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Objectives Flashcards

1
Q

Causes of airway obstruc

A 
Tongue
Anaphylaxis
FB
Ext comp eg tum
Trauma
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2
Q

Upper airway anatomy

A 
Upper airway-
Nose and paranasal sini
Oral cavity
Nasopharynx base skull to soft palate
Oropharynx to superior epiglottis
Hypopharnx to inferior cricoid cartilage
Larynx
Lower airway-
Trachea
Principle, secondary and segmental bronchi
Terminal bronichiole
Respiratory bronchiole
Avleolar ducts and sacs
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3
Q

Identify resp failure

A

Hypoxia- dyspnoea, restless, agitated, confused, cyanosis. If chronic then polycythemia, pulm HTN.
Hypercapnia- headache, periph vasodilation, tachyc, bounding pulse, flap, drowsy.

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4
Q

Causes acute resp failure

A

T1- pneumonia, PO, PE, asthma, ARDS
Chronic eg COPD, fibrosis
T2- very severe asthma or COPD or pneum, end stage fibrosis, OSA, anaphylaxis
Also sedatives, CNS tum, trauma, NMDs, chest wall, compl obstruc

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5
Q

Resp failure

A

T1- paO2 under 8kPa, normal or low pCO2
Due to VQ mism
T2- pO2 under 8, pCO2 over 6kPa
Due to alv hypoventil +/- VQ mism

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6
Q

Resp failure mx

A

T1- O2, assisted ventilation
T2- controlled O2, assisted ventil, maybe intubation
O2 eg nasal under 4L, simple over 5L, venturi 24-8 for COPD, NRB
Monitoring- bloods, ABG, CXR, sputum and blood cult, spirom.

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7
Q

Hypoxia

A

Hypoxaemic- resp fail
Anaemic- low Hb or CO
Circulatory- shock, PVD
Cytotoxic- cyanide

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8
Q

Bradypnoea causes

A 
Airway obstruction and exhaustion- asthma, COPD, OSA, oedema
RICP
Obesity
Alcohol, drugs, sedation
Cardiogenic shock
CNS disorder
Hypothyroid
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9
Q

tachypnoea causes

A 
Obstructive disorders- asthma, COPD
Pneumonia
Fibrosis
PE
Pneumothorax
pleural effusion
HF
Anxiety
Arrhythmia
Anaemia
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10
Q

Resp ix

A

Bloods- FBC, UE, CRP, ABG or VBG, LFT, clotting, D dimer, CA markers, a1 antiT
CXR
Sputum and blood cult
Spirometry

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11
Q

ABG interp

A

PH low and CO2 high- resp acidosis
PH low and CO2 low and HCO3 low- metab acid
PH high and CO2 low- resp alk
PH high and HCO3 high- metab alk

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12
Q

NIV ventil indics

BIPAP and CPAP

A

COPD resp acidosis pH 7.25-7.35
T2 RF
Cardiogenic PO unresp to CPAP
Tracheal intubation weaning

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13
Q

techs to assist ventil

A

CPAP- usually nasal, constant pos press, upper airways splinted open, improves VQ match
CPAP IS NOT NIV
BiPAP- 2 levs of pos press (IPAP and EPAP)

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14
Q

Modified wells score

A 
3- symps eg swell, pain
3- other dx less likely than PE
1.5- HR over 100
1.5- immob over 3d, or surg in last 4wk
1.5- prev PE or DVT
1- haemoptysis
1- malig

Score over 4 means PE likely, 4 or less means unlikely

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15
Q

shock px

A 
Hypot under 90
Tachyc usually over 100
Alt conciousness or syncope
Poor periph perfus- cool, clammy, pallor, high CRT
Oliguria under 50ml/hr
Tachyp
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16
Q

Shock causes

A

Hypovol- bleed, DNV, burns, pancreatitis, sepsis
Cardiogenic-
Primary eg MI, arrhythmia, valve, myocarditis
mechanical or Secondary eg tamponade, massive PE, tens pthorax
Distributive- septic more comm in eld or v yng, DM, renal/liver fail, imm comprom. Anaphylactic

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17
Q

Shock mx

A 
ABCDE
High O2
IV access and take bloods
Obs
ABG
ECG
CXR
Catheter and UO
Fluids if req
Ionot or vasoactive meds
Assisted ventil
Specif- lap, thrombolysis, PCI, pericardiocentesis, antidotes, abx
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18
Q

Acute renal failure causes

A

STOP most comm- sepsis, toxin, obstruc eg prostate, parenchymal eg ATN
Pre- DEHYD, shock eg sepsis, A stenosis
Intrinsic- ATN, drugs (Mb, ACEi, AG, NSAID), HTN, infec, nephritis, vasculitis
Post- obstruc eg prostate, stones, CA, stricture, fibrosis.

