phase response
IV line infection
re-feeding syndrome
acalculous cholecystitis
fatty liver
electrolyte and glucose imbalance
What is the electrolyte disturbance that you get in re-feeding syndrome?
hypokalaemia
hypophosphateamia
hypomagnesaemia
Where on the chest do you perform CPR to get maximal output?
- middle of the sternum
- 1/3 depth or 4-5 cm (check tidal volume and pulses)
VF on ECG
- broad
- irregular
VF on ECG next step
1) continue CPR as defibrillator is charging
2) defibrillate
3) restart CPR for 2 minutes
4) second shock
5) CPR for 3 minutes
6)
what type of defibrillation in cardiac arrest / VF?
unsynchronised
VT features
- broad complex
- fast rate
- constant QRS morphology
can be monomorphic or polymorphic (torsades de pointes)
summarise cycle of CPR
1st shock -> CPR
2nd shock -> CPR
3 shock -> adrenaline 1mg IV (1 in ????), amiodarone (300mg) -> continue CPR
Mx of asystole on ECG (pulseless)
- CPR
- adrenaline
(make sure that the pads are on, especially if completely flat)
6Hs and 4 Ts
Hypothermia
Hypovolaemia
H
H
Hypoglycaemia
Heroin OD
Thrombosis
loin to groin pain in elderely
AAA - do not miss
be careful of diagnosing renal colic
can often be a ruptured AAA!!
causes of commonly missed life threatening causes of epigastric pain?
- ruptured AAA
- inferior MI
(peptic ulcer, pancreatitis, gallstones - commonly considered)
causes of life threatening abdo pain with soft abdomen
- mesenteric ischaemia (pain out of proportion to examination findings)
Pain out of proportion - diagnoses
-> usually vascular
PE
mesenteric ischaemia
necrotising fasciitis
What to consider if a pt with asthma is not responding to treatment
In pts with acute asthma make sure that you did not miss a pneumothorax (CXR)
call anaesthetist
IVDU + back pain
dx?
discitis until proven otherwise
-> MRI
define shock
inadequate tissue perfusion and oxygenation
