Flashcards in Emergency And Ward Medicine Deck (48):
Important differentials for acute lower abdo pain in any woman of childbearing potential?
Ruptured ovarian cyst, ovarian torsion (ovarian accident)
5 step approach to ABGs?
Patients clinical picture
Respiratory component - CO2 as marker of ventilation
Metabolic component - bicarbonate and base excess
What indicates respiratory involvement on an ABG? How?
CO2 - if it is in the 'expected direction' e.g. High in an acidosis then it is a respiratory acidosis, if in the 'opposite' direction it is a compensatory change for a metabolic disturbance
Describe the role of base excess in ABGs?
Essentially the CO2 equivalent for metabolic disturbance - if in the 'expected direction' of pH change then it is a metabolic disturbance (e.g. Negative = metabolic acidosis)
2 important causes of coma + sweating?
What does the serum anion gap represent?
The unmeasured anions - albumin, phosphate, sulphate, lactate, ketoacids
KLAPS of unmeasured anions?
2 causes of a low anion gap?
IgM/IgG multiple myeloma
5 causes of a raised anion gap?
Ketoacids - alcohol or DM
Sulphate/phosphate - AKI
Which type of bilirubin is water soluble and therefore detectable directly and visible in urine?
What does bilirubinuria suggest?
Conjugated bilirubin (as this is the only type that is water soluble) - cholestasis
3 causes of isolated raised ALP?
Bony mets/blastic lesions e.g. Breast, prostate cancer
2 causes of a low ALP?
Metabolic cause of a really really low ALP in the context of acute liver failure?
2 causes of an isolated raised AST?
What does a raised ALT and AST with a predominant AST suggest?
5 major causes of a macrocytic anaemia?
Other B12/folate def
5 SIRS criteria?
HR > 90
RR > 20
Temp >38.3 or 12000 or
What blood abnormality may be present in non-diabetics in the context of SIRS?
What is severe sepsis?
SIRS + bacteraemia + end organ damage
Signs of severe sepsis?
Hypotension and reduced urine output
Bounding pulse, increased CRT
Mottling, clotting dysfunction/DIC
2 criteria for septic shock?
Persistent hypotension in spite of adequate fluid resus
Organ hypoperfusion as evidenced by lactate >4
Warm vs cold shock?
Warm shock is early; bounding pulse, peripheral vasodilation and warmth
Cold shock is late; relative hypoperfusion and peripheral shutdown
What type of shock is septic?
What is the sepsis 6?
High flow O2 via non-rebreathe mask
Take blood cultures
Measure urine output
Endocrine complication of septic (typically meningeal) shock?
Waterhouse-Friedrichson syndrome - bilateral adrenal haemorrhage
Describe foot associated with autonomic neuropathy?
Dry (reduced sweating)
Bounding pulses due to peripheral vasodilation
What is Charcot arthropathy?
Hypervascularisation making unstable and easily fractured
Describe an acute Charcot joint?
Hot, red, swollen in DM patient ddx septic, osteomyelitis, DVT, cellulitis, gout
Warm with bounding pulses, 'painful' in a neuropathic foot
Most important management of an acute Charcot joint?
Offload - air cast
To prevent arch collapse, subluxation of Ts and MTs, 'rocker bottom foot'
How long do you have to wait post-bronchodilator to assess asthma reversibility via PEFR?
SPACESPIT for describing lumps?
Size and Shape
Attachments and skin changes
3 crystalloid fluids?
2 colloid fluids?
Extrinsic RFs for pressure ulcers?
Friction and shearing
Intrinsic RFs for pressure ulcers?
What is a grade 1 pressure ulcer?
Intact skin with patch of non-blanching erythema, typically over bony prominence
What scoring systems are used to assess RFs for pressure ulcers?
What is a grade II pressure ulcer?
Partial thickness skin loss, involving epidermis and or dermis
Or intact/open blister
What is a grade 3 pressure ulcer?
Full thickness skin loss, damage or necrosis of subcutaneous tissue down to but not through underlying tissue
What is a grade 4 pressure ulcer?
Skin loss through full thickness of skin, extensive destruction and necrosis to underlying bone, tissue muscle or joint capsule. +/- Slough and eschar
What is erythema nodosum?
Painful raised rash on lower limbs
Normal QRS interval length?
Less than 0.12s
Drop of BP by how much is postural hypotension?
At least 20/10
When should BP be measured when checking for postural hypotension?
Lay down for 5 mins then measure
Stand up for 1 min then measure
Measure after 3 mins of standing
How long is a urine sample valid to be tested for after it is produced?
How big suggests small bowel dilatation? How do you know it's small bowel?
Valvulae coniventes thoughout thickness