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Flashcards in General Deck (31):
1

SBAR

Situation - who you are, where you are, who the patient is, how they are
Background - patients reason for admission, brief medical hx
Assessment - vitals and clinical impressions
Recommendations - what you need and when you need it

2

Anaphylaxis:
Management

Airway - 100% O2/intubate
Adrenaline IM 0.5mg 1.1000 (1:10,000 IV)
IV access
Antihistamine (Chloramphenamine 10mg IV)
Steroid (Hydrocortisone 200mg IV)
Fluids
Treat wheeze of present e.g salbutamol

3

GCS

M1 no response to pain
M2 extensor to pain
M3 flexor to pain
M4 withdraw to pain
M5 localizing response to pain
M6 obeying commands

V1 none
V2 incomprehensible
V3 inappropriate
V4 conversational
V5 oriented

E1 none
E2 to pain
E3 to speech
E4 eyes open

4

Sepsis Six

Lactate and Hb
Fluid resus
IV ABx
O2
Cultures
Urine output

5

SIRS criteria

Any two of:
Temp >38 or 20
HR >90
WCC >12 or

6

Alcohol withdrawal:
management

Chlordiazepoxide 10-50mg QDS 5-10 days (depending on severity) gradually reducing dose, to ease symptoms

If CI can give carbamazepine 800mg

For hallucinations haloperidol or olanzapine.

If seizures give diazepam 4mg IV/rectal

7

Alcohol dependency:
Management

Pabrinex vitamin supplement to avoid Wernickes

Acamprosate/ naltrexone/disulfram to prevent relapse

8

Reye's syndrome

Rare complication of viral infection eg influenza, gastroenteritis, varicella or aspirin use
Mitochondrial dysfunction leads to cerebral edema, ⬆️ICP, fatty degeneration with little clinical signs
Vomiting, lethargy, drowsy, tachypnoea, diarrhoea, raised ICP Sx, neuro Sx
Tx - supportive

9

Fluids:
Liver failure

Too much Na+ causes ascites
Only use 5% dextrose

10

Fluids:
Chronic renal failure

Avoid excess fluid, sodium and potassium. Avoid hartmanns as contains lactate.

11

Fluids:
Sepsis

Needs fluids to treat intravascular depletion, but avoid too much Nacl i.e don't wap up loads of saline, because of renal strain and acidosis risk.
Go for hartmanns

12

Fluids:
Alcoholic

Must give pabrinex before any 5% dextrose as can precipitate korsakoffs

13

Fluids:
Brain haemorrhage

NO DEXTROSE
Causes osmotic haematoma swelling

14

Fluids:
Heart failure

Don't exceed more than 2l/24 hours

15

Fluid Challenge for hypotension patients

250-500ml crystalloid over 5 minutes
Monitor BP, UO, JVP
Respond fully ➡️ just maintenance
Responds then falls ➡️ more fluids
No response ➡️ either fluid overloaded or really depleted. Assess

16

Fluids:
Acute haemorrhage

2l hartmanns STAT

17

Fluid overload:
Signs

Fluid intake> output
Raised CVO
Pulmonary edema
Weight above pre op weight
CVP rises and plateaus with fluid challenge

18

Churg-Strauss Syndrome:
Features, blood test, Tx

Triad of:
Late onset asthma+esinophilia+small vessel vasculitis (e.g vassopasm, MI, DVT)

pANCA +ve

Sepsis/SIRS type picture

Tx steroids, INF

19

Wegeners granulomatosis:
Features, blood test, Tx

Vasculitis affecting particularly kidneys, and resp.

Saddle nose, obstruction, epistaxis
Progressive glomerulonephritis - proteinuria, haematuria
Skin purpura, nodules

cANCA

TX: steroids and cyclophosphamide

20

Hypovolaemia Sx

S sinus tachycardia
H hypotension
O oliguria
C cold
K Klammy
S slow cap refill

21

Metabolic effect of Diarrhoea

Hypokalaemic alkalosis

22

Metabolic effect of vomiting

Hypochloraemic alkalosis

23

Shock symptoms

Sinus tachycardia
Hypotension
Oliguria
Cold
Klammy
Slow cap refill

24

Stages of clubbing

1. Increased fluctuancy of nail bed
2. Loss of angle
3. Increased curvature of nail
4. Expansion terminal phalanx

25

JVP:
General features

Neck relaxed as behind sternocleidomastoid
Pulsation but not visible vein
Double pulsation

26

Type I Hypersensitivity

Analphylaxis
Atopy
IgE

27

Type II hypersensitivy

Autoimmune haemolytic anaemia
IgG or IgM

28

Type III hypersensitivity

IgG IgA
SLE

29

Type IV delayed hypersensitivity

Delayed hypersensitivity
T cell mediated
TB, graft vs host

30

Target cells

Sickle cell

31

Sarcoidosis

Non caseating granulomas
Young adults/African
BHL, swinging fever, polyarthalgia
Cough, fever, malaise, dyspnoea, weight loss
Hypercalcaemia