New Flashcards
1
Q
Febrile neutropaenia
A
Initial response
- Worried about sepsis
- Call for help
- Check vitals + primary survey
- > haemodynamic instability
- IV access
- > fluid support
- > early empirical antibiotics
Hx
- Gingivitis
- > onset and evolution
- UTI
- > details of presentation/response to treatment
- > bladder/kidney disease
- > catheterisation
- Leukaemia
- > fatigue/SOB
- > easy bruising/bleeding
- > night sweats/weight loss
- Systems review
- Past
- > haematological malignancy
- > cancer
- > immunosuppression
- > autoimmune
- Medications
- > allergies
- > drug reactions
- > clozapine
- > bactrim = check sensitivities
- Social
- > sexual hx (HIV)
- > IVDU (hep)
Exam
- Gingiva
- > focal vs diffuse
- Lymphadenopathy
- Splenomegaly
- Systems review
- > lung fields
- > abdo soft non tender
- > rashes
- > bone tenderness
- > neck stiffness
Investigations
- VBG
- > glucose
- > pH
- > lactate
- > electrolytes
- FBC
- > pancytopenia
- Smear
- > blasts
- Blood cultures
- > including fungal
- Urine MCS/dipstick
- Urea/creatinine
- LFTs
- Blood group and antibody
- HIV + Hepatitis serology
- Chemo work up
- > CMV serology
- > LDH/uric acid/CMP
- > aptt/pt/fibrinogen
- Chest xray
Management
- Empirical antibiotics within 1hr
- > piperacillin/tazobactam +- gent + vanc (mucosal)
2
Q
Infective endocarditis evaluation and management
A
Hx
- URTI
- > onset and evolution
- > pleuritic chest pain/cough/haemoptysis
- Cardiac
- > angina
- > palpitations
- > orthopnoea/PND/exertional dyspnoea
- > oedema
- Septic emboli
- > headaches/photophobia/neck stiffness
- > weakness/vision change/paraesthesias
- > arthralgia
- > flank pain
- Past
- > details of valve replacement
- > details of heart disease
- Warfarin
- > dose
- > side effects
- > control
- > latest INR (increase due to antibiotics)
- Social
- > IVDU
Exam
- Vitals
- > fever
- > haemodynamically stable
- Hands/feet
- > osler (painful nodules on pulps)
- > janeway (painless erythematous macules on palms)
- > splinter haemorrhages
- Face
- > palatal petechiae
- Cardio
- > evidence of heart failure
- > new murmur
- Lung fields
- > added sounds
- Fundoscopy
- > roth spots (pale oval surrounded by haemorrhage)
Investigations
- ECG
- VBG
- > glucose
- > lactate
- > pH
- Blood cultures
- > 3 sets from 3 sites
- > first and last 1 hr apart
- RF
- ESR
- C3/C4
- Urea/creatinine
- > AKI
- Urinalysis
- > proteinurira
- > RBCs
- > casts
- Echo
- > consult guidelines for TTE vs TOE
- > mobile valvular vegetations
- CXR
- > ddx
- Consider
- > MRI if neuro signs/symptoms
- > CTPA/D dimer
Diagnosis
- Modified dukes criteria
- > two major
- > one major + three minor
- > five minor
- Major criteria
- > 2 typical or persistent atypical blood culture growth
- > positive echo
- Minor criteria
- > fever
- > predisposition (prosthesis/IVDU)
- > vascular (emboli/ICH/mycotic aneurysm/janeway)
- > immunologic (oslers/roth/RF/glomerulonephritis)
- > microbio (abnormal culture/typical serology)
Management
- IV access
- > fluids (caution HF)
- > analgesia
- Ensure adequate oxygenation
- Empirical antibiotics
- > benpen IV for 1 month
- > gentamicin IV for 2 weeks
- > vancomycin for penicillin allergy
- Surgery
- > haemodynamic instability
- > overwhelming sepsis
- > fungal disease
- > prosthetic
- Tertiary referral
- > approx half require surgery
- > mortality reduced by specialist care
- Multidisciplinary team
- > cardiologist
- > cardiac surgeon
- > ID
- Consider
- > ceasing anticoagulation/antiplatelet
3
Q
Drug reaction evaluation and management
A
Issues
- Drug reaction
- > DRESS/SJS/TENS
- Viral exanthema
- Sepsis
- Anaphylaxis
Primary survey
- haemodynamically stable
- IV access
- > fluids
- > electrolytes
- > analgesia
Hx
- PC
