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Specialty Flashcards

1
Q

Name 3 methods of estimating burns

A

Lund and browder
Wallace’s rule of 9s
Palm of hand =1%

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2
Q

What is the parklands formula

A

Crystalloid
4mls /kg /%TBSA Over 24 hours
First half given in 8 hours

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3
Q

What grades of spinal subluxation are there

A

Grade 1-4
1 is <25% of the vertebral body anteroposterior width
4 is > 75%

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4
Q

Why does bradycardia occur in neurogenic shock

A

High thoracic injuries causes paralysis to the thoracic sympathetic outflow leading to un opposed vagal stimulation

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5
Q

When and why should you use sux after a spinal cord injury

A

72 hours after a spinal injury life threatening hyperkalaemia can occur

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6
Q

What is the components of qSOFA score

A

BP < 100
RR > 15
GCS <15

Score of 2 suggests high risk of death or prolonged itu stay

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7
Q

What is the sofa score

A 
Resp- PF ratio
Coag- platelets
Liver - bili
Heart - MAP
Cns- GCS 
Renal - creat +uop

Score 0 to 4 on each Parameter
An increase in 2 points is a 20% increase in mortality

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8
Q

How useful is lactate as an addition to qSOFA and why is it not included

A

Performs well as a parameter
Not all hospitals have access to it
Could increase qSOFA ability to predict mortality

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9
Q

Define sepsis and septic shock

A

Life threatening organ dysfunction cause by a dysregulated host response to infection

Septic shock occurs when vasopressors are required for a MAP > 65, lactate >2 in the absence of hypovolaemia

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10
Q

What features would indicate the need for intervention in hepatic trauma

A

Haemodynamic instability
Sentinel clot
Extravasation of contrast
Score > 3 liver injury scale (grade 1-5)

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11
Q

When and what vaccinations and prophylaxis should a patient receive post splenectomy

A 
2 weeks post 
Haem influenza b
Pneumococcal
Meningococcal
\+ flu

Life long abx
<16 >50 years
Post response to vaccine
Invasive pneumococcal disease

Pen V or erythro

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12
Q

When and what vaccinations and prophylaxis should a patient receive post splenectomy

A 
2 weeks post 
Haem influenza b
Pneumococcal
Meningococcal
\+ flu

Life long abx
<16 >50 years
Post response to vaccine
Invasive pneumococcal disease

Pen V or erythro

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13
Q

How do you estimate a child’s weight

A

Age + 4 x2

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14
Q

How do you estimate an endotracheal tube size

A

Age / 4+ 4

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15
Q

How does the size difference between a cuffed and uncuffed ET

A

0.5 to 1 size smaller internal diameter tube

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16
Q

Common causes of retroperitoneal haemorrhage

A 
Trauma
Ruptured abdominal aortic aneurysm
Interventional procedures
Haemorrhagic pancreatitis
Spontaneous- anticoagulant/ low plts
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17
Q

How long does it take for grey turners sign to appear

A

24-48 hours

Bruising to flanks

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18
Q

Complications of retroperitoneal Haematoma

A 
Compartment syndrome
Femoral neuropathy 
Renal impairment 
Infection 
Hypovolaemia
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19
Q

Reversal agents of DOACs

A

Idarucozumab - Dabigatran
Haemodalysis
Pct

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20
Q

Risk factors for DIOS

A 
Severe CF genotype 
Pancreatic insufficiency 
Inadequate salt intake
Dehydration 
Poorly controlled fat malabsorption 
History of meconium ileus
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21
Q

Definition of DIOS

A

Acute onset of pain in central or right lower quadrant over days associated with pain and nausea.

