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SFP Clinical Interviews > A-E Approaches > Flashcards

A-E Approaches Flashcards

1
Q

What is the clinical prioritisation spiel?

A

I would prioritise these patients based on clinical urgency. I acknowledge that there are multiple unwell patients, so I will therefore first see if I have colleagues to help.

However, if this is not possible I will assess Patient 2
FIRST as this is a ‘B’ Breathing issue.

Then, I will assess Patient 1 SECOND as this is a ‘C’
Circulation issue”

“I will bleep my nurse colleague regarding Patient 2, kindly ask for a new set of observations, location, and request that they meet me by the patient’s bedside whilst I am walking towards the ward.”

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2
Q

What is the treatment of ACS?

A
  1. Aspirin 300mg PO
  2. Antiplatelet Clopidogrel 300mg PO
  3. if BP >90, use GTN spray 2 puffs for pain
  4. IV Fluids if required, with Metoclopramide 10mg IV and Morphine 2.5mg-10mg IV
  5. If STE-ACS -> angiography and PCI within 90-120min
  6. If NSTE-ACS -> risk stratify with GRACE score
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3
Q

What is the management for acute coronary syndrome?

A
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4
Q

What is the treatment of Pulmonary Oedema?

A

LMNOP
Loop Dieuretic - Furosemide 40mg IV
Morphine
Nitrates IV if BP >110 or GTN spray if BP >90
O2 15L via NRBM
Patient sat up

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5
Q

What is the management for pulmonary oedema?

A
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6
Q

What is the triad of Cardiac Tamponade?

A

Hypotension
Muffled heart sounds
Elevated JVP

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7
Q

What is the treatment of cardiac tamponade?

A

echocardiography guided pericardiocentesis

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8
Q

What is the management for cardiac tamponade?

A
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9
Q

What is the treatment of Aortic Dissection?

A

Type A:
Cardiothoracic surgery
Type B:
- Morphine IV 2.5g-10g
- Consider anti-hypertensives
- Labetalol 50mg over 1 minute
- GTN spray 0.6 - 8mg/hour

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10
Q

What is the management for aortic dissection?

A
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11
Q

What is the index used to indicate poor prognosis in ruptured AAA?
+
What are the parameters?

A

**Hardman Index
**
+
Age >76
LoC
Hb <9g/dl
Cr 180
Signs of ischemia on ECG

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12
Q

What is the management for ruptured AAA

A
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13
Q

What are the 8 reversible causes of cardiac arrest?

A

Hypotension
Hypothermia
Hypoglycaemia
Hypoxia

Tamponade
Toxins
Tension pneumothorax
Thromboembolism

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14
Q

What is the management for Cardiac Arrest?

A
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15
Q

What is the treatment of bradycardia?

A

asymptomatic and >40 -> conservatively treat

symptomatic and <50 -> IV Atropine 0.5mgs (max 3mgs)
second line is isopnealine infusion
urgent trans venous pacing if refractory to treatment

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16
Q

What is the management of bradycardia?

A
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17
Q

What is the treatment of narrow complex tachycardia?
+
What must be given if contraindicated?

A

Haemodynamically stable
First line: Vagal manouvers eg Valsalva and Carotid massage

Second line: IV Adenosine 6mgs, if no response 12mgs, then 12mgs again

If asthmatic: IV Verapamil

Haemodynamically unstable
urgent sedation and synchronised DC cardioversion

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18
Q

What is the management of narrow complex tachycardia?

A
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19
Q

What is the treatment of regular VT?

A

IV amiodarone 300mgs over 1 hour

then 900mgs of 24 hours

synchronised cardioversion if no response to medical therapy

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20
Q

What is the treatment of torsades de pointes?

A

IV Magnesium Sulphate 2mgs over 15-30 mins

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21
Q

What is the management of broad complex tachycardia?

A
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22
Q

What is the order of treatment of acute asthma?

A
  1. High flow oxygen
  2. Nebuilsed salbutamol with repeat doses at 15–30 minute intervals
  3. **Nebulised ipratropium bromide ** (0.5 mg 4–6 hourly) -> together with salbutamol produces greater bronchodilation
  4. Prednisolone 40–50 mg daily for at least five days or until recovery -> reduces mortality, relapses, subsequent hospital admission and requirement for β2 agonist therapy
  5. Consider **IV magnesium sulphate **after consultation with senior
  6. IV aminophylline only after consultation with senior medical staff.
23
Q

What is the management of acute asthma?