- > onset and evolution of rash
- > timing in regards to medication
- > current dosing
- Severity screen
- > skin pain
- > facial/lip/tongue swelling
- > dyspnoea/chest tightness/wheezing
- > flu like illness
- > arthralgias
- > syncope/presyncope
- Past
- > autoimmune disease
- > atopy
- > immunosuppression
- Known allergies
- > previous reactions
- Medications review
- > prescription/over the counter/herbal
- > include any started months ago
Exam
- Vitals
- > febrile
- > haemodynamically stable
- Inspect
- > lesion characteristics (blistering/necrosis)
- > mucosal/skin/eyes
- > proportion of body covered
- Palpate
- > blanchable
- > desquamation (Nikolsky sign)
- > lymphadenopathy
Investigations
- FBC
- > neutropenia = AGEP
- > eosinophilia = DRESS
- EUCs + LFTs
- > electrolytes
- > DRESS/SJS/TEN end organ damage
- Consider
- > ANA/RF
- > skin biopsy (severe/uncertain diagnosis)
Management
- Immediately cease drug
- Serious adverse effect
- > dermatology/ophthalmology review
- > IV fluids + electrolytes
- > maintain thermoregulation
- Supportive
- > analgesia
- > topical corticosteroids (betamethasone cream)
- > anti-histamines (diphenhydramine IV/cetirizine oral)
- > wet dressing
- > moisturiser
- Prevention
- > update patient notes
- > education on avoidance
- > consider cross reactivity
- > consider need for bracelet
- > consider sensitivity testing
4
Q
PE
A
Initial response
- Call for help
- > may be febrile neutropenia
- Vitals
- Primary survey
- > A = exclude anaphylaxis
- > B = pulse ox/wheeze/crepitations
- > C = obstructive/cardiogenic shock/JVP
- > D = altered level of consciousness
- > E = evidence of DVT
- > F = ensure IV access/insert catheter
- Bedside investigations
- > ECG (exclude STEMI/high risk of arrhythmia)
- > Troponins
- > VBG (hypoxia/hypercapnoea/acid base/lactate)
- > FBC
- > Coags
- > Urea/creatinine
- > Mobile chest (ddx)
- Unstable
- > secure airway/titrate oxygen/NIPPV
- > small fluid bolus (if no evidence of HF)
- > consider pressor
- Empiric treatment
- > haematology advice (cancer risk)
- > arrest/peri = immediate thrombolysis
- > UFH infusion 10,000 unit loading dose
- > unlikely to be severe bleed from breast cancer
Targeted hx
- PC
- > pleuritic pain/angina
- > cough with sputum/haemoptysis
- > presyncope
- Past/Notes
- > VTE + prophylaxis
- > anaphylaxis
- > COPD/asthma
- > heart/lung disease
- > details of chemo/immunosuppression
- Contraindications to thrombolysis
- > recent bleeds
- > stroke
- > coagulopathy
- > anticoagulation
Diagnosis
- Well’s score
- > 0-4 = PERC rule
- > above 4 = CTPA + anticoagulation
- PERC rule
- > any criteria = D dimer
- > no criteria = rule out
- D dimer
- > above 500 = CTPA + anticoagulation
- > less 500 = rule out
- CTPA (if stable)
- > thrombus in vessel
- Echo (if unstable)
- > RV dysfunction
- V/Q scan (poor renal function)
- Lower limb ultra sound
- > DVT
Management
- Stable
- > consult haematology/oncology
- > review kidney function
- Anticoagulation
- > LMW preferred in cancer
- > 1mg/kg BD for 3-6 months
- Febrile neutropenia workup
- > review FBC
- > blood cultures
- > urine + stool MCS
- > chest xray
5
Q
COPD
A
Issues
- COPD
- > worsening hypoxia
- > loss of respiratory drive
- Altered level of consciousness
- > AEIOU GATES
Initial response
- Call for help
- Concurrent
- > vitals
- > primary survey
- > bedside investigations
- > empiric management
Primary survey
- A
- > exclude upper airway obstruction
- B
- > determine respiratory rate
- > wheeze/silent chest
- C
- > evidence of shock / HF
- > arrhythmia
- D
- > serial GCS
- E
- > top to toe
- > evidence of infection / trauma / DVT
Bedside investigations
- ECG
- VBG
- > CO2 retention
- > acid base
- > glucose
- > electrolytes
- Trops