Can be palpable mass.
Grade 1 ->3 mild to severe

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22
Q

Management of DIOS

A 
Hydration 
Fecal disempation protocol
Add in Kleen prep 
NG tube 
Surgical advice
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23
Q

What is the pathophysiology of thyrotoxicosis

A

Overproduction of the thyroid hormone via direct causes or precipitants

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24
Q

Causes of thyrotoxicosis

A

Graves (autoimmune thyroid stim immunoglobulin binds to tsh receptor -> thyroid hormone production )

Toxic nodular goitre
Adenoma
Trauma
Too much thyroid hormone

Sepsis/ surgery/ mi / iodine contrast / poor DM control/ nsaids

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25
Q

Presentation of thyrotoxicosis

A

Tachycardia
AF or arrhythmia
Flush / sweating
High output cardiac failure

Agitation
Confusion
Pyschosis

Fever
Rhabdo
Dehydration

Also pain / N+ V

Lid retraction, proptosis exopthalmos
Hair loss

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26
Q

What blood tests do you see in thyrotoxicosis

A 
High t3 and t4 
Low tsh 
High glucose 
Mixed or metabolic acidosis 
Aki
Hypokalaemia
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27
Q

Treatment thyrotoxicosis

A

Oxygen
Fluid
Cool
Remove any precipitants

Propranolol
Propylthiouracil
Carbimazole
Steroids

Consider dig/ ami / vit B / plasma exchange

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28
Q

How does propranolol work in the treatment of thyrotoxicosis

A

Symptomatic control

Reduced conversion of T4 to T3

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29
Q

How does propylthiouracil work in the treatment of thyrotoxicosis

A

Blocks iodination of tyrosine and peripheral conversion of T4-> T3

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30
Q

How does carbimazole work in the treatment of thyrotoxicosis

A

Block thyroid hormone production.

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31
Q

What is a myxoedema crisis

A

Rare and life threatening syndrome caused by a deficiency in thyroid hormone

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32
Q

Causes of myxoedema coma

A 
Iodine deficiency 
Hashimotos (autoimmune anti- thyroid antibodies) 
Thyroid surgery or radioactive iodine 
Amiodarone
Thyroid or pituitary injury
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33
Q

Presentation of myxoedema coma

A

Hypoventilation
Hypoxaemia

Bradycardia, long qtc flat T waves
Pericardial effusion

Seizures, coma, slow reflexes

Hypothermia, low Na, low phosphate, low glucose

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34
Q

Management of myxoedema coma

A

Abcde
Fluid resus with na
Correct electrolytes
Stop precipitants

Liothyronine
Levothyroxine
Corticosteroids

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35
Q

How does levothyroxine work

A

Manufactured form of T4

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36
Q

Fast scan views

A

Right upper quadrant - peri hepatic
Left upper quadrant - peri splenic
Subcostal - pericardium
Suprapubic - pouch Douglas

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37
Q

Life threatening injuries on a Trauma

A 
A- airway obstruction 
T- tension pneumothorax
O open pneumothorax 
M massive haemothorax
F flail chest 
C cardiac tamponade
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38
Q

What is in the Extended fast scan

A

Fast scan with bilateral lung bases

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39
Q

What is the dose of txa

A

1g over 10mins

1g over 8 hours

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40
Q

Diagnostic criteria of pre eclampsia

A

Hypertension >140/90
Proteinuria
>20weeks

41
Q

Definition of severe pre eclampsia

A 
Severe HTN 160/110
Proteinuria 
And 
Headache
Visual disturbance 
Clonus
RUQ pain 
Low platelet
42
Q

Definition of eclampsia

A

Pre eclampsia
+
Seizures

43
Q

Treatment of pre eclampsia

A

Delivery
Mgso4 4g over 5mins then 1g over 24
Control BP with labetalol or hydralazine

44
Q

Definition of hellp

A

Haemolysis
Elevated LFTs
Low platelets

Third trimester to 7/7 post partum

45
Q

Pathophysiology of hellp

A

Activation of compliment and coagulation cascade form generalised endothelial injury
Increasing vascular tone
Platelet aggregation

46
Q

Hellp blood tests

A

Maha
AST raised
Aki

47
Q

Pathophysiology pre eclampsia

A

Torturous spiral arteries
Hypoperfusion and hypoxia
Cytokine and inflammatory response
Maternal endothelin dysfunction