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19
Q

Acute renal failure px

A

Malaise, lethargy, nausea, reduc UO
High urea and cr
Elec imbal
Signs of cause eg sepsis, dehyd, vol overload, mass, renal bruit, pos dip or cult

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20
Q

Acute renal fail mx

A 
Tx cause
Tx fluid balance
Tx elec imbal and acidosis
Review meds
Monitor- UE, VBG, urinalysis, USS, UO
Indics for dialysis- hyperK, fluid overload, acidosis, dialysable toxin, uraemia (pericarditis, LOC, NV)
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21
Q

Acidosis causes

A

Resp- hypoventil in COPD, asthma, PO, CNS depression, obesity, GB, MG
Metab-
With normal anion gap (3-12)- reataining H (RTA, addisons) or losing HCO3 (diarr)
With high anion gap- methanol, uraemia, DKA, lactate, other poison

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22
Q

alkalosis causes

A

Resp- hyperventil eg anx, hypoxia, PE, pneumonia, asthma, PO
Metab-
Chloride responsive eg vom, diuretic, CS
Chloride resis eg cushings, hypoK

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23
Q

Acidosis px

A 
Fatigue, drowsy
Confusion
SOB, rapid shallow breathing
Headache
Lack appetite
Jaundice
Tachyc
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24
Q