- D dimer
- Urea/creatinine
- > uraemia
- Blood cultures
- Mobile CXR
- > pneumonia
- > tension pneumothorax
Empiric management
- Secure airway
- > suction
- > consider need for intubation
- > NIPPV
- Titrate oxygen
- > senior advice
- > issue of hypoxia/loss of respiratory drive
- > aim for 88-92%
- > 2L nasal canula if CO2 retention on VBG
- IV access
- > fluid bolus
- > pressor if shocked
- Bronchodilator
- > nebulised = requires interruption of NIPPV)
- > mDI = can be given in line
- Beta agonist
- > salbutamol 5mg neb/8 MDI
- > almeterol 2.5mg neb/8 MDI
- SAMA
- > ipratropium 500mcg neb/8 MDI
- Glucocorticoids
- > methylprednisone 60mg IV
- Antibiotics
- > ceftriaxone IV
- Monitor
- > resp rate
- > GCS
- > cardiac monitoring
- > pulse ox/VBG
- ICU transfer
6
Q
hyperkalaemia evaluation and management
A
Could be ischaemic gut
Initial instruction
- Get vitals
- Primary survey
- > respiratory effort
- > cariogenic shock
- Gain IV access
- > take VBG (check for pseudo)
- > begin fluids
- Urgent ECG
- > continuous cardiac monitoring
Targeted hx
- PC
- > palpitations
- > weakness/stiffness
- > increasing abdo pain
- > obstipation + vomiting
- Past
- > heart disease
- > diabetes
- > kidney disease
- Review
- > previous electrolytes
- > medications (NSAIDs/spironolactone/ACEI/ARB)
- > urine output (obstruction)
Exam
- irregular pulse
- ascending weakness/paralysis
- palpable bladder
- peritonitis
Investigations
- Review ECG
- > peaked T waves
- > prolonged PR
- > flattened P wave
- > widened QRS
- Review VBG
- > confirm hyperkalaemia
- > hyponatraemia/hypocalcaemia worsens cardiac risk
- > acidosis
- > lactate
- > glucose (insulin therapy)
- Order FBC
- > haemolysis
- Order urea/creatinine
- > AKI
- ESR/CRP
- > compare to baseline ischaemic gut
Management
- Aggressive fluids
- > increase renal perfusion
- > insert catheter
- Stabilise myocardium
- > calcium gluconate IV
- Drive K intracellularly
- > insulin + glucose IV
- > nebulised salbutamol
- Increase K excretion
- > furosemide IV
- > haemodialysis if refractory
- Monitor
- > ECG
- > respiratory effort
- > calcium/sodium/potassium
- > glucose
- > urine output
7
Q
Hypocalcaemia
A
Hx -PC ->unwell ->abdo pain/steatorrhoea = pancreatitis ->urine output ->confusion/seizures/tetany Past ->parathyroid surgery ->kidney disease ->malignancy ->crohns ->transfusions (iron/copper infiltration) -Family hx ->genetic causes -Meds ->chemo ->glucocorticoids ->anticonvulsants ->digoxin (cardiac toxicity with correction) ->PPI (hypomagnesaemia) -Social ->vit D ->malnutrition = hypoalbuminaemia
Exam
- Vitals
- > bradycardia
- > hypotension
- Kyphoscoliosis
- > osteoporosis
- Cardiac
- > arrhythmia
- Hands
- > skin = dry/course puffy
- > nails = dystrophic
- > bradydactyly = pseudo
- Trousseau’s sign
- > carpopedal spasm with BP cuff
- Chvosteks sign
- > mouth/nasal twitch with tapping on CNVII at ear
- Dystonias
- > CNS calcification
- DRE
- > prostate cancer
Investigations
- ECG
- > prolonged QT interval
- Total calcium
- > corrected for albumin
- PTH
- Magnesium/phosphate
- EUCs
- Consider
- > vit D
- > alphos (mets)
- > lipase
Management
- Call for help
- > ICU for central line
- Correct calcium
- > CVA calcium gluconate + 5% dextrose
- > push over 10 mins then set up infusion
- Correct hypomagnesaemia
- > leads to resistant hypocalcaemia
- > slow push then infusion
- Monitor
- > ECG = arrhythmia with rapid infusion
- > calcium/magnesium level
- > glucose
8
Q
rhabdo evaluation and management
A
Hx
- PC
- > details of incident
- > onset and evolution of pain
- > details of haematuria/any clots
- > fever/mailaise/nausea and vomiting
- Causes
- > fluid intake
- > any other trauma
- > bites/stings
- > ingestion of beets
- Past
- > kidney disease
