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1. 4th year > Acute Care > Flashcards

Acute Care Flashcards

1
Q

head position if doing suction/if there is vomit/blood

A

lateral

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2
Q

intubation if GCS is what

A

< 8

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3
Q

how do you measure the size of an oropharyngeal airway

A

incisor teeth to angle of mandible

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4
Q

should you always give oxygen in ABCDE

A

all critically ill patients should receive oxygen

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5
Q

what are the oxygen sats for people with COPD

A

if acutely unwell 15L non-rebreather mask, can titrate later on to achieve 88-92 via 2-4L venturi

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6
Q

B) action: anaphylaxis

A

adrenaline

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7
Q

B) action: short of breath

A

sit them up

oxygen

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8
Q

B) action: opiate overdose

A

naloxone

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9
Q

B) action: tension pneumothorax

A

needle decompression in 2ICS MCL followed by chest drain in 5ICS MAL

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10
Q

C) action: fluid challenge

A

500ml bolus 0.9% saline STAT

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11
Q

C) action: fluid challenge in HF

A

250ml initially

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12
Q

what do you do if someone responds fully to fluid challenge

A

continue with maintenance fluids

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13
Q

what do you do if someone responds to fluid challenge but BP falls again

A

give more fluids / another fluid challenge

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14
Q

what does it mean if someone doesnt respond to a fluid challenge

A

they are either volume overloaded or volume deplete

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15
Q

action: patient is hypotensive and fluid overloaded

A

inotropes

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16
Q

action: patient is hypotensive despite fluid resuscitation

A

vasopressors

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17
Q

action: circulatory shock venous access

A

2 wide bore IV cannula - take bloods including group and save/cross match plus fluid challenge of 1000ml crystalloid STAT

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18
Q

major haemorrhage and cardiac arrest number

A

2222

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19
Q

action: ACS

A

12 lead ECG and immediate drug treatment

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20
Q

what is assessed in disability

A 
AVPU
GCS
blood glucose 
pupils 
pain
temperature
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21
Q

action: hypoglycaemia

A

100ml 10% dextrose

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22
Q

GCS: eye opening score 1-4

A

Opens spontaneously.
Opens to command.
Opens to pain.
No response.

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23
Q

GCS: verbal response score 1-5

A 
Orientated and talking. 
Confused and disoriented
Inappropriate words
Incomprehensible sounds
No verbal response
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24
Q

motor response 1-6

A 
Obeys commands.
Localizes to pain. 
Flexion & withdrawal to pain. 
Abnormal flexion to pain. 
Extension to pain. 
No response.
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25
Q

how is pain administered in GCS

A

supra orbital notch

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26
Q

what is abnormal flexion in GCS

A

decorticate posturing (core- hands at chest)

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27
Q

what is the BP and HR in cushings triad

A

hypertension

bradycardia

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28
Q

skull base fracture signs: anterior fossa

A

panda eyes - bilateral periorbital bruising

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29
Q

skull base fracture signs: middle fossa

A

battle sign - mastoid bruising behind ear

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30
Q

how else might a skull base fracture of middle fossa present

A

SNHL
facial nerve palsy
(temporal bone)

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31
Q

sudden onset

worst headache ever

A

sub arachnoid haemorrhage

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32
Q

where is the pain of a SAH usually focused

A

occiput

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33
Q

1st line IX of SAH

A

CT brain

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34
Q

2nd line IX of SAH

A

lumbar puncture

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35
Q

what is a positive LP result of a SAH

A

xanthochromic CSF (turns yellow)

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36
Q

when should a LP be performed post SAH

A

at least 12 hours post-presentation

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37
Q

what investigation can help find cause of SAH

A

CT intracranial angiogram

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38
Q

treatment SAH

A

IV saline
nimodipine
neurosurgery/IVRs - endovascular coiling, aneurysm clipping

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39
Q

how long do poeple with SAH get nimodipine

A

21 days

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40
Q

4 complications of SAH

A

re-bleed
delayed ischaemic neurological deficits (3-12 days later)
hydrocephalus
hyponatraemia

