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Things I don't know, but need to know, for fourth year > Acute Care > Flashcards

Acute Care Flashcards

1
Q

Adrenaline Dose in anaphylaxis

A

0.5ml of 1:1000 IM

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2
Q

Adrenaline Dose in Cardiac Arrest

A

1mg or 10 ml of 1:10,000 IV

1ml of 1:1000 IV

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3
Q

What is the Fluid replacement formulae?

A

30ml/kg/hr

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4
Q

What is the formulae for K+ Na+ Cl- replacement?

A

K+ Na+ Cl-

1mmol/kg/hr

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5
Q

When is IV magnesium given?

A

If Mg levels <0.4 or signs of tetany.

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6
Q

When is Oral Mg used?

A

If >0.4

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7
Q

What is a side effect of oral Mg?

A

Diarrhoea

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8
Q

What is a usual infusion of IV Mg

A

40mmol over 24 hours

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9
Q

Causes of Hypomagnesia

A 
PPI
Diarrhoea
Chronic alcoholism 
Diuretics 
TPN
Hypokalaemia
Hypercalcaemia
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10
Q

How does Hypomagnesia present

A

Parasthesia, Tetany, Seizures, Arrythmia, reduced PTH

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11
Q

When is IV Calcium Gluconate used?

A

If K+ over 6.5 or ECG changes

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12
Q

What is the initial fluid resus volume?

A

500ml 0.9% saline

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13
Q

If someone is in an acute confusional state what is used?

A

Oral or IM haloperidol

NEVER BDZ as will worsen confusion

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14
Q

In an ABG what is the normal anion gap?

A

8 to 14 if not using K+

10-18 if using K+

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15
Q

What causes an elevated anion gap?

A

Excess exogenous or organic acid.

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16
Q

Causes of a Metabolic Acidosis with a raised Anion Gap

A 
Methanol
Uraemia
DKA
Paraldehyde
Isoniazide
Lactic Acidosis 
Ethyelen Glycol
Salicylate Poisoning - Aspirin
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17
Q

What fractures are associated most with Compartment syndrome?

A

Supracondylar

Tibial Shaft

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18
Q

If a patient presents with a paracetamol overdose when they took all of them at once within an hour of arrival and A + E. What is the initial management?

A

Activated Charcoal

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19
Q

What are indications for Acetylcysteine use in a paracetamol overdose?

A

Patient staggered the dose over longer than an hour, or doubt over duration
Levels >100mg/l at 4 hours or 15mg/l at 24 hours

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20
Q

How is Acetylcysteine infused?

A

Over 1 hour

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21
Q

What are the indications for a liver transplant in a paracetamol overdose?

A

PTT > 100 seconds
Creatinine > 300
Grade III or IV encephalopathy

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22
Q

What is the preferred fluid used in burn resuscitation?

A

Hartmans (crystalloid) > Coloid

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23
Q

What is the formulae for Resuscitation fluid in burns and how is this applied?

A

4ml x % burn x kg
50% in first 8 hours
50% in last 16 hours

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24
Q

What is the maintenance fluid in burns?

A

0.5ml x % burn x kg

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25
Q

Signs of DKA

A 
Blood Glucose >11
Ketone >3
pH <7.3
Bicarbonate <15
Raised Anion Gap
\+/- pseudohyponatraemia
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26
Q

An STEMI presents in A + E what is given?

A

Aspirin + Ticagrelor + 5000 units of Heparin

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27
Q

Patient OD - Increased HR, Warm, Dilated Pupils, Dry

A

AntiCholinergic Medication

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28
Q

Patient OD - Pinpoint Pupils, Increased Bowel Sounds, Sweaty

A

Cholinergic - Mushrooms, Pilocarpine

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29
Q

Patient OD - Bradychardia, Reduced RR, Cold, Pinpoint pupils, Absent bowel sounds, Dry

A

Opiod

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30
Q

Patient OD - Tachychardia, Increased RR, Dilated Pupils, Hot , Inceased Bowel sounds, Sweaty

A

Sympathomimetics - Cocaine Ecstasy etc

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31
Q

How do you differentiate Opiod from BDZ overdose?

A

BDZ pupils aren’t affected.

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32
Q

If you have a patient who has OD who’s bloods show and Acidotic Picture and ECG shows Tachychardia or Arrhythmias what is the most important management?