- > thyroid disease
- Family hx
- > neuromuscular disorders
- Medications
- > statin
- > NSAIDs/ACEI/ARB/steroids
- Social
- > cocaine
Exam
- Vitals
- > febrile
- > haemodynamically stable
- Assess volume status
- Tenderness
- Weakness
Investigations
- ECG
- > hyperkalaemia
- Urinalysis
- > positive dipstick but no RBCs = myoglobin
- > urine casts
- CK
- > 5 times ULN
- Uric acid
- VBG
- > electrolytes (hyperkalaemia/hypocalcaemia)
- > metabolic acidosis
- FBC
- > platelets
- Coags
- > DIC screen = appt/pt/fibrinogen
- Urea/creatinine
- > AKI
- LFTs
- > elevated AST
- Consider
- > TSH
- > ESR
- > ANA
- > tox screen
Management
- IV access
- > analgesia
- > fluids
- Aggressive rehydration
- > insert catheter
- > aiming for 2mL/kg/hr
- Consider
- > IV bicarbonate (acid urine = myoglobin/uric acid toxic)
- > dialysis (severe acidosis/electrolyte disturbance)
- Monitor
- > fluid status (risk of overload)
- > electrolytes
- > compartment syndrome
9
Q
Orthostasis evaluation and management
A
Hx
- Typical
- > dizziness
- > weakness
- > dimming of vision
- Timing
- > early morning
- > prolonged standing
- > after exercise
- > heat
- > large meal
- Atypical
- > occurs while seated
- > not relieved by sitting/lying down
- Neuropathy
- > pain/burning/tingling/loss of sensation
- Exclude cardiac
- > palpitations
- > chest pain
- Paraneoplastic
- > weight loss
- > cough + haemoptysis
- > breast lump
- Past
- > falls
- > neuro (parkinsons)
- > dementia (lewy body)
- > diabetes
- Medication review
- Social
- > alcohol
- > home setup
- > carer/carers
Exam
- Postural BP
- > SBP <20, DBP <10
- Autonomic failure
- > HR increase <20
- Pulse
- > absent sinus arrhythmia
- Volume status
- Gait
- Peripheral neuro exam
- > power/sensation/proprioception
- Cardiac
- > murmurs
Investigations
- ECG
- Glucose
- FBC
- > anaemia
- EUC
- > electrolytes
- > dehydration
Management
- Geriatrician/neurology consult
- > tilt table
- > supine + standing norad (pre vs post)
- > valsava
- > respiratory HRV
- > ambulatory BP monitoring
- Review medications
- > reduce dose/cease where possible
- > consider alternative anti-HTN
- Advise
- > sit before standing
- > no straining on toilet/valsava while exercising
- > may need to treat constipation
- > eat smaller, more frequent meals
- > toe standing/crossing legs/muscle tensing
- Non pharm
- > stockings to increase venous return
- > increase salt supplementation
- > 2L water per day
- Pharm
- > fludocortisone (mineralocorticoid)
- > midodrine (alpha 1 agonist)
- > pyridostigmine (AcH inhibitor)
- > droxidopa (noadrenaline pro-drug for neurogenic)
10
Q
Graves disease evaluation and management
A
Hx
- PC
- > onset and evolution
- > pain
- Hyperthyroid
- > irritability
- > sweating
- > palpitations
- > heat intolerance
- > anxiety
- > tremor
- > insomnia
- > diarrhoea
- > weight loss
- Red flags
- > stridor
- > dysphonia
- > dysphagia
- > dyspnoea
- > diplopia
- Menstrual hx
- > LMP
- > amenorrhoea
- Past
- > autoimmune
- > diabetes
- > coeliac
- Family
- > autoimmune
- Medications
- > amiodarone
- > lithium
- Social
- > smoking
Exam
- Vitals
- > tachycardia
- Pulse
- > arrhythmia
- Reflexes
- > brisk
- Eyes
- > visual acuity
- > proptosis
- > chemosis
- > lid lag
- > ophthalmoplegia
- Inspect
- > acropathy
- > pretibial myxoedema
- > tremor
- Thyroid
- > diffuse or focal
- > tender or non tender
- > size/firmness/fixation
- > swallowing
- > bruit
Investigations
- bHCG
- TSH
- > usually undetectable
- > high free T4/total T3
- Antibodies
- > TSI
- FBC
- > anaemia
- Lipids
- Glucose
- Radioactive iodine imaging
- > not necessary if thyrotoxic with antibodies
- > diffuse uptake = graves
- > heterogeneous uptake = multinodular goitre
- Doppler ultrasound