alkalosis px

A 
Confusion
Tremor, tetany
Light headed
NV
Numbin and tingling
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25
Mx of acid base disturbance
Tx cause Oxygen if req Tx elec imbal Acidosis- sodium bicarb, CPAP
26
Tachyc causes
``` Arrhythmia- ST, SVT, flutter, atrial tachyc, AF, AVRT, VT, pre excited AF, torsades, VF HTN or hypot IHD Valve dis Anaemia Exercise Stress Cardiomyopathy Infection and fever Smoking Drugs eg alc, caffeine, cocaine, medications Elec imbal Hyperthyroid ```
27
Bradyc causes
``` Arrhythmia- SAN dis, HB AVN dis IHD Congenital heart dis Myocarditis Hypothyroid Elec imbal OSA Rheumatic dis Meds ```
28
Oliguria causes
``` Dehydration Obstruc Sepsis and other vasc collapse Low CO Intrinsic renal eg ATN, glom dis, vasc lesions ```
29
Hypotension causes
``` Dehyd eg DNV Blood loss Severe inflammation Myocarditis Valve dis PE Tamponade Bradyc ```
30
Hypernatraemia
Causes- iatrogenic, DNV, burn, DI, DKA, conns Px-lethargy, weak, thirst, irrit, confus, coma, seiz, dehyd Mx- hydration, maybe saline if hypovol Tx cause
31
hyponatraemia
Causes- hypovol, diuretics, addisons, kidn inj, DNV, burn, SIADH, hypothyr, CCF, low alb Px- NV, malaise, headache, irrit, confus, weak, reduc GCS, seiz, CCF, oedema Mx- fluids, maybe hypertonic saline Tx cause
32
hyperCa
Causes- thiazide, lithium, high PTH, high vit D, bone CA, myeloma, hyperthyr, sarcoid, dehyd Px-NV, abdo pain, constip, polyU/D, dep, wl, weak, tired, HTN, confus, pyrexia, renal stones, short QT, bone pain Mx- fluids, bisP Tx cause
33
hypoCa
Causes- loops, CKD, low vit D, low PTH, bisP, alkalosis, pancreatitis Px- spasmodic Mx- Ca gluconate, sandocal supplems. Vit D (colecalciferol, alfacalcidol) Tx cause
34
HyperK
Causes- transfusion, trauma, acidosis, addisons, K sparing diuretic, ACEi, A/CKD Px- fast irreg pulse, CP, weak, palpit, dizziness, tall T, small P, wide QRS, VF. Mx- Ca gluconate 10ml 10% IV 5 mins, actrapid 10U in 250ml 10% dextrose, neb salb, Ca resonium, maybe haemodialysis Tx cause
35
hypoK
Causes- conns, DNV, diuretics, alkalosis, RTA, salbutamol Px- weak, hypotonia and reflexia, cramps, tetany, palpit, dizzy, constip, arrhthmia, small or inv T, promin U, long PR, STD. Mx- sandoK oral, K supplem IV fluid Tx cause
36
bleeding diathesis causes | Susceptability to haemorrhage
``` warfarin liver fail vitK defic DIC haemorrhgaic virus, meningitis leukaemia AI eg antiPlipid, vasculitis Genetic eg haemophilia, VWD impaired skin heal eg scurvy and cushings Vascular malformations ```
37
bleeding diathesis mx
``` Tx cause Plasma exchange Pl transfusion Anticoagulants Packing an active bleed ```
38
Circulation ix
Bloods- UE, clotting, ABG, eGFR, CRP, FBC, culture, trop Obs incl standing lying BP Swabs sputum or urine dip if suspect sepsis USS, CT (angio), CXR ECG Echo
39
clinical assessment of cardiac output
Signs of low CO- BP under 90, UO under 0.5ml/kg/hr, HR under 60 or tachyc, fatigue, confusion, thready pulse, high JVP, SOB, hypoxaemia, pulm and periph oedema, metabolic acidosis Ix- Doppler, electromagnetic flowmeter, echo, ABG
40
Pathophysiology of atherosclerosis
``` Endothelial damage Lipop oxidation Foam macrophage Cytokines Fat and sm infilt Plaque formation ```
41
Pathophysiology of TE
``` Virchows triad- wall, flow, components Platelets aggregation and adhesion Cytokines, clotting cascade Localised thrombus, vasoconstriction Lodge in artery- ischaemia ```
42
Mx of epistaxis
Body forward mouth open Pinch cartilaginous part of nose 10-15min Naseptin cream if this works If above doesnt work- cautery with silver nitrate stick if bleeding pt can be seen, or packing Then naseptin aftercare (chlorhex and neomycin)
43
GCS score | Eyes 4, voice 5, motor 6
Eyes- 4 spont, 3 to speech, 2 to pain, 1 none Voice- 5 orientated, 4 confused, 3 innap words, 2 sounds, 1 none Motor- 6 obeys, 5 loc pain, 4 withdraw from pain, 3 abn flex decorticate, 2 abn ext decerebrate, 1 none
44
Causes of low GCS
``` Drugs, alc Epilepsy Hypoglycaemia CVA Brain hypoxia Dementia Head trauma Brain tumour Heart dis Liver dis Uraemia Shock Sepsis ```
45
Delirium causes
Predisp- Eld, male, sensory impair, psych comorb eg dementia or dep, func imapir, malnutrition, other comorb eg CVS and PD Precip- Meds eg cholinergics, infections, metab abn (gluc, Ca, Na, thyr, liver or renal fail), hypoperfusion, hypoxia, shock, anaemia, sleep depriv, pain, surgery, neurol illness, head injury, dehydration
46
Seizure causes