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41
Q

what is seen on CT of SAH

A

acute blood (bright) in the basal cisterns, sulci and ventricles

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42
Q 
relatively minor trauma
fluctuating consciousness 
dull headache 
confusion/sleepy 
FND
A

subdural haemorrhage

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43
Q

2 RFs for SDH

A

alcoholism

age

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44
Q

CT scan for SDH

  • acute
  • chronic
A

crescent shaped haematoma
acute - bright
chronic - dark

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45
Q

what can be given as epilepsy prophylaxis after SDH

A

7 days phenytoin

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46
Q

tx SDH if expanding mass with FND

A

burr hole craniotomy

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47
Q

head injury followed by a lucid period then loss of consciousness again
increasingly severe headache associated with sudden decline in level of consciousness

A

EDH

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48
Q

will a recent head injury be apparant in EDH

A

yes

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49
Q

what artery is likely damaged in an extradural haemorrhage

A

middle meningeal artery

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50
Q

what would a fixed dilated pupil in EDH imply

A

brain herniation

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51
Q

CT scan of EDH

A

lens shaped (biconvex) haematoma

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52
Q

is EDH restricted by the suture lines

A

yes

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53
Q

is a SDH restricted by the suture lines

A

no

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54
Q

when is a CT indicated in terms of GCS

A

GCS < 13 on initial assessment or < 15 at 2 hours later

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55
Q

dx treatment of raised ICP

A

mannitol

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56
Q

tear drop sign on facial xray

A

blow out fracture

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57
Q

how many back blows and abdominal thrusts in choking person

A

5 back blows then 5 abdominal thrusts

continue cycle if unsuccessful

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58
Q

what 3 drugs are given in anaphylaxis

A

adrenaline
hydrocortisone
chlorphenamine

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59
Q

dose: adrenaline in anaphylaxis in adult or child over 12

A

500mcg

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60
Q

dose: adrenaline anaphylaxis child 6-12

A

300 mcg

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61
Q

dose: adrenaline anaphylaxis child < 6

A

150 mcg

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62
Q

adult anaphylaxis protocol

A

adrenaline 0.5mg IM

hydrocortisone 200mg slow IV, chlorphenamine 10mg slow IV

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63
Q

how much can adrenaline be repeated

A

every 5 mins up to 3 times

use a different site each time

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64
Q

what do you do if colloid fluids are running in anaphylaxis

A

stop - may be cause of reaction

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65
Q

fluids in anaphylaxis

A

2 large bore IV cannula IV 500ml crystalloid over 15mins or 1L STAT if hypotensive

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66
Q

how long do you observe post adrenaline in anaphylaxis

A

6 hours

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67
Q

how long should prednisolone be continued after anaphylaxis

A

3-5 days 30-40mg PO

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68
Q

should chlorphenamine be continued in anaphylaxis

A

4mg/6hr if itching

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69
Q

what specific blood should be taken in anaphylaxis

A

serum tryptase

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70
Q

tx bradycardia

A

500mcg atropine IV

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71
Q

how many times can atropine be repeated

A

up to 6 times (3mg in total)

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72
Q

unstable tachycardia

A

DC cardioversion up to 3 times

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73
Q

2nd line unstable tachycardia

A

amiodarone 300mg IV over 10-20 mins

followed by 900mg over 24 hours

74
Q

tx stable broad complex tachycardia

A

loading dose amiodarone followed by 24 hour infusion

75
Q

2nd line stable broad complex tachycardia

A

lidocaine

76
Q

polymorphic VT (TdP)

A

IV Mag Sulf

77
Q

tx stable narrow complex tachy 1st line

A

vagal manoeuvres

78
Q

2nd line tx stable narrow complex tachy

A

IV adenosine

79
Q

2nd line tx stable narrow complex tachy

asthmatics

A

IV verapamil

80
Q

tx acute AF if haemodynamically unstable

A

emergency cardioversion (rhythm control) DCCV

81
Q

1st line chemical cardioversion in AF if structural heart disease

A

amiodarone

82
Q

1st line chemical cardioversion in AF if no structural heart disease

A

flecainide

83
Q

tx stable AF if onset is < 48 hours

A

rate or rhythm control

84
Q

tx stable AF if onset is > 48 hours

A

rate control

85
Q

1st line rate control in AF

A

BB or CCB (diltiazem)

