Acute and Critical Care Flashcards
ATMIST
Age Time Mechanism Injuries Signs (observations) Treatments
How would you manage a catastrophic haemorrhage?
- Remove clots to identify source of bleeding
- Apply direct pressure (thumb, two fingers or palm)
- More direct pressure
- Indirect pressure
- Tourniquet
- Haemostatic agents (ceelox)
Management of Addisonian crisis
IV hydrocortisone and 1L 0.9% saline over 30-60mins
Causes of Addisonian crisis
Sepsis or surgery causing acute exacerbation of chronic insufficiency (Addison’s or hypopituitarism)
Adrenal haemorrhage
Steroid withdrawal (low ACTH so low cortisol)
Two main causes of hypercalcaemia
- Hyperparathyroidism
- Malignancy
(adrenal insufficiency, lithium toxicity, vitamin D toxicity)
Management of hypercalcaemia
- IV N/saline
- Bisphosphonates
Glucocorticoids
Calcitonin
Denosumab
Hypercalcaemia features
Bones, stones, groans and psychic moans
Corneal calcification
Short qt
Hypertension
Cushings Triad
Hypertension
Bradycardia
Reduced resp rate
Pre-renal causes of AKI and treatment
Hypovolaemic shock (haemorrhage, severe dnv)
Septic shock (leaky vessel walls)
Cardiogenic shock (compensatory vasoconstriction can result in normal BP)
Treatment: FLUIDS
What drugs can affect the kidney tubules
CT drugs
Gentamycin
Furosemide
Intrinsic/renal causes of AKI
Glomerularnephritis Acute tubular necrosis Acute interstitial nephritis (e.g. hypersensitivity to penicillin or NSAIDs) Rhabdomyolysis Tumour lysis syndrome
Post-renal causes of AKI
Benign prostatic hyperplasia
Kidney stone
External compression of ureter
Risk factors for AKI
CKD
Other organ failure (CVD, liver disease, diabetes)
Potentially nephrotoxic drugs (diuretics, ARBs, NSAIDs, ACE-i)
Iodinated contrast
Age