48
Q

Define acute fatty liver of pregnancy

A

Third trimester or early post partum
Life threatening
Presenting with nausea vomiting abdo pain ascites and jaundice

49
Q

Blood tests of acute fatty liver of pregnancy

A 
Raised bilirubin
Raised alt
Hypertension 
Hypoglycaemia 
High ammonia 
Raised creatinine 
Leucocytosis 
DIC
50
Q

What is the Glasgow aneurysm score and cut off for morality

A 
Age 
Shock
MI disease
cVa disease
Renal disease

> 78.8 is mortality of 8.7

51
Q

What is the 4H and 4T

A

Hypoxia
Hypothermia
Hyper/ hypo kalaemia or glycaemia
Hypovolaemia

Tension pneumothorax
Cardiac tamponade
Toxins
Thrombolic disease

52
Q

At what gestation do you require left lateral tilt

A

20 weeks

53
Q

When do you consider delivering a baby during maternal CPR

A

Consider after 4 minutes and before 5 minutes

54
Q

How to calculate weight of child

A

Age + 4 x 2

55
Q

Why does albumin contribute to the anion gap

A

It is a negatively charged anion and therefore you overestimate the gap if it is low.

Every 1g decrease is 0.25 decrease in AA gap

56
Q

What are the daily requirements for water carbs protein sodium calcium

A 
Water 30mls/ kg
Carbs 2g/kg 
Protein and fat 1g/kg
Sodium and potassium 1mmol/kg
Calcium 0.1mmol /kg
57
Q

What is the composition of Pn

A

40% lipid
60% carb and glucose

Low protein <3 days
High post day 3

58
Q

What electrolytes change in refeeding

A

Phosphate
Potassium
Magnesium

59
Q

What is needed to start a fire

A

Heat
Oxygen
Fuel

60
Q

Rate and depth of chest compressions.

A

100-120 compression

5-6 cm or 1/3 depth chest

61
Q

Plasma markers of Tumour lysis

A 
Raised Uric acid 
Phosphate 
Urea
Creatinine
LDh 
High phosphate 
Low calcium 
High potassium
62
Q

Treatment of tumour lysis

A

Hydration
Electrolyte correction
RRT
Rasburicase

63
Q

How does allopurinol work

A

Xanthine oxidase inhibitor preventing uric acid formation

64
Q

What is the definition of base excess

A

The amount of acid or base required to restore 1l of blood to a pH of 7.4 at body temp and normal pco2

65
Q

What is the standard base excess

A

Base excess corrected to haemophilic concentration of 50

66
Q

How much energy does 1 g of protein and carb provide

A

1 g of protein 4kcal

67
Q

How much energy does 1 g of fat provide

A

9g

68
Q

What is respiratory quotient

A

The amount of co2 produced / the amount of oxygen consumed

69
Q

What is refeeding syndrome blood changes

A

Hypo kalaemia
Hypo phosphatemia
Hypo magnasaemia

70
Q

Drowning subtypes

A

1 no water inhalation
2 water inhalation but adequate ventilation
3 evidence of inhalation and inadequate ventilation
4 absent ventilation

71
Q

Response to water inhalation

A 
Laryngospasm
Aspiration of water 
Poor gas exchange
Washout of surfactant 
Diver reflex- hypotension Brady
Catecholamine surge 
Rise in icp
72
Q

Re warming following drowning

A

2-3 degrees per hour

73
Q

What is inhalational injury

A

Upper airway thermal injury
Chemical irritation to respiratory tract
Hypoxia

74
Q

Presentation on bloods of carbon monoxide poisoning

A

Normal po2
Hbco >5
Sats normal

75
Q

Presentation of cyanide inhalation on bloods

A

Lactic acidosis

High scvo2

76
Q

Outline cam iCU test

A

Altered mental status
Inattention: saveaheart
Rass
disorganised thinking: stone float on water are there fish in the sea , raise 2 fingers on one hand

