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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?

24
Q

What is the management of acute exaccerbation of COPD?

25
What is the management of pulmonary embolism?
26
What is the management of anaphylaxis?
27
What is the management of upper GI bleed?
28
What is the management of delerium tremens?
29
What is the management of diabetic ketoacidosis?
30
What is the management of HHS?
31
What is the management of hypoglycaemia?
32
What is the management of thyroid storm?
33
What are the steps in treating a Myxodemal Coma?
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
What is the management of myxoedemal coma?
35
What is the management of acute cerebrovascular event?
36
What is the management of meningitis?
37
What is the management of status epilipticus?
38
What is the management of spinal cord compression?
39
What is the management of septic shock?
40
What is the management of hyperkalaemia?
41
What is the management of burns?
42
What is the management of acute renal colic?
43
What is the treatment of paracetamol overdose?
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
What condition is the downsloping ST segment seen in?
characteristic 'Salvador Dali's moustache' or reverse tick sign seen in Digoxin toxicity
45
What is the management of epistaxis?
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
What is the referral criteria for ITU admission for asthma?
Alterted mental status Acidaemia ABG Hypercapnia Deteriorating Peak Flow Reading
47
How to treat thyroid storm?
**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
3 instances where Adenosine is contraindicated?
long QT syndrome decompensated heart failure asthma
49
Criteria for performing a **CT head scan within 1 hour** of head injury?
- 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
Criteria for performing a CT head scan within 8 hours following head injury?
- 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
What is charcot's triad?
jaundice fever right upper quadrant pain
52
What is Reynolds' pentad?
Hypovolaemic shock Altered mental status + **Charcot's triad** jaundice fever right upper quadrant pain
53
What is the pentad seen in ascending cholangitis called?
Reynolds

SFP Clinical Interviews (3 decks)

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