Acute care Flashcards by Afreen Salim

Glasgow Coma Score (GCS)
eyes

E 4 Eyes open, spontaneous
E 3 Eyes open to voice/speech
E 2 Eyes open to pain
E 1 Eyes do not open

How well did you know this?

Not at all

Perfectly

Glasgow Coma Score (GCS) voice

V 5 Orientated
V 4 Confused
V 3 Inappropriate Words/speech
V 2 Incomprehensible sounds
V 1 No sound

How well did you know this?

Not at all

Perfectly

Glasgow Coma Score (GCS)
motor

M 6 Obeys commands
M 5 Localises to pain
M 4 withdrawal from pain
M 3 Abnormal flexion to pain (decorticate)
M 2 Extends to pain (decerebrate)
M 1 No response

How well did you know this?

Not at all

Perfectly

patient is unable to maintain their own airway adequately at GCS

8 or below

How well did you know this?

Not at all

Perfectly

Parkland formula can be used to calculate the amount of fluids required for an individual according to their weight.

4 x weight (kg) x %burn = ml fluid required in the first 24 hours from the time of the burn
Half of the total fluid calculated should be given in the first eight hours following the burn. The second half should be given in the subsequent 16 hours (depending on urine output) .

How well did you know this?

Not at all

Perfectly

Referral to a burns unit should be made if

All burns ≥ 2% TBSA in children or ≥ 3% TBSA in adults
All full-thickness burns
All circumferential burns
Any burn not healed in 2 weeks
Any burn with suspicion of non-accidental injury (should be referred to burn unit / centre for assessment within 24 hours)

How well did you know this?

Not at all

Perfectly

Red flags for sepsis

new deterioration in GCS/AVPU
Systolic BP <90, OR 40 mmHg below normal
Heart rate >130 p min
RR >25 p min
Need oxygen to keep SPO2 92%, 88% in COPD
Non blanching rash or mottled/ashen/cyanotic skin
Not passed urine in last 18h
Urine output less than 0.5 ml/kg/her if catheterised
recent chemo within last 6 weeks

How well did you know this?

Not at all

Perfectly

Sepsis six

Give oxygen
Take blood cultures
Give iv antibiotics
Give iv fluids
Take lactate
Take/ monitor hourly urine output

How well did you know this?

Not at all

Perfectly

Anaphylaxis adult adrenaline dose

Adult adrenaline dose: 500micrograms IM (0.5mL) 1:1000

How well did you know this?

Not at all

Perfectly

Children 6-12 years anaphylaxis adrenaline dose

300 microgramsIM (0.3mL) 1:1000

How well did you know this?

Not at all

Perfectly

Children less than 6 years anaphylaxis adrenaline dose

150 micrograms im (0.15 ml) 1:1000

How well did you know this?

Not at all

Perfectly

Canadian C-spine Rules

high risk (age >65, dangerous mechanism or paranesthesia),

How well did you know this?

Not at all

Perfectly

no c spine imobilisation if:

low risk (delayed neck pain, simple rear-end RTA, sitting position in ED, nil midline tenderness of C-spine, ambulatory at any time) and able to rotate neck (45degrees L and R)

How well did you know this?

Not at all

Perfectly

Cushing’s triad refers to a set of signs that are indicative of increased intracranial pressure (ICP)

bradycardia, hypertension, and irregular breathing.

How well did you know this?

Not at all

Perfectly

Cauda equina key features

lower motor neurone signs and symptoms
reduced lower limb sensation (often bilateral)
bladder or bowel dysfunction ( constipation/retention or incontinence)
lower limb motor weakness
severe back pain
impotence
saddle anaesthesia

How well did you know this?

Not at all

Perfectly

Cord compression key features

surgical emergency with a similar pathophysiology to CES, however is characterised by upper motor neurone signs

Difference between metastatic spinal cord compression and cauda equina

MSCC is where a cancer or metastasis presses on and subsequently compresses the spinal cord.
Compression can also occur due to compromise of spinal stability due to vertebral metastases and compression from associated fractures.
Cauda equina syndrome is the same process but occurring at or below the level of the cauda equina (typically at the level of L1)
Both usually presents with pain and weakness and should be treated the same way

Emergency initial treatment for STEMI/NSTEMI

MMONAC
Morphine
Metoclopramide
Oxygen (if sats <94%)
Nitrates (GTN spray)
Aspirin 300 mg
Clopidogrel 300 mg (Although, in practice, other similar drugs such as Ticagrelor are increasingly being used)

