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Z IPE > Acute Care > Flashcards

Acute Care Flashcards

1
Q

Red flags for headaches

A 
FINE JVPP
	• F - Focal neurological deficit
	• I - Injury
	• N - Neck stiffness
	• E - Early morning headache
	• J - Jaw claudication
	• V - Vomiting or Visual disturbance
	• P - Photophobia or Pregnancy
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2
Q

Thunderclap headache

A

Subarach

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3
Q

Unilateral headache + eye pain

A

cluster

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4
Q

Worse in morning and bending forward

A

raised icp

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5
Q

headahce + scalp tenderness in over 50s

A

Giant cell arteritis

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6
Q

Ix of headaches

A 
BOXES - Bloods:
	• FBC, CRP, U&E
	• ESR
	• Blood culture if pyrexia
	• Meningococcal PCR

Special test:
• LP
CT head

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7
Q

S&S of temporal arteritis

A 
• Headache
	• Rapid onset <1 mth
	• Jaw claudication
	• Visual disturbances
	• Tender palpable temporal artery
Systemic symptoms
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8
Q

Ix of temporal arteritis and tx

A

Ix:
• ESR - >50mm/hr
• Temporal artery biopsy - skip lesions

Tx:
• Prednisolone 250-1000mg IV if visual sx
• Urgent opthalmology review if visual symptoms

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9
Q

Differentials of SOB

A
  1. PE
    1. Pneumothorax
    2. Asthma/COPD
    3. Pneumonia
    4. Acute HF
    5. ACS
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10
Q

Ix for SOB

A

BOXES

Bloods:
	• FBC, U&amp;E, CRP
	• D-Dimer to rule out PE
	• Blood culture if pyrexic
	• ABG

Orifice tests:
• Sputum

X-rays:
• CXR

ECG

Special:
• CTPA for PE

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11
Q

asthma emergency tx

A

O - Oxygen high flow non rebreath 15L
S - Salbutamol nebs 5mg
H - Hydrocortisone 100mg IV
I - Ipratropium 500mcg Neb
T - Theophylline: aminophylline infusion 1g in 1L saline 0.5ml/kg/h
M - Magnesium sulphate 2g IV over 20 mins
E - Escalate care with intubation and ventilation

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12
Q

COPD emergency tx

A 
O - Oxygen 24-28% venturi mask
S - salbutamol nebs 5mg
H - Hydrocortisone 100mg IV
I - Ipratropium 500mcg nebs
T - Theophylline: aminophylline infusion 1g in 1L saline 0.5ml/kg/h

ABG

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13
Q

Decompensated HF tx

A

Management:

1. Sit pt upright
2. 100% oxygen non rebreath mask
3. IV access and ECG. Treat arrhythmias
4. Investigations whilst continuing treatment
5. Diamorphine IV 1.25-5mg
6. Furosemide 40-80mg IV
7. GTN spray 2 puffs. DON’T GIVE IF HEMOCOMPROMISED
8. If systolic >100mmHg, nitrate infusion eg isosorbide dinitrate
9. If pt worsening, consider CPAP

Consider discontinuation of beta blockers in short term.

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14
Q

Anaphylaxis tx

A 
Tx:
	• IM adrenaline 0.5mg repeat every 5 mins up to 3 times
	• 15L oxygen
	• 5mg salb nebs
	• IV fluid challenge
	• Hydrocortisone 200mg IV
	• Chlorphenamine 10mg IV
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15
Q

Choking adult tx

A

Tx:

1. Ask pt to cough - if they can, encourage to cough and monitor
2. If they cant - 5 back blows and then 5 abdo thrusts. Keep going until pt becomes unconscious
3. Unconscious pt:
	a. Begin CPR - even if carotid pulse present
	b. Call for help and ambulance
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16
Q

IHD RFs

A 
IHD RFs - HOPEFULS:
H - HTN
O - Obesity
P - PVD
E - Elevated LDL
F - FHx
U - Up glucose (DM)
L - Low HDLL
S - Smoking, Sex (male), Sedentary
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17
Q

Chest pain differentials acute

A

3Ps, 2As

1. ACS
2. PE
3. Aortic dissection
4. Pnuemothorax
5. Pneumonia
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18
Q

Chest pain ix

A

BOXES - Bloods - trop, FBC, WBC, CRP
CXR
ECG
CTPA (PE), CT angio (aortic dissection)

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19
Q

Give wells score criteria. When do you anticoagulate?

A 
Don’t Die, Tell The Team To Calculate Criteria:
D - DVT
D - Diagnosis most likely PE
T - Tachycardia
TT - Three days immobility 
T - Thromboembolism in past
C - Coughing up blood
C - Cancer

2 or more anticoagulate

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20
Q

Acute STEMI tx

A

STEMI Management:

1. Use ECG monitor
2. Bloods for FBC, U&amp;E, glucose, lipids, cardiac enzymes
3. