Acute Care Flashcards
What assessments and interventions would you make for someone’s Airway?
Look (obstruction, breathing, resp muscles, cyanosis)
Listen (stridor, snoring, gurgling)
Intervene: head-tilt, chin-lift, jaw-thrust
What assessments and interventions would you make for someone’s Breathing?
Look (chest movement, rate, depth, cyanosis)
Listen (breath sounds bilaterally)
Feel (air movement, trachea)
O2 sats
Intervene: high-flow O2, ventilatory support
What assessments and interventions would you make for someone’s Circulation?
Pulse, blood pressure, cap refill, JVP
Intervene: 2x IV access, fluids, blood samples, ECG
What assessments and interventions would you make for someone’s Disability?
AVPU, glucose, GCS, pupil reation and size
Intervene: glucose
What assessments and interventions would you make for someone’s Exposure?
Temperature, injury, rashes
What is the minute volume (in regards to respiration) comprised of?
Tidal volume x Respiratory Rate
Alveolar ventilation + Dead space ventilation
A healthy lung would have ventilation:perfusion (V:Q) ratio of 1. What would the V:Q ratio be in a shunt?
Q would be higher than V, signifying wasted perfusion
A healthy lung would have ventilation:perfusion (V:Q) ratio of 1. What would the V:Q ratio be if there is dead space?
V would be higher than Q, signifying wasted ventilation
Why does CO2 retention suggest low alveolar ventilation?
Due to physiological dead space, alveoli aren’t perfused and there is an overall decrease in alveolar ventilation, which impedes CO2 elimination
What is the consequence of alveolar hypoventilation and increase in alveolar CO2?
Hypoxia
Opioid analgesia is the commonest cause of hypercapnia secondary to reduced hypoxic drive. True/False?
True
What is hypoxic drive of respiration?
Due to chronic hypercapnia, body relies on O2 levels to control breathing - if high O2 levels detected, respiratory drive/effort will be decrease
This is why caution should be taken when giving high-flow O2 to COPD patients
What is cardiogenic shock?
Reduction in cardiac output due to reduced stroke volume due to reduced contractility
Essentially, “pump failure”
What is obstructive shock?
Mechanical obstruction of flow causes hypoperfusion
Caused by impaired filling or emptying of heart
What is hypovolaemic shock?
Inadequate circulating volume causes hypoperfusion
What is distributive shock?
Peripheral vasodilation causes reduced vascular resistance and thus fall in blood pressure
Results in inappropriate distribution of blood flow
List clinical features of tricyclic antidepressant/amphetamine
poisoning
Dilated pupils Divergent squint Tachycardia Hyper-reflexia Extensor plantar response
List clinical features of barbiturates/BZD/opioid poisoning
Coma Hypotension Respiratory depression Pin-point pupils Hypo-reflexia
List clinical features of salicylate poisoning
Tinnitus, deafness Hyperventilation Sweating Nausea Tachycardia
What are the most useful investigations in poisoned patients?
Paracetamol levels Salicylate levels Blood glucose ABG's Urea and electrolytes
What is the antidote for beta-blocker poisoning?
Glucagon
Atropine
What is the antidote for carbon monoxide poisoning?
Oxygen
What is the antidote for iron poisoning?
Desferrioxamine
What is the antidote for opioid poisoning?
Naloxone
What is the antidote for paracetamol poisoning?
Acetylcysteine
Methionine
What is the antidote for sulfonylurea poisoning?
Glucose
Octreotide
What is the antidote for warfarin poisoning?
Vitamin K
Clotting factors
FFP
List risk factors/drugs that can precipitate paracetamol poisoning
Alcoholics Malnutrition (drugs that induce hepatic enzymes) Anticonvulsants Rifampicin St John's wort
List clinical features of paracetamol poisoning
Nausea, vomiting Abdo pain Tenderness over liver Jaundice Coma, hepatic encephalopathy (much later)
Liver function tests are usually normal in paracetamol poisoning until 18 hours after overdose. True/False?
True
Which test is the most sensitive lab evidence of liver damage from paracetamol poisoning after 24 hours?
Prolonged INR
List side effects of acetylcysteine/Parvolex
Erythema, urticaria around infusion site Generalised rash, itch Nausea Angioedema Bronchospasms Hypo/hyper tension
What should be given if skin/allergic reactions occur with Parvolex?
IV chlorphenamine
How is paracetamol poisoning managed within 4 hours of ingestion?
Activated charcoal if within 1 hour
IV acetylcysteine/oral methionine if not
List indications for urgent CT scan following a head injury
GCS less than 13 GCS of 13 or 14 after 2 hours Suspected open/depressed fracture Any sign of basal skull fracture Post-traumatic seizure Focal neurological deficit Post-traumatic amnesia of over 30 mins Persistent vomiting Coagulopathy Significant mechanism of injury
What is the GCS made up of?
Eye response (4) Verbal response (5) Motor response (6)
List the eye response components of the GCS
1- no eye opening
2- eye opens to pain
3- eye opens to voice
4- spontaneous eye opening
List the verbal response components of the GCS
1- no vocal response 2- incomprehensible speech 3- inappropriate speech 4- confused speech 5- orientated/normal speech
List the motor response components of the GCS
1- no motor response 2- extends to pain 3- flexes to pain 4- withdraws from pain 5- localises pain 6- obeys commands
What is the triple airway maneuvre?
Head tilt
Chin lift
Jaw thrust
How do you size up an oropharyngeal (Guedel) airway?
Distance from angle of jaw to corner of patient’s mouth
List the main airway adjuncts used
Guedel airway
Nasopharyngeal airway
Bag-valve mask
What is the daily maintenance requirement of H2O?
1.5 ml / kg / h
Roughly 2-3L a day
What is the daily maintenance requirement of Na?
1-2 mmol / kg / day
What is the daily maintenance requirement of K?
0.5 - 1 mmol / kg / day
Urine output should be greater than ___ ml/kg/h
Urine output should be greater than 0.5 ml/kg/h
List the Na, Cl, K, HCO3 and glucose concentrations in normal plasma
Na: 135-145 Cl: 100-110 K: 3.5-5 HCO3: 22-26 Glucose: 3.5-7.8
List the Na, Cl, K, HCO3 and glucose concentrations in normal saline 0.9%
Na: 154 Cl: 154 K: nil HCO3: nil Glucose: nil
List the Na, Cl, K, HCO3 and glucose concentrations in Hartmann’s solution
Na: 131 Cl: 111 K: 5 HCO3: 29 Glucose: nil
List the Na, Cl, K, HCO3 and glucose concentrations in dextrose-saline
Na: 30 Cl: 30 K: nil HCO3: nil Glucose: 40g
Which type of fluid is good for replacing plasma loss?
Hartmann’s solution
How do you calculate someone’s fluid requirements?
Overall requirement = maintenance requirement + replacement of losses
Calculate requirements over 24 hours
List causes of extracellular fluid loss
Diarrhoea and vomiting NG aspirates Stoma Burns Pancreatitis
What is typically used to replace extracellular fluid losses?
Hartmann’s
Which type of fluid is typically given for normal maintenance fluids?
Dextrose-saline
What fluid would you prescribe for an acutely hypotensive patient in whom cause is uncertain?
250-500ml saline over 5 mins, then reassess