Contraindications to thrombolysis in MI

Aortic Dissection
GI bleed
Allergic reaction
Iatrogenic: recent surgery
Neurological disease: recent stroke (within 3 months), malignancy
Severe HTN (>200/120)
Trauma, including recent CPR

Hypovolaemic shock

Inadequate circulating volume secondary to fluid loss
Causes:
Haemorrhagic ( eg trauma, GI bleeding, obstetric haemorrhage, ruptured AAA)
D & V
DKA
Burns

Distributive shock

Inadequate perfusion secondary to maldistribution
Causes:
Sepsis
Neurogenic shock
Anaphylactic

Obstructive shock

Inadequate cardiac output as a result of mechanical obstruction
Causes:
PE
Tension pneumothorax
Cardiac tamponade (prevents heart from filling adequately)
Acute IVC or SVC obstruction

Cardiogenic shock

Inadequate cardiac output as a result of cardiac failure
Causes:
MI
Myocardial contusion
Myocarditis
Late sepsis
Overdose ( beta blockers)
Complete heart block

Clinical signs hypovolaemic shock

peripheral vasoconstriction an increase in diastolic pressure, increased capillary refill time,
Hypotension and tachycardia
Weak thready pulse with cool pale moist skin

Clinical signs Distributive shock

warm peripheries and dry euvolemic bounding pulse

Clinical signs Neurogenic shock

leads to vasodilation and absence of sweating warm dry skin

Clinical signs cardiogenic shock

Hypotension and tachycardia, may be bradycardic ( eg bradyarrhythmia) Weak thready pulse with cool pale moist skin

septic shock =

Sepsis with hypotension unresponsive to fluid resuscitation

amber flags sepsis

Concerns about mental status Acute deterioration in functional ability Immunosuppressed Trauma/surgery/procedure in the last 8 weeks Respiratory rate 21-24 bpm Systolic BP 91-100 mmHg Heart rate 91-130 bpm or new dysrhythmia Tympanic Temperature <36.0oC Clinical signs of wound infection

red flags sepsis

Evidence of new or altered mental state Systolic BP <90mmHg (or drop of >40 from normal) Heart rate >130 per minute Respiratory Rate >25 per minute Requires oxygen to keep SpO2 >92% ( >88% in COPD) Non-blanching rash / mottled/ashen/cyanotic Lactate >2 mmol/l Recent Chemotherapy Not passed urine in the last 18 hours (<0.5ml/hr if catheterised)

sepsis management

Give oxygen Take blood cultures Give iv antibiotics Give iv fluids- 500ml bolus Hartmann’s solution or 0.9% sodium chloride over 15m, up to 4x Take lactate Take/ monitor hourly urine output

CT scan within 1 hour for cervical spine

GCS less than 13 on initial assessment patient has been intubated plain X-rays are technically inadequate/suspicious a definitive diagnosis of cervical spine injury is needed urgently (for example, before surgery) patient is having other body areas scanned for head injury/multi-region trauma the patient is alert and stable, there is clinical suspicion of cervical spine injury and any of the following apply: - age 65 years or older - dangerous mechanism of injury (fall from a height of greater than 1 metre or 5 stairs; axial load to the head, for example, diving; high-speed motor vehicle collision; rollover motor accident; ejection from a motor vehicle; accident involving motorised recreational vehicles; bicycle collision) - focal peripheral neurological deficit - paraesthesia in the upper or lower limbs

Life threatening asthma features

33,92 CHEST. PEF <33% SO2 <92% or PO2 <8 Cyanosis Hypotension Exhaustion, altered consciousness Silent chest Tachyarrhythmias

Severe asthma is characterised by any one of:

PEF 33-50% RR more than equals to 25 HR more than equals to 110 Inability to complete sentence in one breath

Moderate asthma is characterised by the following:

Increasing symptoms PEF >50-75% No features of severe asthma

Dystonic reactions are rapidly abolished by injection of drugs such as

procyclidine hydrochloride or diazepam

When to give adrenaline in cardiac arrest

Img IV as soon as poss for a non shockable rhythm After 3 attempts for a shockable rhythm Repeat adrenaline every 3-5 minutes while ALS continues

When to give amiodarone in cardiac arrest

300mgIV given for shockable rhythm after 3 shocks further 150mg IV given after 5 shocks Lidocaine may be used as an alternative 100mg IV