A
24
Q

What is the management of acute exaccerbation of COPD?

A
25
Q

What is the management of pulmonary embolism?

A
26
Q

What is the management of anaphylaxis?

A
27
Q

What is the management of upper GI bleed?

A
28
Q

What is the management of delerium tremens?

A
29
Q

What is the management of diabetic ketoacidosis?

A
30
Q

What is the management of HHS?

A
31
Q

What is the management of hypoglycaemia?

A
32
Q

What is the management of thyroid storm?

A
33
Q

What are the steps in treating a Myxodemal Coma?

A
  1. ITU/HDU care
  2. IV T3/T4
  3. 50-100mg IV hydrocortisone
  4. Mechanical ventilation and oxygen - if hypoventilation
  5. IV fluid - to correct hypovolaemia
  6. Correct hypothermia
  7. Correct hypoglycaemia
  8. Treat any heart failure
34
Q

What is the management of myxoedemal coma?

A
35
Q

What is the management of acute cerebrovascular event?

A
36
Q

What is the management of meningitis?

A
37
Q

What is the management of status epilipticus?

A
38
Q

What is the management of spinal cord compression?

A
39
Q

What is the management of septic shock?

A
40
Q

What is the management of hyperkalaemia?

A
41
Q

What is the management of burns?

A
42
Q

What is the management of acute renal colic?

A
43
Q

What is the treatment of paracetamol overdose?

A

If ingestion less than 1 hour ago + dose >150mg/kg -> Activated charcoal
If staggered overdose or ingestion >15 hours ago-> N-acetylcysteine immediately
If ingestion <4 hours ago -> **Wait until 4 hours to take a level **and treat with **N-acetylcysteine **based on level
If ingestion 4-15 hours ago -> Take immediate level and treat based on level

44
Q

What condition is the downsloping ST segment seen in?

A

characteristic ‘Salvador Dali’s moustache’ or reverse tick sign
seen in Digoxin toxicity

45
Q

What is the management of epistaxis?

A
  1. Direct compression of the nasal alae, sitting up and leaning forward
  2. topical anaesthetic spray (lidocaine) + vasoconstrictor (phenylepipherine)
  3. nasal cautery
  4. nasal packing
46
Q

What is the referral criteria for ITU admission for asthma?

A

Alterted mental status
Acidaemia
ABG
Hypercapnia
Deteriorating Peak Flow Reading

47
Q

How to treat thyroid storm?

A

1. Symptom control:

First Line: IV propanolol

Second Line: IV digoxin if propanolol fails or is contraindicated (e.g. asthma, low BP)

2. Reduce thyroid activity:

First Line: Propylthiouracil - preferred because it inhibits peripheral thyroxine conversion
Lugol’s iodine 4 hours later

Second Line: Methimazole/carbimazole

IV hydrocortisone to reduce thyroid inflammation

3. Treat complications: (e.g. heart failure, hyperthermia)

48
Q

3 instances where Adenosine is contraindicated?

A

long QT syndrome
decompensated heart failure
asthma

49
Q

Criteria for performing a CT head scan within 1 hour of head injury?

A
  • GCS less than 13 on initial assessment in the emergency department.
  • GCS less than 15 at 2 hours after the injury on assessment in the emergency department.
  • Suspected open or depressed skull fracture.
  • Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
  • Post-traumatic seizure.
  • Focal neurological deficit.
  • More than 1 episode of vomiting.
50
Q

Criteria for performing a CT head scan within 8 hours following head injury?

A
  • Age 65 years or older.
  • Any history of bleeding or clotting disorders.
  • Dangerous mechanism of injury
  • More than 30 minutes’ retrograde amnesia of events immediately before the head injury.
51
Q

What is charcot’s triad?

A

jaundice
fever
right upper quadrant pain

52
Q

What is Reynolds’ pentad?

A

Hypovolaemic shock
Altered mental status
+
Charcot’s triad
jaundice
fever
right upper quadrant pain

53
Q

What is the pentad seen in ascending cholangitis called?

A

Reynolds

SFP Clinical Interviews (3 decks)

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