13/6 Flashcards
What eye has the RAPD defect?
The one that dilates
How is normal pressure hydrocephalus managed?
Surgical insertion of a shunt - ventriculoperitoneal
What is super important in managing any pt with signs of raised ICP
Elevate head of bed to 30/40 degrees
What medication OD is associated with down-sloping ST segment?
Digoxin
How do you work out the right size of oropharngeal, nasopharngeal and iGel
iGel = based on weight
Oro = angle of mouth to angle of mandible
Naso = edge of nose to tragus
Talk over how to insert a naso and oro
naso
- size
- lube
- longer bit of the bevel on the other side to the septum
- push along the flat
- O2 on top
oro
- size
- lube
- upside down first of all (curving up towards you)
- then twist - curving down the neck
- O2 on top
Indiations for ABx in otitits media
Antibiotics 4 SIck BoPs
4 days of sx
Systemically unwell
Immunocompromised
Bilateral <2yo
Perforation and/or discharge in canal
Who is most likely to get malignant otitis media?
What antibiotics should be used to cover the pseudomonas aeruginosa infection?
Diabetics
Ciprofloxacin
DDx for sensironeual vs obstructive
SN
- presbycusis
- noise-induced
- gentamicin
- post-meningitis
- vestibular schwannoma
- labrynithitis
Conductive
- otitis externa
- cholesteatoma
- otosclerosis
- blocked wax
- acute/chronic otitis media
Management of chronic sinusitis?
Avoid allergen
Intranasal corticosteroids
Nasal irrigiation with saline solution
Most common cause of bacterial otitis media
Haem influenza
Strep pneumonia
Atypical lymphocytes?
EBV
Glue ear in an adult
Concerning
Glue ear occurs due to a blocking of the Eustchian tubes - is it a ca?
Refer urgently to ENT
What causes acute epiglottitis?
Haem influenza
U find a pt unconcious with no pulse or resp
What do you do?
How does this differ if shockable vs unshockable rhythm?
- 2222 - cardiac arrest call
- Jump on the chest and start compressions
- Get colleague to fit i-gel and do ventilations
- fit defib and assess rhythm
- Get/establish IV access (if not prepare for IO)
Shockable
- 3 shocks then amiodarone 300mg and 1mg adrenaline (repeat adrenaline every 3-5mins)
- 5 shocks and still no response - 150mg amiodarone (lidocaine can be used instead if needed)
Unshockable
1mg adernaline ASAP and repeat every 3-5mins
Continue chest compressions whilst defib charging
What does Vfib and pulseless Vtach look like?
Vfib - chaotic rhythm and rate
Vtach - regular broach complex tachy
How does your CPR approach change if the cardiac arrest was witnessed?
If witnessed - up to 3 successive shocks as opposed to 1 followed by CPR
How would you assess and manage the 4Hs and 4Ts
Hypothermia
- steady rewarming and maintain pyshiological suppport
Hypovolaemia
- ABG
- FAST scan - USS to check for internal bleeding
- Bloods and fluids and potentially catastrophic haemorraghe control
Hyper/hypo electrolyte
U+Es
ABG
If hyperkalaemia = calcium gluconate + insulin/dextrose infusion
Hypokalaemia = give K+ and check Mg+
Hypoxia
- check O2 sats
- continue to deliver O2
Tension pneumothorax
- clinically assess and CXR
- needle decompression into 2nd intercostal mid-clavicular
Tamponade
- Bedside echo
- pericardiocentesis
Toxins
- U+Es
- core temp
- Toxbase and find correct reversal agents
Thrombis
- PE - if known PE = thrombolytic drugs
- if STEMI after ROSC = STEMI management
How do diabetic drugs change for surgery?
Insulin - omit morning dose but take night time as normal
Metformin - can be taken up to BD
SUs - omit dose before the surgery on the day
SLGT2-i - omit on day of surgery
Go over song for pregnancy checks
1st visit is from 8
- check everything with mum is great,
urine, bloods and resus state
Give advice and educate
From 11-13
Is the best time to the DOWNs screen
While you’re at it check the dates
At 16 or 10+6
Do BP and urine dipstick
Second scan is at 20
To check the fingers and toes
Make sure there’s plently (also check placenta location at this point)
Once again at 28
Urine, blood and resus state
Anti-D if appropraite
Must give anti-D once more
when the week is 34
And PLAN FOR BIRTH, what a chore
Check the lie at 36
If breech offer a quick fix
Last visit at 38
All that’s left to do is wait
Explain rhesus status
What pregnancies is it dangerous to
What are sensitising events
What can it cause in babies if not appropraitely managed?
When is IM anti-D given and why does it help
Rhesus disease
- only an issue if mum is -ve as if baby is +ve they can produce Ig against their cells
- this then means in future pregnancies the Ig can travel across the placenta and attack babies Hb
haemolytic anaemia -> raised bilirubin -> brain damage
Haemolytic anaemia + jaundice = haemolytic disease of the newborn
Senisitising events = times when mum and babies blood can mix e.g. miscarriage >12wks
birth
Abdo trauma
Check for rhesus status at 8wks
Give IM Anti-D at 28 (+ sometimes 34 too wks)
Anti-D destroys the babies blood cells in mothers circulation and stops Ig from forming
How is acute pancreatitis managed?
Conservative
ABCDE
Aggresive IV fluids
Catherised - to monitor fluid balance
Medical
Opioids
Anti-emetics - ondanestron
No need for antibiotics
Important to monitor fluid intake and losses so keeping pt in hospital is needed to be able to provide them with the best care and monitor for complications:
- infection (abscess formation) -> sepsis
- pancreatic necrosis
- haemorraghe
- hypovoleamia (often due to vomitting)
If it progresses to severe pts can die from this so best to have you in and monitor to enhance survival rates
Meds at risk of Serotonin syndrome
SSTTM
SSRI
St Johns Wort
Triptans
Tramadol
MAOI
Management of kawaski’s disease
High dose aspirin
Iv Ig
Echo - check for conorary artery anersyms
When can anti-epileptic drugs be stopped?
After 2 years seizure free over 2-3 months
Done by a specialist
reduced GCS, pinpoint pupils and paralysis =
Pontine haemorraghe
When should men get urethral swabs?
What should be advised to pts who test positive?
Only when symptomatic
Abstain from sex for at least a week post injection or until treatment is finished
What is the management for personality disorders?
DBT - dialect behaviour therapy