- > needed if nodules present
- > graves = high vascular flow
- > painless thyroiditis = low vascular flow
- MRI
- > extra-orbital muscle swelling
Management
- Pharm
- > PTU/carbimazole +- thyroxine for 12-18 months
- > propanolol if symptomatic
- Radioactive iodine ablation
- > first line or pharm failure
- > contraindicated in pregnancy/breast feeding
- > risk of orbitopathy aggrevation (corticosteroid course)
- > lifelong thyroxine
- Surgery
- > pregnancy planned soon/large goitre/malignancy
- > thionamides prior to surgery decrease vasularity
- > lifelong thyroxine
- Thyroid storm
- > IV glucose + fluids
- > cooling
- > paracetamol (NSAIDs/aspirin displaces thyroxine)
- > propanolol IV
- > hydrocortisone IV
- > propylthiouracil PO (prevents T4/T3 conversion)
- > K iodide 1hr after PTU (wolf-chaikoff)
11
Q
Toxic megacolon evaluation and management
A
Initial response
- Call for help
- Attach vitals
- Primary survey
- > haemodynamically stable
- > SIRS/septic shock
History
- PC
- > onset and evolution
- > number of bloody stools per day
- > colicky abdo pain
- > systemic symptoms
- > associated nausea and vomiting
- UC
- > details of diagnosis and treatment
- > prior control and previous admissions
- > reason for non-compliance
- Past
- > previous resections
- Medications
- > anti-cholinergics/opioids/anti-diarrhoels
- > recent antibiotic use
- Social
- > recent travel
- > food and water exposure
- > sick contacts
Exam
- Vitals
- > fever
- > haemodynamical instability
- Mental status
- Volume status
- Abdo
- > distension
- > reduced bowel sounds
- > peritonism
Investigations
- VBG
- > lactate
- > electrolytes (hypokalaemia/hypomagnesaemia)
- Blood cultures
- FBC
- > leukocytosis
- > anaemia
- EUCs
- Albumin
- > low
- CRP/ESR
- > raised
- Stool MCS
- > ova
- > cysts
- > parasites
- > c diff toxin
- Abdo xray
- > if unstable
- > perforation
- CT abdo
- > colonic distension
- > stranding
- > free fluid
- > free air in perforation
- Flexible sigmoidoscopy with biopsy
- > identify IBD/pseudomembranous/full thickness necrosis
- > contraindicated in suspected perforation
Management
- Keep NBM
- Consider nasogastric decompression
- Insert catheter
- IV access
- > fluid rescuss
- > K/Mg replacement
- > analgesia
- Broad spectrum antibiotics
- > consult gastro
- > IV pip/taz or meropenem
- Steroids
- > IV 100mg hydrocortisone QID
- Monitor daily
- > vitals
- > peritonism
- > FBC/EUCs/albumin/lactate/CRP
- Surgery
- > no improvement after 72hrs of confirmed case
- > perforation/requiring transfusions/impending rupture
- > abdominal colectomy + end ileostomy
12
Q
Methotrexate monitoring
A
Before starting
- Baseline
- > FBC/LFT/EUCs
- > CRP/ESR
- > hand xrays
- > questionnaire (DAS + HAQ)
- Screen for infection
- > check hep B/C status/TB
- Check renal function
- > reduce dose if CrCl <50
- Check liver function
- > contraindicated if chronic liver disease
- Check pregnancy status + plans
- > pregnancy + breastfeeding contraindicated
- Get immunisations up to date
- > less effective post
Avoid side effects
- Folic acid supplement
- > reduces GI side effects
- > reduces transaminitis
- Dosing
- > divide into TDS dosing
- > take with food
- > take in evening before bed
- > switch to parental
Counselling
- Common side effects
- > nausea/vomiting
- > malaise
- > alopecia
- > infections
- > photosensitivity
- Rare but serious
- > anaphylaxis
- > SJS
- > fibrosis + cirrhosis
- Dosing
- > once a week (not daily) at same time
- > provide written information on this
- Avoid
- > alcohol (increases side effects)
- > sun exposure (photosensitivity)
- > conceiving (contraception required)
Toxicity monitoring
- Schedule
- > baseline
- > every 2-4 weeks then increasing
- FBC
- > leukopaenia
