Revision lectures Flashcards
What are the 5 Rs of fluid prescribing?
Resucuitation - 10ml/kg over 15 mins (repeat x4, halve if elderly/cardiac problems)
Routine maintenance
Replacement of ongoing losses
Redistribution
Reassessment
Why do you give glucose in fluids?
to prevent ketosis, not for nutritional purposes
How should you approach fluid prescribing?
Clinical assessment of patient
- history and notes review
- notes for intra-op blood loss, fluid balance and post-op plan
- examination and assessment of dehydration
- look for EWS red flags
- do relevant investigations
Management
Reassessment
Signs of hypervolaemia?
oedema, raised JVP, bi-basal crackles, S3 heart sounds, ascites
Signs of hypovolaemia?
dry mucous membranes, low skin turgor, cool peripheries, cap refill > 2 secs
altered consciousness, pallor, tachycardia, tachypnoea, hypotension
NG and drains - increased loss
Surgical site examination
Why might patients show hypokalaemia on bloods post op?
drain loss and NG tube loss of K+
What should you do after prescribing fluids to any patient?
document
reassess
if more than 3 days NBM, consider TPM
obtain senior support early if complex case
Which factors effect the accuracy of HbA1c?
haemoglobinopathies - thalassemia , sickle cell
haemolytic anaemia
splenectomy
haemoldialysis / blood transfusion
CKD
HIV
pregnancy
being a child
Major complications of diabetes?
Macrovascular
- Cerebrovascular
- Peripheral vascular
- Cardiovascular
Microvascular
- Retinopathy
- Nephropathy
- Neuropathy (Autonomic or peripheral)
Main side effects for:
metformin?
sulfonylurea?
metformin:
GI upset, lactic acidosis
sulfonylurea:
hypos - falls and affects driving
What is required for diagnosis of diabetes?
WHO criteria
Fasting plasma glucose > 7
Random glucose > 11.1
If asymptomatic then requires 2 readings
How could you explain AF to a patient in a GP setting?
rather than contracting properly, the chambers at the top of your heart quiver (demonstrate with hands)
blood not being pumped as effectively - explains palpitations / dizzy sensation
actually quite common, one of the most common rhythm abnormalities- more common as you get older
Sometimes it’s not triggered by anything in particular but there are risk factors for it - high blood pressure can increase your risk (causes structural change to heart over many years)
How would you explain AF mx to a patient in GP?
There are two main things :
One is the heart Rhythm - low dose of bisoprolol - once daily oral tablet - risk of bradycardia and hypotension
One is risk of stroke - we reduce that by putting you on a blood thinner - DOAC like apixiban - risk of nausea and bleeding
can cardiovert if young and new onset - refer to hospital specialists
How would you safety net for AF in GP?
Face arms speech 999
Feel very SOB then call for help
Side effects - bleeding risk
Beta blockers lower your BP so if you feel faint or dizzy then you need to come back
What statin should you prescribe to reduce cardiovascular risk?
How would you explain?
Adverse effects?
atorvastatin 20mg OD or 80mg OD if secondary
fat in your blood called cholesterol
if you have too much it can get deposited in the blood vessels in your body
can increase risk of heart attacks, stroke and PAD
this medication stops you from making too much cholesterol, take it once at night
AE: muscle pain, hyperglycaemia, headache, GI upset