A

IV Sodium Bicarbonate - Increase contractility and reduce arrhythmia risk by reducing acidosis.
Magnesium Sulphate if prolonged QRS

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33
Q

If and overdosed patient presents with seizures what is the treatment?

A

BDZ can still be used. Phenytoin should be avoided

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34
Q

What is the management plan of someone presenting with a Sympathomimetic OD?

A 
BDZ - Sedation
Ketamine - Sedation if needed quickly 
Check CK - Rhabdo is common
U+Es - Rhabdo and dehydration
ECG - Vasospasm is common finding
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35
Q

If a patient in DKA had a BP <90 what is their fluid resus?

A

500ml NaCl in 5 mins

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36
Q

If a patient in DKA has a BP >90 what is their fluid resuscitation?

A

1L NaCl over 1 hour

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37
Q

A patient who has received Naloxone is looking to be discharged. What are the guidelines on their discharge?

A

Patent Airway without naloxone for 6 hours

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38
Q

Management of Hypovolaemic Hyponatraemia

A

Normal Isotonic Saline

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39
Q

Hypovolaemic Hyponatramia - Isotonic Saline Increase Na

A

Likely Diagnosis is correct

40
Q

Hypovolaemic Hyponatraemia - Isotonic Saline causes a decrease in Na+

A

SIADH is likely cause

41
Q

Management of Euvolemic Hyponatraemia

A

Fluid Restriction - 500m - 1000ml a day

Vaptans used

42
Q

Management of Hypervolaemic Hyponatraemia

A

Fluid Restriction -> 500ml-1000ml
Vaptans
Loop Diuretics

43
Q

What can be used with care in Acute Hyponatraemia?

A

Hypertonic 3% saline

44
Q

Too rapid Hyponatraemia correction can lead to

A

Central Pontine Myelinolysis ‘locked in syndrome’

45
Q

Too rapid correction of Hypernatraemia

A

Cerebral Oedema

46
Q

ABG in Salicylate Poisoning

A

Initial Respiratory Alkalosis due to stimulation of CNS

Later Metabolic acidosis with +ve anion gap

47
Q

Example of a Salicylate

A

Aspirin

48
Q

Signs of Salicylate Poisoning

A

Hyperventilations

Tinnitus

49
Q

Management of Salicylate Poisoning

A

Urinary Alkalinisation
IV Sodium Bicarbonate
Haemodialysis

50
Q

Indications for Haemodialysis is Salicylate Poisoning.

A

Serum level >700
Pulmonary Oedema
Seizures

51
Q

What is first line for the management of Neuropathic pain?

A

Amitriptyline
Pregablin
Duloxetine
Gabapentin

52
Q

What is second line in neuropathic pain?

A

Try another 1st line drug monotherapy.

53
Q

What is capsaicin useful for?

A

Small areas of localised neuropathic pain.

54
Q

ECG signs of hypothermia

A

J waves

Prolonged PR QT and QRS

55
Q

What is the adrenaline dose used in anaphylaxis in a child under 6 months?

A

100 - 150mcg

0.1 - 0.15ml 1 in 1000

56
Q

What is the adrenaline dose used in 6 months to 6 years in anaphylaxis?

A

150mcg

0.15ml 1 in 1000

57
Q

What is the adrenaline dose in a 6 - 12 year old in anaphylaxis?

A

300mcg

0.3ml 1 in 1000

58
Q

When can someone be discharged from hospital after two hours post anaphylaxis?

A

No symptoms remain
required a single IM
Auto-injector and trained to use it

59
Q

When is someone discharged after 6 hours post anaphylaxis?

A

2 IM doses needed

Previous biphasic reaction

60
Q

When is someone discharged after 12 hours post anaphylactic episode?

A

Over 2 IM doses needed
Severe asthma
Late at night
Live in a remote area with poor access.

61
Q

Paediatric BLS

A

Look for breathing -> 5 rescue breaths -> Pulse -> 15:2 CPR

62
Q

What should be administered in hyponatraemia causing seizures or coma?

A

3% saline IV

63
Q

Major Haemorrhage Protocol

A 
SEND OFF TWO PINK TOPPED FOR GROUP AND SAVE
2L of warm IV crystalloid
Tranexamic Acid
2 units of O negative blood
Fully crossmatched blood
64
Q

Glucose dose in Hypoglycaemia requiring an IV due to reduced consciousness

A

100ml 20% glucose IV STAT

65
Q

Naloxone in Respiratory arrest

A

400mcg bolus

66
Q

Naloxone in over sedation

A

Titrate to affect

67
Q

In paediatric BLS where do you feel for a pulse?

