F1 cases Flashcards
(43 cards)
What are the common causes of bowel obstruction in a surgical patient
- Ileus (recent post op period)
2. Adhesions
Best fluids for ?bowel obstruction
NaCl - because been when vomit a lot a) get metabolic alkalosis and b) lose a lot of chlorine from HCL being thrown up. NaCl is therefore good choice of fluid with potassium added in.
Why should you get a CXR in ?bowel obstruction
To check for perforation
To check for lower lobe pneumonia
What is an ileus
Functional bowel obstruction - reduced bowel motility - nothing blocking it
What does coffee bean sign show on abdominal XR
Sigmoid volvulus
What follow up tests should you say you will do after a abdominal exam
DRE External genitalia Pelvic exam - females Hernial orifices Stool sample Urinalysis
How do you elicit murphy’s sign
Palpate liver edge as patient breaths in
What are the 3 possible causes of abdominal colic
Renal (stone, stricture, clot, tumour), biliary (gallstones), bowel (obstruction, hernia)
Indications for urgent surgery bowel obstruction
peritonitis
strangulation (severe pain)
complete small bowel obstruction
collapsing patient
What bloods need to be requested for a bleeding patient
Explain purpose of each one
Clotting - if they are going to need to go to theatre will need to know if they are coagulopathic
Group & save - will check blood group of patient and screens for atypical antibodies (NO BLOOD ISSUED)
Cross match - will mix patients blood with donor blood to check no reaction
What does a group and save do
A G&S determines the patient’s blood group (ABO and RhD) and screens the blood for any atypical antibodies; the process takes around 40 minutes and no blood is issued
A G&S is recommended if blood loss is not anticipated, but blood may be required should there be greater blood loss than expected
What does cross match do
A cross-match involves physically mixing the patient’s blood with the donor’s blood, in order to see if any immune reaction takes places; if it does not, the donor blood is issued and can be transfused in to the patient, otherwise alternative blood is trialled
This process also takes ~40 minutes (in addition to the 40 minutes required to G&S the blood, which must be done first), and should be done if blood loss is anticipated
What can you use for reversal of heparin and LMWH overdose
Protamine sulphate
Heparin antagonist
Works better for unfractioned heparin (Heparin) than LMWH
Does not work for fondaparinux
How can you distinguish chronic co2 retention in blood gas
Bicarb level
Assessing the HCO3 in conjunction with the CO2 can help differentiate if the CO2 retention is acute or chronic. This is known as the 1 for 10 rule. 1 for 10 rule. ACUTE: For every rise of 10 of the PaCO2 above 40 mmHg, the bicarbonate will rise by 1; CHRONIC: For every rise of 10 of the PaCO2 above 40mmHg, the bicarbonate will rise by 4
What can the anion gap be used for
Confirming metabolic acidosis
Narrowing down list of causes of metabolic acidosis
Why does hypoalbuminaemia cause metabolic acidosis
Because albumin carries ions and so the unmeasured ions carried by albumin creates the ‘gap’. If you have less albumin, you have more free ions and the gap balances out = low anion gap.
What process should you use for interpreting an ABG
- Ph - acidaemia, alkalaemia
- Respiratory or metabolic. CO2 (High or low) (T1 or T2 resp failure?). HCO3 and BE.
- Compensated - are there any changes in the other system that suggest compensation? Resp acute or chronic?
Raised bicarb with COPD - chronic - Anion gap - will narrow causes of metabolic acidosis
How do you check for compensation on an ABG
Identify if respiratory or metabolic
Then look if there is some counter-response from opposing system.
Can be partial (ph still abnormal)
Or full (ph pushed back to normal)
How does a mixed ABG look
When the respiratory and metabolic components both show a pattern consistent with the direction on the ph, rather than just one, or just one plus compensatory pattern
List a method for considering the possible differential diagnosis for an ABG result
1. Resp - is it type 1 or type 2 RESP failure. Type 1 - V/Q mistmatch causes mainly Type 2 - ventilatory failure causes 2. Metabolic Anion gap - high, normal or low High - CAT MUDPILES Normal - Na (hyponatramia), Bicarb (diarrhoea), Cl (?) Low - hypoalbuminaemia
When should you not give a 500ml fluid challenge
Heart failure/ ?valve disease
Trauma
Whats the difference between pitting and non-pitting odema, how do you assess and grade it
Pitting - sign of poor circulation or blood pooling
causes are CCF, Renal disease (poor circulation), cirrhosis, cancer (low albumin), and venous insufficiency (pooling). Lymph normal.
Non-pitting - sign of lymph block, or myxedma (thyroid - mucopolysaccarides pass into tissues and so pull water back after being pushed so not pitting)
What volume of fluid should you give as a fluid bolus and why
500 ml
250 ml elderly/ dodgy heart/ trauma
what’s the max fluid you can give
2L
Unless have HF etc dont give this much
