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Flashcards in Tips Deck (28)
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1

SAMPLE

Signs and symptoms
Allergies
Meds- esp beta blockers, anticoag etc
PMH
Last oral intake, or LMP in women
Events leading to illness or injury

2

Important histiry Qs in general

Travel hx
Contact with illness
Preganacy and periods

3

On examination

Always check calves for DVT

4

Polyfusor phosphates

Fluids cont Na, K, and phosphate
For hypoP eg DNV

5

aortic dissection

Px- CP tearing to back, low BP
Ix- CT angio

6

Ottawa rules ankle XR if

Any pain in malleolar zone AND

Bone tenderness at post edge or tip of lat malleolus OR
Medial malleolus OR
Inability to weight bear both immediately and in ED for 4 steps

7

Ottawa rules foot XR if

Pain in midfoot zone AND

Bone tenderness at base 5th MT OR
Navicular OR
Cant weight bear as for ankle

8

Massive PE defin

SBP under 90, or reduced by 40 for over 15 min.
Persis bradyc under 40
Pulselessness
Requiring ionotropic support not due to another cause eg sepsis etc.

9

PE mx

Wells over 4- immed CTPA and LMWH hep
Wells under 4- do D dimer then the above if pos

LMWH for at least 5d til INR over 2
Then start warfarin or NOAC within 24hr and contin for at east 3/12
Also A to E, O2 and fluids if req

10

massive PE notes

Hypot or imminent cardiac arrest
Signs of RH strain on CT or echo
Consider Tlysis with IV alteplase

11

Indics for irradiated blood

Bone marrow transplant recip
Autograft recipient
Hodgkins
Due for bone marrow harvest next 7d
Certain Imm supp drugs
Due to receive certain other blood products
Red cell exch in infants
Suspected or known immune defic
Intra uterine transfus

12

indic for CMV neg blood

Haem dis likely to get SC transplants
Intrauterine transfusions
Neonates up to 28d
Planned during preg
Certain chemo pts

13

transfusion obs
Before, at 20min, 1hr, and completion of each unit

Temp
BP
HR
RR

14

Transfusion reaction signs

Fever, chills, rigors, flushing
Tachyc
Changed BP
Collapse
Urticaria
Bone, muscle, chest pain
SOB
NV
General malaise
Resp distress

15

Transfusion reac immed mx

STOP the transfus and call help
Maint IV access, slow fluids
Monit temp, HR, RR, sats, BP
Check pt and product details

16

transfusion reacs and mx

MILD FEVER means Febrile reaction- paracetamol. Restart slower with more obs.
URTICARIA means Mild allergic reac- chlorphenamine. Slow and more obs.
ABO incompat- saline, inform transfus dept, catheter and UO, furosemide if low UO, return bag and giving set, tx DIC
Severe allergic (bronchospasm, angioedema, abdo pain, hypot)- return bag and set, chloerphen, O2, neb salb, adren IM and rep, IV adren if v bad
Haemolytic reac or bact contam- return bag and set, take cultures clotting etc, urinalysis, monit UO, broad abx, O2, fluids
Acute LVF (dysp, hypot) means Fluid overload- O2, furosemide. Measure gas and CVP.
TRALI not LVF- CXR, high O2, tx ARDS, ventil if req

17

VT
Is regular

QRS concordance in chest leads
Marked LAD
AV dissoc
Fusion or capture beats
RSR and pos QRS in V1
Mx- amiodarone 300mg, synch DC shock fails

18

PT mx

Primary-
SOB OR over 2cm rim then aspirate
If unsucc then retry once, then chest drain
Secondary-
SOB AND over 50yo AND over 2cm then drain immed
If not then asp first and admit for 24hr
If due to trauma or mech ventil- chest drain immed

19

GI bleed mx

A to E
NBM
IV fluids
Blood for grade 3 or 4 shock
Catheter and monitor UO
Urgent endosc
Sclerohterapy maybe
Terlipressin maybe
Omeprazole if ulcer

20

Meningitis mx

Bloods, swabs, LP us after CT if no RICP, CXR
Fluids
Cefotaxime
Maybe dex
ICU if shock

21

Status epil mx
Over 30 min or repeated without recov btw

O2, suction, intub if req
Recovery posit
Take bloods, ecg
Slow IV bolus lorazepam 4mg to large V. Repeat in 10 min.
Maybe thiamine, glucose
Fluids if low BP
Phenytoin infusion if contins
GA if refractory

22

Head inj ix

Obs incl pupils
Eye movem and visual fields
Fundoscopy
Anterograde amnesia
RICP signs

23

indics for CT head

GCS under 13 at all, or under 15 after 2hr
Focal neurol
Skull frac suspected
Siezure
Vomit more than once
LOC AND- over 65, or coagulop, or dangerous mech, or manesia over 30 min

24

Head inj ventilate if

GCS under 8
PO2 under 9 in air
Spont hyperventil
Resp irreg

25

admit head injury if

Diffuclt to assess eg intox, child, post ictal
Severe headache, vom, frac
More than brief LOC

26

Head injury mx

A to E
Ocygen if req, C spine, airway
Tx seizure
Assess GCS and amnesia
Ix- UE, gluc, FBC, tox, ABG, clotting
Neuro exam
Brief hx- mech, tox, lucid, fits, LOC, vom, memory
Check for signs of frac skull or neck
CT if indic

27

RICP mx

Elevate head
Fluid restrict
Hyperventilate
Mannitol
Tx cause

28

Ionotropes and vasopressors

Ionot incr contractility eg dobutamine, adren, noraderen
Vasopressors vasoconstrict eg phenylephrine, vasopressin, dopamine, adren, noradren