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Internal Med 2023 > summary 1 > Flashcards

summary 1 Flashcards

1
Q

acute coronary syndrome

A
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2
Q

ECG changes for a STEMI

A
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3
Q

assessment and appraoch

A

call code STEMI and call seniro for help
A-E assessment
FBC, UEC, troponin, coags, G+S
ROMANCE
R eassure
O2 to maintain sats >94%
M orphine 1-2.5mg IV every 5 minutes to effect
A spirin 300mg
GTN spray (caution if SBP < 100)
Clopidogrel or ticagrelor 180mg (consult local guidelines)
E noxaparin IV (dont give unless specified by cardiology)
definiitive management

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4
Q

definitive management of ACS

A

mainstay: Percutaneous coronary intervention (PCI): <90 minutes, need to conider renal function and bleeding risk
thrombolysis (alpeplase or tenecteplase) - if cant get PCI <90 minutes (typically rural): conssider contraindications to thrombolysis
ALWAYS discuss disposition: ECG caardiac monitoring on CCU for 48 hours

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5
Q

contraindications to thrombolysis

A

cranial: haemorrhhagic bleed, recent ischameic stroke or head trauma (<3 months), known cerebral vasculaar lession or mass
active bleeding
suspected aortic dissection

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6
Q

major complications of ACS

A

A rrythmia: braady, AF, VT, VF
B lood pressure falls: cardiogenic shock
C ardiac failure: APO
D isruption of cardiac muscle: papillary muscle rupture (MR), septal rupture (VSD)
E mbolism: mural thrombus

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7
Q

paroxysmal AF

A

episodes of AF that last for less than 7 days spontaneously (usually within 48 hours)

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8
Q

parsistant AF

A

episodes last for more than 7 days

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9
Q

longstanding persistant AF

A

AF lasting for more than 12 months

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10
Q

permanent AF

A

refractory to cardioversion and sinus rhythm cannot be restored or mainatined

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11
Q

causes of AF

A

cardiac: IHD, VHD, HF, HTN
non-cardiac: electrolyte disturbances, thyrotoxicosis, post operative, lung disease (PE/COPD), infections (pneumonia), OSA, alcohol, CKD, diabetes

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12
Q

approach to patient with AF

A
  1. heamodynamic stability: A-E approach
  2. treat the underlying cause of the AF
  3. anticoagulation: based on CHA2DS2-VASc vs HASBLED
  4. rate or rhytm control
  5. address patients other CV risk factors
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13
Q

hheamodynamic stability of the AF patient

A

A-E
cardiac monitoring
IVC access
definition of instability: shock SBP<90, syncope, ischaemia, heart failure
<48 hours: rhythm control with synchronised DC cardioversion
>48 hours: if anticoagulant for > 3 weeks, urgent synchronised DC cardioversion, if not anticoagulated then TOE guided cardioversion to rule out mural thrmobus then synchronised DC caardioversion

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14
Q

how to treat/investigate the underlying cause of the AF

A

electrolytes: UEC, CMP
ischaemia: troponin
endocrine: TFTss
structural: echo

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15
Q

anticoagulation for AF

A

based on CHA2DS2-VASc vs HAS-BLED
you always want to coagulate over bleeding
choce of anticoaagulation: DOAC (apixaban, rivaroxaban, dabigatran)

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16
Q

CHA2DS2-VASc

A
17
Q

HAS-BLED score

A
18
Q

rate or rhytm control of AF

A

rate control- beta blockers or central CCBs, digoxin
rhythm control: symptomatic young patient

19
Q

classfication of chronic heart failure

A
20
Q

medical management of heart failure

A
21
Q

aetiology of acute decompensated heart failure

A

compliance: fluid/salt compliance, medication compliance
cardiac/resp: new ACSS, arrhythmia (brady or tacky), PE, acute valvular dysfunction
increased demand: anaemia, infection, hyperthyroidism

22
Q

investigation forr acute decompensated heart failure

A

ECG: precipitants (aarrythmia, ACS), signs of LVH
bloods: VBG/ABG, FBC, troponin, BNP
CXR: alveolar oedema, kerrley B lines, cardiomegaly, diversion of upper lobes, effusion

23
Q

mnagement of acute decompensated heart failure

A

call for help
A-E
attac monitoring
senior input
LMNOP (in reverse)
P osition (sit upright)
O2: high flow sats <94%
N itrate (GTN IV if SBP>90)
M orphine: if chest pain or agitation
L asix (IV frusemide)

24
Q

investigationns for COPD

A
25
Q

parmacological COPPD management

A
26
Q

exacerbation of COPD management

A

A-E
O2
SABA - salbutamol

27
Q

wells criteria

A
28
Q

causes of raised d-dimer

A

cancer, CRF, sepsis/infection
post op, trauma
pregnancy

29
Q

pulmonary embolism management

A

A-E
anticogulation:
non-massive: SC heparin and NOAC for 3-6 months
submassive: IV UFH (trombolyss no indicated)
masssive: thrombolyssis + IV UFH. consider embolectomy if thrombolysis contraindicated/no sufficient thrmbolysis

30
Q

transudative pleural effusion

A
31
Q

exudative pleural effusion

A
32
Q

lights criteria for pleural effusions

A
33
Q

plearual effusion management

A

manage underlying cause
drainage: if asymptomatic then usually recovers by itsself and doesnt need drainage
indications for drainage include: ssymptoms and size, based on clnical judgement
toracentei (needle guided drainage) or chest tube drainage

34
Q
A

Internal Med 2023 (51 decks)

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