Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AFP INTERVIEW > ABCDE > Flashcards

ABCDE Flashcards

1
Q

Septic shock

A

Give 3

  • oxygen
  • broad spectrum antibiotics (within 1hr)
  • IV fluids

Take 3

  • blood cultures (urine, sputum, csf)
  • urine output
  • ABG (including lactate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Haemorrhaging shock

A
  • Stop bleeding (may require referral to surgery)
  • Raise legs, give fluids (titrated to HR BP and urine output), lease with seniors regarding escalation
  • haemorrhage estimated at >30% total blood volume = activate massive haemorrhage protocol (administering O Rh -ve blood until units are cross matched)
  • lease with seniors/haematology regarding replacement of RBC and FFP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Anaphylaxis

A

ROHAS FC!!!

  • Reassure patient
  • Oxygen 15L 100% via NRB
  • Help (call peri arrest team to secure airway)
  • Adrenaline IM (adult 0.5ml 1:1000 IM in thigh) repeat every 5mins guided by BP, HR and RR
  • Steroids (IV Hydrocortisone)
  • Fluids (500ml 0.9% NaCl bolus over 15 mins)
  • Chlorphenamine IV

Additionally, consider nebuliser adrenaline if wheeze. Measure mast cell tryptase at 1-6h and test for igE mediated reaction with RAST test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ACS

A

MONARTH!!!

Troponin, D-dimer, BNP

  • Morphine (+metaclopramide)
  • Oxygen (If sats are under 94% or SOB)
  • nitrates (sublingual GTN)
  • Asprin 300mg
  • Reperfusion (refer for PCI if within 12h otherwise fibrinolysis - alteplase) - repeat ECG
  • Ticagrelor 180mg
  • Heparin
Secondary prevention (ABCES)
Asprin, beta blocker, clopidogrel, ace inhibitor, statin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Acute pulmonary oedema

A

LMNOP!!

  • loop diuretics (furosemide IV)
  • diaMorphine (vasodilates)
  • nitrates (venodilates)
  • oxygen (15L 100% o2 NRB)
  • position (sit patient upright)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Broad complex tachycardia

VT, SVT, AF

A

Pulseless VT > follow arrest protocol

Are there adverse signs? - HF, chest pain, shock

YES - immediate cardioversion (call anaesthetist)

NO - is QRS regular?

Regular = 300mg IV amiodarone
Irregular = try IV adenosine (if polymorphic VT try IV mgso4)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Narrow complex tachycardia

Sinus tachycardia, atrial tachyarrhythmia

A

If irregular - manage as AF

Stable
<48h - synchronised dc shock
- pharmacological cardioversion with Flecainide (or amiodarone if structural abnormality - do echo)

> 48h

  • electrical cardioversion if patient has been anticoagulated for 3 weeks on warfarin
  • betablocker/calcium channel blocker/ digoxin - if patient is over 65 or has Hx of IHD

Unstable
- Heparinise + sedate + DC cardiovert

Regular

  • valsalva manoeuvre or carotid massage
  • adenosine (or verapamil if they have asthma)
  • if adverse signs = DC cardiovert > amiodarone
  • no adverse signs = b-blocker, Ca-b, amiodarone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bradyarrythmia

A

If adverse features or risk of asystole:

  • 1st: IV atropine
  • 2nd: repeat IV atropine to max 3mg, transcutaneous pacing, IV isoprenaline or IV adrenaline

No adverse features - just observe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Asthma

A

OSHI(E)M!!!

  • Oxygen 15L 100% NRB
  • Salbutamol nebs
  • IV hydrocortisone or prednisolone
  • Ipratropium bromide nebs
  • escalate to consider MgSo4
  • warn ICU/ seniors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

COPD

A

OSHI(E)T!!!

  • Oxygen
  • salbutamol nebs
  • IV hydrocortisone
  • ipratropium bromide nebs
  • escalate for bipap (or intubation if severely acidotic)
  • Theophylline - decided by seniors
  • consider antibiotics if sputum is purulent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pneumothorax

A

Primary pneumothorax

w/ SOB or >2cm rim of air on CXR?

  • YES = senior advice + aspirate (if unsuccessful insert chest drain)
  • NO = senior advice + send home/safety net + CXR 2-weekly until recovered

Secondary pneumothorax

  • <1cm = Admit for 24hr observation
  • 1-2cm = Admit and attempt aspiration
  • 2cm+ or symptomatic = chest drain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tension pneumothorax

A
  • Immediate needle decompression 2nd ICS MCL

- Inform seniors for CXR + Chest drain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pneumonia

A
  • CURB-65 to assess severity 2 = hospital
  • Oxygen (15L 100% NRB) if still hypoxic:
    CPAP > NIV > Intubation
  • Antibiotics (local protocol/contact microbiology)
  • Analgesia (paracetamol/ NSAID for pleuritic pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pulmonary embolism

A
  • Calculate Wells score
    4 or less = D Dimer
    5+ = CTPA
  • Oxygen
  • IV morphine
  • Warfarin + LMWH until INR 2.5 for >24hrs
    Treatment duration 3 or 6 months (longer if unprovoked) then reassess

If massive PE (w/ haemodynamic compromise) thrombolysis - 50mg bolus Alteplase

Future management -investigate for thrombophilia and malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Upper GI bleed