86
Q

2nd line rate control in AF

A

digoxin (e.g. if heart failure)

87
Q

dose IV adenosine in 2nd line stable narrow complex tachycardia

A

6mg IV bolus

88
Q

4 H causes of cardiac arrest

A

hypoxia
hypovolaemia
hypothermia
hypo-metabolic/hyperkalaemia

89
Q

4T causes of cardiac arrest

A

toxin
thrombosis
tamponade
tension pneumothorax

90
Q

should you call resus team before starting CPR

A

yes

91
Q

compressions

  • number
  • depth
  • rate
  • per breaths
A

30
5-6 cm
100-120
30:2

92
Q

shockable rhythms

A

VF

pulseless VT

93
Q

what can be done if no defib

A

precordial thump

94
Q

what do you do if someone has a cardiac arrest while on a monitor that was showing VF or pulseless VT

A

3 shocks before CPR

95
Q

what 2 drugs are used in cardiac arrest

A

adrenaline

amiodarone

96
Q

what is the dosage of adrenaline in cardiac arrest

A

1mg

97
Q

when should adrenaline be given in cardiac arrest for non-shockable rhythms

A

ASAP

98
Q

when should adrenaline be given in cardiac arrest for shockable rhythms

A

1mg after 3 shocks

repeat 1mg every 3-5 mins

99
Q

when should amiodarone be given in cardiac arrest for shockable rhythms

A

300mg after 3 shocks

150mg after 5 shocks

100
Q

how are drugs delivered in cardiac arrest

A

1st line IV

2nd line IO

101
Q

what drug can be given in cardiac arrest if PE suspected

A

alteplase

102
Q

airway position in cardiac arrest in children under 1

A

head in neutral position

103
Q

how is paediatric ALS started

A

5 rescue breaths then 15 compressions

104
Q

compression depth in < 1 year old

A

2 fingers

105
Q

compression depth in infant

A

4cm

106
Q

rescue breaths : compressions in a paediatric cycle

A

15 compressions:2 breaths

107
Q

what kind of shock:
o Chest pain, palpitations.
o Cold, clammy peripheries.

A

cardiogenic

108
Q

what kind of shock:
o Cold, clammy peripheries.
o Distended neck veins.
o Raised JVP.

A

obstructive

109
Q 
what kind of shock:
o	Cool, cold peripheries. 
o	Dry mucous membranes. 
o	Thready pulse. 
o	Low JVP.
A

hypovolaemic

110
Q

what kind of shock:
o Fever.
o Warm flushed peripheries with increased capillary refill.
o Bounding pulse.

A

distributive

111
Q

what kind of shock:

PE, tension pneumothorax, cardiac tamponade

A

obstructive

112
Q

what kind of shock:
sepsis
anaphylaxis
neurogenic

A

distributive

113
Q

septic shock treatment

A

BUFALO

+ vasopressors

114
Q

when is the earliest serum paracetamol levels can be checked in overdose

A

4 hours post consumption

115
Q

s/s paracetamol overdose

A 
LFT - coagulation problems - raised TT or INR
N+V
abdominal pain
hypoglycaemia
jaundice
encephalopathy
116
Q

tx paracetamol overdose

A

acetylcysteine (parvolex)

117
Q

tx paracetamol overdose if presenting within 1 hour

A

acivated charcoal, wait 4 hours, send paracetamol level

118
Q

how quickly is acetylcysteine infused

A

1 hour

119
Q

how is it decided when acetylcysteine given in paracetamol dose

A

deciding using treatment line (amount ingested and time since) - if on or above line
if staggered overdose
if doubt over ingestion time

120
Q

opioid overdose symptoms

A

Pin point pupils.
Respiratory depression
Reduced LOC - drowsiness, coma.
jerky movements

