Flashcards in Run 1 Deck (68):
A: Assess, manoeuvre, suction adjunct
B: O2 sats and oxygen, RR and resp distress, trachea, chest exam
C: Pulse and peripheral temperature, BP and cap refill, ECG and heart sounds, IV access (bloods and fluids, ABG)
D: AVPU, GCS, pupils, glucose
E: Temperature, rashes, bleeds, abdomen/legs
Accessory muscle use
Retractions (supracostal, suprasternal, intercostal, substernal)
Noisy breathing (wheeze, stridor, grunting)
Nasal flaring, pursed lips
Allergies, medication, PMH, last ate and drank, events
Glucagon 1mg IM
20% glucose 80ml IV
(K.5.5, palpitation, tall tented T waves)
CaGluconate 10% 10mls over 10mins observe ECG repeat every 5 mins to normalise ECG max 3 doses
Insulin (actrapid 10 units + 50ml glucose 50%)
Salbutamol 5mg nebulised
IV ceftriaxone IV 2g
IV dexamethasone 10mg
Abdo pain, N&V, kausmaull respiration, glucose >11, blood ketones >3 or urine +++, polyuria, polydipsia
(body lacks insulin so can't access the glucose in the blood, fatty acids used as energy producing ketones as biproduct)
1- 0.9% NaCl IV 500mls stat
2- insulin 0.1units/kg
3- measure K+ and give KCl accordingly, max 20mmol/1hr
BP <90 or <60
0-2 mild/mod (amox)
3-5 severe (co-amox + doxy)
Status epilepticus management?
IV lorazepam 4mg
0.5mg IM adrenaline
IV hydrocortisone 100mg
IV chloramphenamine 10mg
Trimesters of pregnancy?
1: 0-13 weeks
2: 14-27 weeks
3: 28-40 weeks
How many antenatal checks will a mother have in uncomplicated pregnancies?
First baby: 10
How much folic acid should mothers get and why?
400mcg before pregnancy to 12 weeks (5mg if high risk groups)
Important for DNA and RNA synthesis (normal growth of baby)
What are high risk groups for NTDs?
Previous NTDs, FH, anti epileptic drugs, ceoliac, diabetes, BMI >30
When is booking visit and what is covered?
General info (diet, alcohol, smoking, folic acid, vit D)
BMI, BP, urinalysis and culture (proteinuria, GBS)
Bloods: FBC, ABO, Rh, haemoglobinopathies (sickle, thallassemia), Hep B, syphillis, rubella, HIV offered
When is the early USS scan and what is determined?
Viability, number, due date (40weeks onto 1st day of last period), gestational age (crown to rump length or head circumference)
When is the combined test and what is it?
Down's syndrome screening test
What are the results of the combined test?
USS: nuchal thickness (increased reflects changes in the baby that are strongly associated with chromosomal abnormalities)
Blood test: bHCG (high levels suggest chromosomal abnormalities) PAPP-A (low levels suggest chromosomal abnormalities)
Consider maternal age and if high risk (>1:250) then diagnostic tests offered
When is the triple/quadriple test offered and what is it also known as?
If too far on in the pregnancy to do combined test (not as accurate as the combined test)
Serum screening test
What are the results of the serum screening test?
bHCG (high levels in down's syndrome)
AFP (low levels in down's syndrome)
Inhibin A (high levels in down's syndrome)
Unconjugated Estriol (low levels in down's syndrome)
Risk then calculated considering maternal age and if high risk diagnostic tests offered
What are the diagnostic tests offered for mothers with high risk of chromosomal abnormalities?
Amniocentesis (>15 weeks) collects skin/urine cells from the amniotic sac, 1% miscarriage risk
Chorionic villus sampling (11-14 weeks) collects placental tissue, 2% miscarriage risk
Foetal blood sampling (>18 weeks) collects blood from the umbilical cord, miscarriage 2%
If at any point during the pregnancy Hb drops below 110g/L what should be considered?
300mg ferrous sulphate
When is the anomaly scan and what is done?
USS to look for structural abnormalities if suspected then diagnostic tests offered
If a mother is Rh- what needs to be given and when?
28 weeks and 34weeks
What are the common chromosomal abnormalities?
T21: Down's syndrome
When is presentation first checked?
36 weeks (offer cephalic version if breech)
What should be done at 41 weeks if no birth?
Offer membrane sweep, offer induction of labour
Main pain relief options in labour?