A

Brachial or Femoral

68
Q

If thrombolysis has been administered how long should CPR be carried on for?

A

60-90 minutes

69
Q

Indication for IV sodium bicarbonate in an overdose.

A

pH - <7.1
QRS >160ms
Arrhythmias
Hypotension

70
Q

In a Beta blocker OD what medication should be use and why?

A

Glucagon as dobutamine won’t work as its receptors and blocked

71
Q

In an acute hypoglycaemic patient with reduced consciousness and no IV access what is used?

A

Glucagon IM

72
Q

In children or young people what is the fuild resus formula?

A

20ml/kg over an hour

73
Q

Whats the maximum in

A
74
Q

Headache , N+V Vertigo Confusion weakness and cherry red flushed skin

A

Carbon Monoxide poisoning

75
Q

How do you diagnose CO poisoning?

A

ECG and ABG

Carboxyhaemaglobin level

76
Q

Describe what different levels of carboxyhaemaglobin tell you.

A 
<3% = Non smoker
<10% = smoker
10-30% = symptomatic CO poisoning 
>30% = Severe CO toxicity
77
Q

What is the management of CO poisoning?

A

High flow oxygen via non rebreather mask.

78
Q

if someone with a salicylate OD presents within an hour of ingesting what can be given?

A

activated charcoal

79
Q

What is used in the treatment of Popper related hypoxia?

A

Methylene Blue

80
Q

Why should a slower infusion rate be considered in a younger patient with a DKA?

A

They are at an increased risk of cerebral oedema

81
Q

Presents similar to alcohol + metabolic acidosis with anion gap and osmotic gap
Tachychardia + Hypertension
AKI

A

Ethylene Glycerol Poisoning - Anti Freeze

Fomepizole is first line over ethanol now

82
Q

Oxygen saturation targets in an acutely unwell patient

A

94 -98%
COPD - pCO2 normal = 94-98
- hypercapniac - 88-92% on a 28% venturi mask 4l min

83
Q

How is tranexamic acid administered in a major haemorrhage

A

IV bolus the slow infusion

84
Q

INR cut off for a chest drain insertion.

A

> 1.3

85
Q

Most reliable line for administering long term medication i.e chemotherapy

A

Hickmans line

86
Q

Haemorrhagic shock - class 1

A 
<750 ml loss
<100bpm
Normal BP
>30ml/hr urine
Normal consciousness
87
Q

Haemorrhagic shock - Class II

A 
750-1000ml
>100bpm
Normal BP
20-30ml urine
Anxious
88
Q

Haemorrhagic Shock class III

A 
1500-2000ml 
>120bpm
BP is reduced
5-15ml urine
Confused
89
Q

Haemorrhagic shock class IV

A

> 2000ml
Blood pressure dropped
<5ml urine
Lethargic

90
Q

Management of a N Acetylcysteine anaphylaxis

A

Stop -> nebulised salbutamol -> restart infusion at a slower dose

Non IgE mediated anaphylactoid reaction - not true anaphylaxis
Urticaria and hives.

91
Q

Managment of an acute haemolytic reaction during a transfusion.

A

STOP the transfusion
Aggressive fluid resuscitation
Inform lab - send two pinks tops to lab for crossmatch and direct Coombs test

92
Q

What is the first line management in magnesium sulphate induced respiratory depression.

A

Calcium Gluconate

93
Q

COPD acute exacerbation - oxygen therapy

A

15l Non rebreather mask - all receive even in known CO2 retainers
- 28% venturi mask at 4L after

94
Q

BLS - resus chest compression guidelines

A

Neonate - 3:1. 1 or 2 thumbs
Paediatric - 15:2 1 hand
Adult - 30:2 2 hands

95
Q

What electrolyte should be replaced first?

A

Magnesium as this can cause a resistant hypokalaemia

96
Q

How is someones fluid deficit accounted for in their fluid maintenance.

A

% dehydration x kg x 10

Spread out over 24-48 hours in addition to normal fluid maintenance

Things I don't know, but need to know, for fourth year (31 decks)

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