121
Q

tx opioid overdose

A

naloxone 400mcg bolus (800mcg if IM)

122
Q

tx benzo overdose

A

flumenazil

123
Q

benzo overdose s/s

A

ataxia
dysarthria
reduced consciousness

124
Q

tx aspirin overdose

A

supportive care + fluids + bicarbonate influsion

125
Q

s/s aspirin overdose

A 
Tinnitus. 
Vomiting. 
Dehydration. 
Hyperventilation to combat metabolic acidosis 
Hypokalaemia 
Raised anion gap
126
Q

tx BB overdose

A

glucagon

127
Q

tx carbon monoxide poisoning

A

oxygen

128
Q

anaesthetics: when to stop: ACEI

A

day before surgery

129
Q

anaesthetics: when to stop: warfarin

A

5 days before surgery

130
Q

anaesthetics: when to stop: LMWH

A

24 hours before surgery

131
Q

anaesthetics: when to stop: antiplatelet

A

7 days before surgery

132
Q

how are high risk patients bridged before surgery when asked to stop warfarin for 5 days

A

heparin

133
Q

example of high risk patients that would be bridged with heparin before surgery

A

AF
VTE within 3 months
mechanical heart valve / multiple valve replacements

134
Q

what is given if INR is > 1.5 on day of surgery

A

vitamin K

135
Q

how is warfarin restarted after surgery

A

if no major bleeding restart on day of procedure and cover with heparin and check INR in 48 hours

136
Q

induction agent example - 2

A

propofol, thiopental

137
Q

muscle relaxant used in anaesthetics

A

Rocuronium, Vecuronium, Suxamethonium

138
Q

reversal of muscle relaxant used in anaesthetics

A

neostigmine

139
Q

drug used to make patient drowsy in anaesthetics prior to procedure

A

midazolam

140
Q

opiate used in surgery by anaesthetics

A

fentanyl

141
Q

tx bradycardia in GA

A

atropine IV 500mcg

142
Q

tx hypotension in GA

A

ephedrine

metaraminol

143
Q

tx malignant hypertension in GA

A

IV dantrolene and active cooling

144
Q

3 body parts adrenline cant be used with lidocaine

A

fingers
nose
ears

145
Q

calculation of anion gap

A

Cl + HCO3

(+ minus the -)

146
Q

normal anion gap metabolic acidosis

A
  • Gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
  • Renal tubular acidosis
  • Drugs: e.g. acetazolamide
  • Ammonium chloride injection
  • Addison’s disease
147
Q

raised anion gap metabolic acidosis

A
  • Lactate: shock, hypoxia
  • Ketones: diabetic ketoacidosis, alcohol
  • Urate: renal failure
  • Acid poisoning: salicylates, methanol
148
Q

metabolic alkalosis

A
  • Vomiting / aspiration (e.g. Peptic ulcer leading to pyloric stenosis, nasogastric suction)
  • Diuretics
  • Liquorice, carbenoxolone
  • Hypokalaemia
  • Primary hyperaldosteronism
  • Cushing’s syndrome
  • Bartter’s syndrome
  • Congenital adrenal hyperplasia
149
Q

resp acidosis

A
  • COPD
  • Decompensation in other respiratory conditions e.g. Life-threatening asthma / pulmonary oedema
  • Sedative drugs: benzodiazepines, opiate overdose
150
Q

resp alkalosis

A
  • Psychogenic: anxiety leading to hyperventilation
  • Hypoxia causing a subsequent hyperventilation: pulmonary embolism, high altitude
  • Early salicylate poisoning*
  • CNS stimulation: stroke, subarachnoid haemorrhage, encephalitis
  • Pregnancy
151
Q

tx status epilepticus

A

IV lorazepam (can repeat once after 10-20 mins)
primary care
- buccal midazolam
- rectal diazepam

152
Q

tx seizure if benzo fails twice

A

phenytoin, phenobarbital, levtiracetem or sodium valproate

GA

153
Q

tx hypoglycaemia orientated and able to swallow

  • what to give
  • when to recheck BM
  • can you repeat
  • what to do if BM still low
A