A
  • calculate blatchford score
  • Keep patient nil by mouth + notify surgeons
  • Bleep endoscopist
  • Give antibiotics and terlipressin if due to Varices
  • If massive bleed activate major haemorrhage protocol
  • Correct clotting abnormalities
  • check for/eradicate H pylori - triple therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Meningitis

A

CT then LP (normal pressure = 10-20cmH2O

  • IV Cefotaxime + Ampicillin
    (Outside hospital administer IM Benpen)
  • IV fluids
  • Escalate (seniors, ITU, microbiology)
  • Consider IV dexamethasone
17
Q

Encephalitis

Same as meningitis but with impaired consciousness/ odd behaviour

A

Acyclovir within 30mins for herpes simplex virus (for 2 weeks)

Adjust management following microbiology

18
Q

Status epilepticus

A

Start clock and maybe put out early crash call

0 mins - ABCDE

5 mins - 1st dose IV lorazepam or PR diazepam or oral midazolam + senior review

15 mins - 2nd dose IV lorazepam or PR diazepam or oral midazolam

25 mins - IV phenytoin / IV phenobarbital / contact anaesthetists ready for next step

45 mins - rapid sequence induction with sodium thiopental and EEG monitoring in ITU

19
Q

Raised ICP

A

LHOC!!!

Lie - elevate head to facilitate venous drainage

Hypotension - correct low BP

Osmotic agents - Mannitol (discuss with seniors)

Corticosteroids - IV dexamethasone (if tumour or vasculitis)

Consider craniotomy or burr hole if risk of coning

20
Q

Head injury

A
  • Look for battles sign / raccoon eyes / blood on otoscopy (all signs of basal skull fracture)
  • CT head
  • CT spine
21
Q

Subarachnoid haemorrhage

A
  • CT/MRI brain
  • lumbar puncture to check for bilirubin (Xanthochromia)
  • Liaise with seniors, request neurosurgical review, transfer to ICU if falling GCS
  • Lie patient flat
  • Opioids + anti-emetics
  • Nimodipine (prevents arterial spasm)
  • Dexamethasone if raised ICP
22
Q

Stroke

A
  • CT brain (look for haemorrhage)
  • Asprin 300mg (if haemorrhage excluded)
  • Thrombolysis if
    Within 4.5 hours
    Haemorrhagic stroke excluded
    No contraindications
  • Also consider future anticoagulation, statin, clopidogrel
  • carotid endarterectomy if stenosis >70%
23
Q

Pheochromocytoma

Sudden onset fear, anxiety, sweating, headaches, hypertension

A
  • Measure urinary metanephrine levels
  • alpha blocker following by a beta blocker
  • e.g. phentolamine, followed by labetalol
  • adrenalectomy after 4-6 weeks (requires lifelong hormone replacement)
24
Q

Pancreatitis

A
  • Calculate modified Glasgow score PANCREAS (3+ = consider ITU)
  • IV fluids titrated to adequate urine output
  • Analgesia (pethidine or morphine)
  • early threshold for escalation
25
Q

Acute kidney injury

Pre-renal (hypotension, sepsis, cardiac)
Renal (drugs, GN, vasculitis)
Post-renal (obstruction)

A

Early ABG/VBG and ECG looking for K+
U&E’s and urinalysis

URGENT + FLUIDS

  • Fluid bolus if dehydrated (500ml)
  • Low BP (if SBP <110)
  • Urinalysis
  • Imaging (urgent USS if suspected obstruction)
  • Drugs (stop metformin, NSAIDS, ACE, ARB, diuretics, gentamycin/nitrofuratoin)
  • Sepsis 6
26
Q

Diabetic ketoacidosis

Glucose >11mmol

A

Can check for ketones with capillary ketone strips

FIKDH!!!

Fluids - 500ml boluses (consult seniors and follow hospital protocol)

Insulin - 0.1 units/kg/hr

K+ replacement (start when urine output is adequate)

Dextrose - start once BM <15 (10% dextrose infusion)

Heparin/LMWH - prothrombotic state

27
Q

Thyrotoxicosis

A

Escalate to seniors

Symptom control - propranolol / diltiazem

Carbimazole

Lugol’s iodine (blocks thyroid)

Hydrocortisone or dexamethasone (prevents peripheral conversion of t4 to t3)

If no improvement in 24hrs - Thyroidectomy

28
Q

Addison’s

Sepsis-like presentation with no fever

A

Want to request blood cortisol + ACTH

  • IV Hydrocortisone
  • IV dextrose of hypoglycaemic
  • Search and treat underlying cause
  • Waterhouse-Friderichsen = IV hydrocortisone + IV cefotaxime

Long-term

  • Short synachthen test - diagnose adrenal insufficiency
  • Long synachthen test to check for delayed increase in cortisol (Adrenal atrophied) - cortisol is impaired throughout in addison’s)
29
Q

Hyperkalemia

A
  • Cardiac protection - calcium gluconate
  • Salbutamol + insulin/dextrose (pushes k+ intracellular)
  • Remove K+ from the body = loop diuretics, calcium resonium PO or enema (takes 48hrs)
  • Consider renal replacement therapy

AFP INTERVIEW (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions