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Acute care > 4th year Acute care 1 > Flashcards

4th year Acute care 1 Flashcards

1
Q

What are the 3 methods of treatment for overdose?

A

Prevent absorption
Enhance elimination
Anti-dotes

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2
Q

What are the 3 commonest drugs in overdose?

A

Paracetamol
Anti-depressants
Opiates

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3
Q

Where is paracetamol absorbed?

A

In the small bowel

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4
Q

What treatment can be given for paracetamol overdose if within the first hour?

A

Activated charcoal

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5
Q

When should you measure the first paracetamol level in suspected overdose?

A

At 4 hours

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6
Q

What is the anti-dote for paracetamol overdose?

A

Acetylcysteine - replenished glutathione which detoxifies paracetamol

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7
Q

When should you measure LFT’s in paracetamol overdose?

A

At 24 hours - all paracetamol should be gone from the system

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8
Q

What ss the toxidrome for opiate overdose?

A

Pin point pupils
Respiratory depression
Decreased consciousness

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9
Q

When should you treat an opiate overdose?

A

If RR <10, 02 <95%, or if drowsy/snoring

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10
Q

What is the treatment for opiate overdose?

A

Naloxone

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11
Q

What dose should you give as a bolus of naloxone?

A

400mcg

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12
Q

What does of Naloxone should be given to post op patients with opiate overdose?

A

40mcg

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13
Q

Name 3 symptoms/signs of tricyclic overdose?

A 
Big pupils
Tachycardia
Hypotension
Dyskinesia
Dysarthria
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14
Q

What complications can arise as a result of tricyclic overdose?

A

Arrhythmia and seizures

Long QRS,

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15
Q

What is the treatment for tricyclic overdose?

A

Sodium bicarbonate

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16
Q

What drugs should be given to treat seizures in tricyclic overdose?

A

Lorazepam - 4mg

If unsuccessful after 2 doses - give phenytoin IV

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17
Q

What is the treatment for benzodiazepine overdose?

A

Flumazenil

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18
Q

What is a risk of treating benzodiazepine overdose?

A

May lower seizure threshold and mean that seizures cannot be treated

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19
Q

Flumazenil should not be given in benzodiazepine overdose if the patient has also taken which other type of drug?

A

Tricyclic - seizure risk

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20
Q

What antibiotic should be given for a dog bite?

A

Co-amoxiclav

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21
Q

What are the 5 types of shock?

A 
Hypovolaemic
Cardiogenic
Neurogenic
Septic 
Anaphylactic
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22
Q

What is the definition of shock?

A

Abnormality of the circulatory system resulting in inadequate organ perfusion

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23
Q

Name 3 causes of hypovolaemic shock?

A

Loss of blood
Severe burn
GI obstruction, malabsorption

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24
Q

Why does hypo perfusion worsen bleeding?

A

Hypoperfusion causes acidosis which causes clotting factors not to work

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25
Q

What ratio of red cells to FFP should be given in hypovolaemic shock due to blood loss?

A

1:1

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26
Q

Name 3 causes of a cardiogenic shock?

A

Pump failure - MI
Sever arrhythmia
Flow obstruction e.g. PE

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27
Q

What treatment should you not give in cardiogenic shock?

A

Fluids - risk of pulmonary oedema

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28
Q

What to inotropes do?

A

Tightens vessels to increase BP

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29
Q

Name 1 cause of neurogenic shock?

A

High spinal cord transection

30
Q

Name the two types of vasogenic shock?

A

Anaphylaxis and septic

31
Q

Name 1 inotropic drug?

A

Dobutamine

32
Q

What type of shock is likely if the patient is cold and clammy?

A

Cardiogenic or hypovolaemic

33
Q

Wha type of shock is likely if the patient is warm with a bounding pulse?

A

Septic

34
Q

What might cause a difference in BP between the left and right sides?

A

Aortic dissection

35
Q

What are the 6 steps in securing an airway?

A 
Head tilt chin lift
Jaw thrust
Oropharyngeal airway
Nasopharyngeal airway
Laryngeal mask airway
ET tube
36
Q

How should you measure an oropharyngeal airway?