4-5 glucose tablets
check BM after 10-15 minutes
repeat up to 3 times
if BM still < 4 call for help

154
Q

tx hypoglycaemia confused/disoriented or aggressive

A

glucogel
recheck BM after 10-15 min
repeat up to 3 times
if ineffective IM glucagon 1mg

155
Q

tx hypoglycaemia unconscious/fitting

A

IV glucose over 10 mins
- 75ml 20% glucose (or 150ml of 10% glucose)
recheck after 10 minutes
once BM > 4 give 10% glucose infusion at 100ml / hour and restart insulin

156
Q

Tx DKA

A

IV insulin (0.1 unit/kg/hour)
once glucose is < 15mmol/L start 5% dextrose
LMWH
monitor potassium

157
Q

tx HONK

A

insulin sliding scale

158
Q

treatment hyperkalaemia rhyme

A 
Conor Gets - calcium gluconate
A Really - act rapid
Good - glucose 
Score - salbutamol
Conor Really - calcium resonium
Likes Doing - loop diuretic
Drugs - dialysis
159
Q

treatment hyperkalaemia - calcium gluconate

A

10ml calcium gluconate 10% IV

160
Q

treatment hyperkalaemia - insulin and glucose

A

10 units ActRapid and 50ml 50% glucose IV

161
Q

treatment hyperkalaemia - salbutamol

A

2.5mg nebulised

162
Q

reversal of warfarin

A

vitamin K and prothrombin complex concentrate

163
Q

addisonian crisis

A

IV hydrocortison 100mg stat

fluid resus - IV saline or dextrose if hypoglycaemia

164
Q

ix acute phase stroke

A

Non-contrast CT brain

165
Q

presentation 1 week after stroke with mild deficits investigation

A

MRI

166
Q

tx stroke confirmed ischaemic and presenting within 4.5 hours

A

thrombolysis + thrombectomy within 6 hours

167
Q

what is given as soon as haemorrhagic stroke ruled out

A

300mg aspirin

168
Q

what is given if presenting > 4.5 hours of ischaemic stroke

A

300mg aspirin

169
Q

how long is aspirin continued after stroke

A

14 days at least

170
Q

what is given immediately in TIA

A

aspirin 300mg

171
Q

tx acute intracranial venous thrombosus

A

LMWH

warfarin for longer term

172
Q

management of acute variceal upper GI bleed rhyme

A

FKTAB - flirty katharine takes all boys

173
Q

management of acute variceal upper GI bleed

A 
FFP
vitamin K
Terlipressin
Antibiotics 
Endoscopic banding
174
Q

management of acute asthma rhyme

A 
O SHIT ME
oxygen
salbutamol
hydrocortisone
ipratropium
theophylline
mag sulf
escalate
175
Q

management of acute asthma

A

sit up and give high flow O2 via non-rebreather 15L mask
salbutamol nebulised 2.5-5mg
40/50mg prednisolone orally or 500mg hydrocortisone IV
- get help -
Ipratropoium bromide (SAMA) via nebulsier is given for life threat and severe, or if patient hasn’t responded to SABA and steroid
IV theophylline
IV Mag sulf 2g over 20 mins

176
Q

management of thyroid storm

A

IV propranolol
IV dexamethasone
carbimazole
fluids, paracetamol

177
Q

elderly patient on NSAID
raised urea disproportionate to creatinine
shock

A

upper GI bleed - haemorrhagic shock

178
Q

COPD acute treatment rhyme

A 
ISOTAPE
ipratropium
salbutamol
oxygen
theophylline
amoxicillin
prednisolone
escalate
179
Q

tx hypercalcaemia

A

IV saline
following hydration bisphosphonates can be used
calcitonin works quicker than bisphosphonates
furosemide may be used if patient cannot handle aggressive fluid therapy

180
Q

thyroid storm tx

A

IV propranolol
IV dexamethasone
carbimazol/PTU
Lugol’s iodine - later

1. 4th year (23 decks)

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