20 cards Flashcards
What is the severity score that predicts mortality in TEN
SCORTEN
Age >40 yo, presence of ca, HR >120, inital percentage of epidermal detachement >10%, serum urea >10, serum glucose >14, serum bicarb <20
Insulin regime in DKA
Fixed rate and step short acting, continuous long acting
Steps to DKA mng within 1st hour
- IV cannula, bloods incl VBG, BGL , finger prick ketones, blood cultures
- IVF - 1L normal saline over 1 hour, repeat if hypotensive
- IV insulin - start if k>3.5 mmol/L at 0.1u/kg/hr
- if K <3.5, then correct - prescribe and administer patients usual long acting insulin
check betahcg and trop if indicated, septic screen and treat, fluid balance chart and neuro obs, remove continuous insulin pump, consider cardiac monitoring, DVT ppx.
If euglycemic or BGL <14 - START AT 10% AT 100ML/HOUR - CONTACT SENIOR
Typical lab findings of rhabdomyolysis
hypocalcemia
hyperkalemia
Increased AST
Increased LDH
Causes of rhabdomyolysis
crush injury
prolonged immobilisation
overexertion of muscles
drugs
seizures
Mechanism of AKI in rhabdomyolysis
Shift of fluid into damaged msucles
release of toxic heme pigments from myoglobin
Common complication in elderly pt with SBO
aspiration pneumonia
First step in managing suspected aspiration pneumonia
Start emperic ABx
Which induction agent is preferred in septic shock
Ketamine
Why is ketamine the preferred induction agent in septic shock
SNS stimulation which maintains bp and co
also has bronchodilator properties whihc is useful fot respiratory distress
Why would you not use propofol as an induction agent is septic shock
can result in hypotension and myocardial depressikon
Basic steps in rapid sequence induction
- pre oxygenation
- ketamine administration then neuromuscular blocking agent like succinylcholine/ suxamethonium
- laryngoscopy
What is the earliest effective intervention for VF?
Early defib
Management of VF in a monitored setting
3 stacked shocks then chest compressions
Management of hyperacute transplant rejection?
Removal of graft
What type of biopsy is required for diagnosis of Hodgkin’s lymphoma?
excision biopsy
Which anti-hypertensive is contraindicated in patients with renovascular disease?
ACEi
First line antibiotic for infective COPD excacerbation
Amoxycillin clarithromycin or doxycyclin
What is used in the management of Von Willebrand disease
desmopressin
Diagnostic criteria of AKI in adults?
Increase in creatinine >26 mmol/L in 48 hrs or increase in creatinine >50% in 7 days or decrease urine output <0.5mL/kg/hr for 6 hrs
Investigation of choice in a clinically unstable patient with suspected aortic dissection
transesophageal echo
