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Flashcards in High Yield Facts Deck (21)
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1

Reversible causes of Cardiac Arrest

4Hs and 4Ts

Hypoxia
Hypo-Hyper-kalaemia (metabolic)
Hypovolaemia
Hypothermia


Tamponade
Toxins
Tension pneumothorax
Thromboembolism

2

Sick sinus syndrome

Dysfunction of the sinoatrial node often precipitated by ischaemia/fibrosis

Results in bradycardia (±arrest), sinoatrial block or SVT with alternating bradycardia/asystole (tachy-brady syndrome)

Needs pacing if symptomatic.

3

Enoxaparin

LMWH

40mg/24h SC
or
20mg/24h if eGFR <30ml/min

4

Septic screen

FBC (repeat every 2d)
Inflammatory markers, ESR, CRP (repeat every 2–4d)
Urine culture (separate samples from any nephrostomies/urostomies)
Sputum culture, if indicated
Blood cultures (3 sets at 6–8h intervals from different veins; additional sets from any central lines)
Microbiology swabs of wounds/pressure areas/cannula or central line sites
CXR if productive cough or abnormal clinical signs present.

If infectious source still not identified, consider:
Procalcitonin (will be negative if non-infective cause, Emergency department [link])
Stopping all antibiotics (if stable) and repeating all cultures after 48h
Echocardiogram if new murmur or new stigmata of bacterial endocarditis
Check sickle-cell status
Blood film for parasites (if malaria is suspected)
Lumbar puncture if CNS infection suspected or needs excluding (CT first).

5

Severe Asthma

Incomplete sentences

PEFR <50 of best

RR >25

6

Life-threatening Asthma

PEFR <33% of best

Silent chest

Poor respiratory effort, exhaustion, cyanosis

Sats <92%

PaO2 <8kPa

Normal PaCO2

Altered GCS

Arrhythmia

7

Near-fatal Asthma

CO2 retention – call ICU

8

Magnesium sulphate

2g over 20 minutes

IV

9

When to admit asthma attack

PEFR<75% predicted after 1h therapy

Gradually reduce supplemental O2 and step from nebs back to inhalers over several days; always check inhaler technique and ensure follow-up plan in place before discharge.

10

Antibiotics for COPD exacerbation

Doxycycline 200mg PO loading then 100mg/24h PO
or
Amoxicillin 500mg/8h PO

11

CURB-65

Confusion

Urea >7.0mmol/L

Respiratory Rate >30

Blood pressure (systolic >90 or diastolic <60 mmHg)

65- age 65 or over

1 point for each feature

12

Curb Score 0-1

Low risk of mortality ~3%

?Unstable
?Comorbidities

No --> Discharge and amoxicillin 500mg/8h PO at home

Yes --> admit, amoxicillin 500mg/8h PO

13

Curb score 2

Moderate risk of mortality ~9%

Admit to hospital

Supportive care

500mg Amoxicillin/8h PO
+
500mg Clarithromycin/12h PO

Send blood cultures

Send sputum cultures

Send pleural aspirate for pneumococcal antigen testing and culture

Send urine for pneumococcal, legionella antigen

14

Curb score 3-5

High risk of mortality ~15-4%

Admit to hospital, critical care unit

Supportive treatment

IV co-amoxiclav 1.2g
+
IV clarithromycin 500mg

Send blood cultures

Send sputum cultures

Send pleural aspirate for pneumococcal antigen testing and culture

Send urine for pneumococcal, legionella antigen

Consider atypicals

15

Modified Wells Score

>4 --> CTPA or treat with LMWH
Enoxaparin 1.5mg/kg/24h SC

<4 --> D-dimer
If negative, review diagnosis
If positive --> immediate CTPA or LMWH

16

Pleural effusion exudate vs transudate

<25g/L --> Transudate

>35g/L ---> Exudate

17

Needle decompression

2nd intercostal space
Mid-clavicular line

18

Acute Abdominal Pain DDx


• Perforation

• Bowel infarction/ischaemia

• Bowel obstruction

• Acute pancreatitis

• Acute cholangitis

• Appendicitis

• Leaking abdominal aortic aneurysm (AAA)

• Strangulated hernia

• Testicular or ovarian torsion

• Ruptured ectopic pregnancy

• Referred pain (MI, aortic dissection)

19

Acute Upper GI Bleeding DDx

Peptic ulcer

Mallory–Weiss tear

Gastro-oesophageal varices

Oesophagitis

Swallowed blood (eg epistaxis)

Other oesophageal or gastric cancer

Vascular malformations

Underlying coagulopathy

20

Hypoglycaemia

<3.5mmol/L

21

Hypoglycaemia Emergency DDx


• Insulin overdose

• Oral hypoglycaemia overdose

• Sepsis

• Alcohol excess

Adrenal failure

• Acute liver failure