- > thrombocytopaenia
- LFTs
- > transaminitis
Efficacy monitoring
- Slow progress
- > may take 6-12 weeks
- Inflammation
- > number of swollen joins
- > CRP/ESR
- Questionnaires
- > use the same one longitudinally
- > DAS (disease activity)
- > HAQ (level of function)
- Xrays
- > joint destruction
- > repeat every 2 years
- RF/anti CCP
- > not used serially
13
Q
TIA evaluation and management
A
Time is brain
- Call for help
- Concurrent
- > Vitals
- > Primary survey
- > Targeted/collateral history
- > Beside investigations
- Empiric management
Vitals
- Cushings reflex
- > HTN/bradycardia/cheynes stokes
- Fever
- Pulse ox
Primary survey
- A
- > loss of protection
- B
- > loss of respiratory drive (brainstem involvement)
- > hypoventilation/hypercapnoea = vasodilation + high ICP
- > risk of aspiration (wheeze/crackles)
- C
- > AF
- > palpate/auscultate carotid
- > murmur
- D
- > GCS
- E
- > signs of anticoagulation
- > signs of peripheral vascular disease
- > head trauma
- F
- > gain IV access
- > insert catheter
- G
- > hypoglycaemia as ddx
- > secondary hyperglycaemia worsens outcome
Hx
- PC
- > onset and full recovery
- > LOC or seizure is -1
- > asymmetrical limb/face weakness/speech/vision is +1
- > ROSIER total score >0 = stroke/TIA likely
- Trigger
- > preceding illness
- > palpitations
- > aura
- > trauma
- Past
- > strokes/TIA
- > specific risk = AF/valvular/carotid stenosis/HTN
- > CVD risk in general
- Thrombolysis contraindications
- > recent bleeds
- > recent surgery
- > active malignancy
- > anticoagulation
- > coagulopathy
- Medications
- Social
- > level of functioning
Investigations
- ECG
- > AF
- > MI
- VBG
- > glucose
- > electrolytes
- FBC
- > platelets
- EUCs
- Coags
- Lipids
- Carotid duplex
- MRI/CT
- > with angio
- Echo
Management
- Transfer to stroke unit
- > improved outcome
- Anti-platelet
- > aspirin 300
- > clopidogrel 300
- Statin
- > high intensity atorvastatin 20-80mg
- AF
- > exclude intra-cerebral haemorrhage
- > enoxaparin
- Discharge
- > no driving for 1 month
- > safety net stroke symptoms
- Follow up
- > TIA clinic within 24hrs
- > carotid endarterectomy if >50% occlusion
14
Q
Pneumonia evaluation and management
A
Initial response
- PPE
- Vitals
- > desaturation
- > sepsis
- Primary survey
- > haemodynamically stable
- > calves soft non tender
Hx
- PC
- > cough + sputum
- > fever
- > pleuritic chest pain
- > dyspnoea
- > malaise/myalgia
- Differentials
- > palpitations/angina/orthopnoea/PND
- > haemoptysis
- Past
- > COPD
- > malignancy
- > heart + valvular disease
- Medications
- > PPI
- > recent antibiotics
- Social
- > smoking
- Review
- > contact with other patients
- > onset timing relative to admission
- > prior intubation
- > VTE prophylaxis
Exam
- Vitals
- > fever
- > tachycardia
- > tachypnoea
- Inspect
- > canula
- Lungs
- > asymmetrical rise
- > crackles
- > bronchial breathing
- > increased vocal resonance
- > dull to percussion
- Heart
- > signs of heart failure
- > new murmur
- Legs
- > DVT
Investigations
- VBG
- > hypoxia
- > lactate
- > glucose
- > respiratory alkalosis/metabolic acidosis
- FBC
- > leukocytosis/leukopenia
- CRP
- EUCs
- LFTs
- Blood cultures
- Nasopharyngeal swab
- > viral PCR multiplex
- > SARS-CoV2 PCR (seperate)
- Sputum MCS
- CXR (AP + lateral)
- > lobar
- > bronchopneumonia
- > atypical
- CT
- > cavitation
- > effusion
Management
- Infection control
- Supportive
- > titrate according to hypercapnoea risk
- > fluids +- pressors
- > analgesia
- > VTE prophylaxis
- Severe
- > ICU support
- > IV pip/taz IV QID + vanc and gent if shocked
- > consider MRSA risk + vancomycin
- > review at 48 hrs for switch to orals
- > total course 7 days
- Mild
- > oral amoxicillin +- clavulonate BD for 7 days