Pudendal nerve block
What are the two types of hypertension in pregnancy?
Pre-existing: previous diagnosis or <20weeks
Gestational: >140/90 after 20weeks
When is prophylactic aspirin given in pregnancy?
For mothers with high risk of pre-eclampsia
(essential HTN, diabetes, BMI>30, >40yrs, CKD, PMH)
What are the treatment options for hypertension in pregnancy?
1st line labetalol
2nd line Nifedipine or methyldopa
What is pre-eclampsia?
Pregnancy induced hypertension and proteinuria (a multi system condition affecting pregnant women)
What is eclampsia?
Pre-eclampsia with seizures
Prophylaxis of seizures in pre-eclampsia?
What is pre term, term and post term dates?
Pre term: <37
Term: 37 - 41
Post term: 42
Meaning of zygosity and chrioinicity?
Number of eggs fertalised
Number of amniotic sacs
Another name for first pregnancy?
When can termination of pregnancy be conducted until?
24 weeks unless serious fetal abnormality or serious risk to mother
What are the types of termination of pregnancy's available?
Medical: Give mifepristone (antiprogesterone) and 24hrs later misoprostol (prostaglandin that induces contractions)
Surgical: if medical fails: Vacuum aspiration (6-13wks), dilation and evacuation (13-24wks)
Differentiating between placental abruption and placenta preva?
Placental abruption: pain, hard woody abdomen, haemorrhage
Placenta previa: painless bleeding
What abx are used in UTI's or asymptomatic bacteriuria in pregnancy?
Nitrofuratoin 100mg bd for 7 days (1st and 2nd trimester)
Trimethoprim 200mg bd for 7 days (3rd trimester)
Test of cure
What epileptic drugs should be avoided in pregnancy and why?
Na Valproate: neural tube defects
Phenytoin: cleft palate and lip
What diabetic drugs should be avoided in pregnancy?
SUs use insulin instead
What drug is useful for N&V in pregnancy?
Why should warfarin not be used in pregnancy?
Risk of haemorrhage
What do healthy start vitamins contain?
C, D, folic acid
What is the pregnancy advice for vit D?
10mcg/day important if not eligible for healthy start vitamins can buy own
What is the pregnancy advice for iron?
Try and eat iron rich foods, anaemia will be check for regularly if Hb drops below 110 then 300mg ferrous sulphate
What is the pregnancy advice for vit A?
>700mcg can be tetarogenic
Do not take supplements with vitamin A and avoid foods with high content (liver)
What is the nutritional advice for pregnancy?
>30g protein, 250-300 excess cals
What happens to HR and CO in pregnancy?
increases due to demands of uteroplacental circulation
What happens to the BP in pregnancy?
Drops in 2nd trimester due to expansion of the uteroplacental circulation then rises again
What does progesterone do in pregnancy?
develops the endometrium, prepares for lactation and decreases uterine contractions
What does oestrogen do in pregnancy?
uterine enlargement, breast developments, relaxation of ligaments
When does hyperemsis gravidarium commonly occur?
What are the symptoms of hyperemesis gravidarium?
severe N&V, WL, dehydration, electrolyte imbalance
Antiepileptics in epilepsy in pregnancy?
Folic acid 5mg
Management of gestational diabetes?
Folic acid 5mg
What are the expected signs in an ectopic pregnancy?
Bleeding, abdominal pain and tenderness, shoulder tip pain, may be unstable
What are the investigations in ectopic pregnancy?
Speculum: OS closed
USS: empty uterus
bHCG: levels will plateau
Management of ectopic pregnancy?
If unstable resus and surgery
If stable IM methotrexate
When to suspect miscarraige?
Heavy bleeding, pain likely cramping, passage of products
Investigations in suspected miscarraige?
Pregnancy test, Speculum to assess OS, USS, hBCG (halves daily)
Management of miscarriage?
Threatened: pain relief, counselling surveillance
Innevitable, incomplete, complete: manual or surgical evacuation, misoprostol, counselling
Gynae history structure and key features?
HPC (STI screen and red flags: discharge, dysuria, intermenstrual bleeding, post coital bleeding, abdo pain, abdo bloating)
SE: (fever, tiredness, WL, change in bowel habit)
Menstrual history (age, LMP, typical cycle, pain, menorrhagia, contraception)
Gynae specific (smear, STIs, procedures)
DH and allergies
Focused sexual history?
LSI, consenual, partner info, type of sex, contraception
LSI in 3 months