3/6 Flashcards
How long should you have stopped PPIs for before OGD?
2 weeks
What is the invx and management of mesenteric ischaemia?
Bedside
- abdo exam - will be acutely painful even on percussion
- ECG - likely show AF
Bloods
- baseline + clotting + group and save + lactate
Imaging
- CTA
Management
- ABCDE with IV fluids
Medical
- IV heparin
Surgical
- embelectomy
- angioplasty
- bypass
(v similar to acute limb ischaemia - in fact basically exactly the same just more of an indication for lactate and doing an abdo rather than peripheral exam)
Triad of pre-eclampsia
Why concerned?
Invx and management inc, preventitive
- New onset HTN
- Oedema
- Proteinuria
Maternal
- eclampsia
- Heart failure
- Liver problems
- HELLP
Fetus
- IUGR
- pre-mature birth
Invx
Bedside
- HTN
- pregnant abdo exam
- dipstick = proteinuria
Bloods
- FBC, U+Es, LFTs - check for HELLP
Management
- if high risk give aspirin 75mg daily from 12 weeks
Medical
1. labetolol
2. nifedpine - if asthmatic
Defintive mangement = delivery
Target sats for COPD?
88-92%
Serotonin syndrome vs neurolpetic malignant syndrome
Similar
- Hyperthermia
- Tachycardic
- Sweaty
- reduced GCS
(think of someone on drugs on a night out)
Serotonin (anti-depressed = big pupils and dancing really happy = hyper relfex)
- dilated pupils
- Hyperreflexia
Malignant neuropletic (caused by anti-psychotics and sudden cessation of drugs like levodopa) (so un psychotic become heavy and boring)
- hyporeflexia
- ‘lead-pipe rigidity’
What dose of aspirin for 2 weeks post stroke?
300mg
Where is the most appropriate place to check for a pulse in an infant?
Brachial and femoral
How is broad tachycardia managed in pt that is stable?
What is the ddx of stable broad irregular tachycardia?
Regular?
Regular
- Amiodarone 300mg IV
- if ineffective DC shock up to 3 times with sedation if concious
Irregular
- Expert help
DDx
- AF with bundle branch block
- AF with ventricular pre-exciation
- Torsade de pointes
Management of AF - both acute and chronic
Chronic
1. Rate (most common way)
1. Bisoporol
2. if ^^ contradicted - CCB - verapamil/diltiazem
3. digoxin
- Rhythm (more hospital based - use if reversible cause, new onset or HF)
- Amiodarone (more for older pts)
- Flecainide (young with no structural heart probs)
OR
DCCV (must have 3wks of AC prior or <48hrs onset)
======================
ACUTE
Adverse signs -> 1.DDCV -> if not successful -> amiodarone
If stable
<48hrs
1. rate/rhythm control ->
2. Heparin
3. DCCV
> 48hrs/onset unclear
Rate ONLY + AC for 3 weeks prior to DCCV
What is the ORBIT score?
Risk of major bleeding events of pts with AC for AF/stroke
Management of anxiety
CBT
SSRIs
Short term benzos sometimes have a role
DDx for psychosis
- Schizoprenia
- Delirium
- Depressive
- Drug-induced
- Mania with psychosis
Non-psych
- Thyroidtoxicosis
- Autoimmune encephalitis
How would you approach a suicide risk assessment?
How can you manage a pt?
Before
- what had been happening before? what triggered it?
- how long had you thought about it before?
- had you hoped to be found?
- note?
During
- Method
- What drug? How much? How did you get them?
- Take with alcohol or other drugs
- Alone?
- Where?
- Did you want to die at that time?
After
- what do you remember happened after you were brought in?
- How did you feel when you were found?
- How do you feel about it now? Any regrets?
- Current mood?
- Are you still feeling suicidal?
- Would you do it again in similar circumstances or if you were to leave the hospital today?
- Anything we can put in place to prevent you feeling this way?
Depression/psych screen
Like a falls Hx
===============
If they feel safe enough - crisis team can visit them every other day at home
If not can admit - but can only stay for 2 weeks
What is asked in a depression screen?
MEE
Mood
Excitement
Energy/sleep
Appetite
Guilt
Impact on life and ADLs
How would you approach an alcohol dependancy osce?
Alcohol Hx
- what do you drink and how much?
- what does a day of drinking look like to you?
- socially/alone?
- When 1st drank
CAGE questions
- ever tried to cut down?
Annoyed by people critising you?
Guilty about drinking?
Eye opener - need 1st thing in AM
Hx of dependance
- Complused to drink?
- “What happens if you don’t drink?
- “Need to drink more to get drunk?”
- Hospital admissions previously
Mood and suicide risk
Risk assess
- harm to your self/ harm to others?
- problems with the police
PMH
FH
SHx - remember gambling
DH
ICE
Manage
Referral to Dundee alcohol and drug dependancy team
- detox help
- parbinex - daily injection to prevent WE
- refer to services like AA
- social support - housing and benefits
Medically
- reducing dose of benzo (chlordiazepoxide) to reduce withdrawal sx