``` Neuro- Epilepsy, tumour, meningitis, enceph, CVA, head trauma, congenital abn, peri natal hypoxia Metab- Hypoglycaemia, hypoNa, hypoCa, hyperuric Drugs- ODs, abuse, alc withdrawal, toxins Febrile convulsions Eclampsia ```
47
Causes of acute focal neurol deficit
``` Ischaemic CVA, or TIA Intracerebral of subarachnoid haemorrhage Head injury or periph nerve injury Menignitis or enceph Vascular malformation ```
48
headache causes
``` Tension Cluster Migraine Trigeminal neuralgia GCA Meningitis, enceph Brain haemorrhage, haematoma or abcess RICP Venous sinus thrombosis Glaucoma Sinusitis Drugs and withdrawal ```
49
Disability ix
``` Bloods- CRP, ESR, FBC, UE, LFT, clotting, gluc, ABG, culture Obs and neuro assess CT or MRI head Urine dip, swabs LP for mening CXR EEG ECG ```
50
delirium mx
``` Tx cause Early recog Mx hypoxia, usch, dehyd and elec imbal Review meds Mx sleep Geriatrician and psych input Non pharm- family inv, consis staff, avoid transfer, explain interventions, calm, large notices, adjustable lights, particip in ADLs, remove catheter, avoid restrain, correct sensory deficit Pharm- haloperidol, rarely BDZ and ACHEi ```
51
poison px
NV R upper abdo pain liver eg paracetamol Reduced GCS Coma Hypoglycaemia Asp- hyperventil, tinnitus, deaf, vasodilat, sweat TCA- dry mouth, seiz, arrhyth, hypothermia, hypot, hyperreflex, resp fail, urin reten, pupil dilat SSRI- agitation, tremor, nystag, tachyc Renal failure rarely Lithium- GI, ataxia, tremor, weakn, dysarthria, twitch, elec imbal, dehyd, convuls, hypot, renal fail BDZ- dysarthria, ataxia, nystag, resp dep Amphetamines- hyper init, hallucin, paranoia, HTN, convuls, hyperthermia Cocaine- agitation, HTN, arrhythmia, tachyc, pupil dilat, hyperthermia and tonia, CP, MI Opioid- drowsy, coma, resp dep, pinpoint pupil Ecstasy- delirium, coma, hyperthermia, rhabdo, renal fail, hep, DIC, ARDS, hyperreflex, hypot, IC haemorrhage, hypoNa, convuls, arrhythmia.
52
Poison diffs
``` Neuro- epilepsy, RICP, IC bleed, trauma Cardiac- arrhythmia, IHD Renal or liver dis Elec imbal Sepsis Resp dis ```
53
Poison mx
Gen- gastric lavage or bowel irrigation, activ charcoal, somet haemodialysis Specif- Paracetmaol- N acetylcysteine. Charcoal under 4hr Digoxin- digibind Ab frags BDZ- flumazenil IV 0.2mg over 15 sec, max 3mg Insulin, BB- glucagon Opioids- naloxone us IV ev 2-3 min Iron salts- desferrioxamine mesilate Ethylene glycol or methanol- fomepizole, ethanol TCA- gastric lavage under 2hr, activ charcoal. Maybe Vasopressors, Na bicarb. Salicylate- Na bicarb, fluids. Maybe dialysis, pressors. CO- hyperbaric O2 Cyanide- amyl nitrate, Na nitrate, Na thuosulfate Heparin- protamine sulfate OrganoP- atropine, pralidoxime SU- octreotide Psych review
54
Hypothermia signs
``` Shiver Slurred speech Slow shallow breathing Weak pulse Lack coord Drowsy and lack energy Confusion or amnesia LOC Bright red cold skin in infants Low temp ```
55
Hypothermia RFs
``` Elderly and infants Cold env Mental illness Alc and drugs Exhaustion, fatigue Comorb- hypothyr, malnutr, DM, CVA, sev arth, PD, trauma, SC injury Infection Meds- antiD, antiP, sedatives, narcotics ```
56
Hypothermia init mx
Warm dry location Heated insulating blankets Blood removal and rewarming via haemodialysis Warm IV fluids Airway rewarming with humidif O2 Irrigation with warm saline- pleural and perit cavities
57
Comm causes of pyrexia
``` Virus or bact infec Heat exhaustion Rheumatoid and AI conditions, vasculitis Malig Hyperthyr Meds- abx, AED, antiHTN Some vaccines- DTP, pneumococcal Shock Collagen vasc dis Fungus and parasite Granulomatoud dis eg sarcoid, crohns, hep PE ```
58
Pyrexia ix
``` Sepsis 6 if indicated Bloods- FBC, ESR, CRP, LFT, ANA, RhF, TFT, culture Labeled white cell scan Cultures- urine, sputum, stool, CSF CXR, CT, MRI, PET LP Skin biop LN asp Bm asp Liver biop Lap surg ```
59
Notifiable dis
``` Acute enceph, acute hep Acute meningitis and mening septacaemia Acute poliomyelitis Anthrax Botulism Cholera Diptheria Thyphoid HUS Invasive grp A strep Legionnaries Leprosy Malaria Measles Mumps Plague Rabies Rubella SARS Scarlet fever Smallpox Tetanus TB Typhus Viral haemorrhgaic fever Whooping cough Yellow fever ```
60
Sepsis in kids
``` Later hypot Cold peripheries, CRT delay Mottled skin Hypotonia Vomit Convulsions Resp distress Oedema Rash Bulging fontanelle mening Temp instabil Lethargy Poor feeding Reduc UO ```

acute care (6 decks)

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