77
Q

What is a raised compartment pressure

A

30

Diastolic - compartment pressure < 30 also bad

78
Q

How do you measure compartment pressures

A

Set up needle
Attach needle to diaphragm chamber and syringe with 3ml saline
Hold at angle use to insert needle and zero
Insert 1-3 cm
Inject 0.3 ml
Measure pressure

79
Q

Define malignant hyperthermia

A 
Rare autosomal dominant 
Decent in ryanodine receptor 
Chromosome 19
Abnormal RYR1 channel allows excessive calcium release following exposure to a trigger 
Sustained skeletal muscle contraction
80
Q

Management of MH

A 
Stop all triggers
Dantrolene 1mg/kg every 10mins 
Hyperventilate with 100% o2
Cool 
Monitor CK, urine , myoglobin levels
81
Q

Define neuroleptic malignant syndrome

A

Reaction to antipsychotic agents (haloperidol and procholperazine)
Dopamine antagonism
1 week of instigation

Altered mental status, autonomic changes and extrapyramidal signs

82
Q

Define seretonin syndrome

A

Interaction between 2 serotonin enhancing drugs
L- dopa, lsd, mdma, ssri, maoi

Altered mental state, autonomic dysfunction and neuromuscular excitability

83
Q

Treatment for seretonin syndrome

A 
Stop offending drugs
Cool
Benzodiazepines or propranolol
Dantrolene
Cyproheptadine
84
Q

Causes of eye problems on itu

A

Disease- facial oedema, decrease GCS, neurological injury

Treatment- proning, cpap, sedation, paralysis

85
Q

The main eye disease on itu

A

Direct cornea injury
Exposure keratopathy
Chemists (conjunctival swelling)
Microbial conjunctivitis and keratitis

86
Q

Outline the degrees of lid lag

A

Grade 0 - completely closed

Grade 1 conjunctival exposure but not cornea

Grade 2 any cornea exposure

87
Q

Treatments required for the different grades of lid lag

A

Grade 1 lubrication

Grade 2 tape and lubricate

88
Q

Explain the use of flurosceine dye in eye disease

A

Drops in the eye
Use a blue light
Epithelial defects glow yellow

89
Q

What is exposure keratopathy

A

Dryness of the cornea due to incomplete lid closure allowing excessive tear evaporation and produces a red eye

90
Q

Risk factors for chemosis of the eye

A 
Compromised venous return 
Positive pressure ventilation
Tight et tape 
Peripheral oedema
Prone
Sirs
91
Q

Common bacteria causing microbial eye Infections

A

Psa
Acinetobacter
Staph epidermis

92
Q

What are the 4 H and 4 Ts

A

Thrombosis
Tamponade
tension pneumothorax
Toxins

Hypovolamia
Hypoxia
Hyper kalaemia
Hypothermia

93
Q

What is dress syndrome

A

Drug reaction with eosinophilia and systemic symptoms

Rash, lymphadenopathy low plts, high eosinophils in response to exposure to medications

94
Q

Which drugs cause dress

A

2-6 weeks following exposure to

Anticonvulsant: carbamaizipne, phenytoin
Antibiotics: amox, taz, vanc 
Anti inflammatory: diclofenac ibuprofen 
Allopurinol
Omeprazole 
All TB drugs
95
Q

Pathophysiology of dress

A

Type 4 hypersensitivity reaction

Cytotoxic T feels initiators autoimmune reaction

96
Q

What does sample stand for in a secondary survey

A 
Signs and symptoms 
Allergies
Medications
Past medical history 
Last oral intake 
Events leading up to injury
97
Q

Class of haemorrhage

A

Class 1: 15%
Class 2 : 15-30%
Increase in hr / decrease pulse pressure

Class 3: 31-40%
Increase HR / low BP/ low uop/ low GCS

Class 4: >40%

98
Q

What size is a c d e cylinder

A

C 170
D 340
E 680

99
Q

Parkland and modified parkland

A

Parkland is 4mls/ kg/ TBSA

Modified 1.5 per 8 hour 1.5 per 16 hour

Icm (16 decks)

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