A

Measure from incisors to angle of mandible

37
Q

What should you do with a reservoir mask before giving to patient?

A

Occlude valve to fill bag with O2

38
Q

What should you give as resus fluid?

A

500ml 0/9% saline

39
Q

What should you give for hypoglycaemia?

A

100ml of 10% glucose
5% not fast enough
50% too thick

40
Q

Which 2 cardio drugs should be withheld before surgery?

A

ACE inhibitors and anticoagulants

41
Q

What should INR be before surgery in patients who have had warfarin discontinued?

A

<1.5

42
Q

How long should clopidogrel be stopped for before surgery?

A

7 days

43
Q

Describe the Glasgow coma scale?

A 
Eye opening
4 - spontaneous opening
3 - to speech
2 - to pain
1 - no response
Best verbal response 
5 - orientated to time and place
4 - confused
3 - inappropriate words
2 - incomprehensible sounds
1 - no response
Best motor response 
6 - obeys commands
5 - localises to pain
4 - flexes to pain
3 - abnormal flexion to pain
2 - extension
1 - no response
44
Q

What is an adults daily sodium and potassium requirement?

A

1-2mmol/kg/day

45
Q

How should morphine be given in acute pain?

A

Diluted in 0/9% saline and give in 1-2mg increments until comfortable

46
Q

What is the standard PCA dose?

A

1mg morphine - 5 minute lock out

47
Q

Conversion rate for oral morphine to IV?

A

Divide by 2

48
Q

Conversion rate for oral morphine to oxycodone?

A

Divide by 2

49
Q

In elderly patients what should you prescribe with an opiate?

A

A laxative

50
Q

What is the main general anaesthetic agent?

A

Propofol

51
Q

What gas is used for general anaesthetic?

A

Isoflurane

52
Q

Beta blocker and SABA Beta 1 or 2?

A

Beta blocker - B1

Salbutamol B2

53
Q

What drug is commonly used for neuromuscular blockade in general anaesthetic?

A

Suxamethonium

54
Q

Step wise treatment of anaphylaxis?

A

100% O2
Adrenaline IM 0.5mg - repeat every 5 mins if needed
Chlorphenamine IV
Hydrocortisone IV

55
Q

Features of severe acute asthma?

A

Unable to complete sentences, RR>25, Pulse >110, PEFR <50% predicted

56
Q

Features of life threatening asthma?

A

PEFR <35% predicted, silent chest, cyanosis, bradycardia, hypotension, PaO2 <8, SaO2 <92%, pH<7.35

57
Q

Stepwise treatment of acute COPD exacerbation?

A

24-28% O2
Salbutamol and ipratopium neb
IV hydrocortisone
Abx if evidence of infection

58
Q

Initial treatment of DKA?

A

IV insulin 4-8 units

59
Q

When should you give dextrose in DKA?

A

When blood glucose is <10mmol/l

60
Q

When is urgent treatment required in hyperkalaemia?

A

When K>7

61
Q

Management of hyperkalaemia?

A

10mg Calcium gluconate IV

Insulin 10u

62
Q

What does a high PaCO2 indicate?

A

Respiratory acidosis

63
Q

What does a low PaCO2 indicate?

A

Respiratory alkalosis

64
Q

What does a low bicarbonate indicate?

A

Metabolic acidosis

65
Q

What does a high bicarbonate indicate?

A

Metabolic alkalosis

66
Q

What does a -ve BE indicate?

A

Metabolic acidosis

67
Q

What does a +ve BE indicate?

A

Metabolic alkalosis

68
Q

How does the body compensate for a metabolic alkalosis?

A

Raising CO2 - hypoventilating

69
Q

How does the body compensate for a metabolic acidosis?

A

Lowering CO2 - hyperventilating

70
Q

How does the body compensate for a respiratory acidosis?

A

Retaining bicarb

71
Q

How does the body compensate for a respiratory alkalosis?

A

Lower bicarb

Acute care (1 decks)

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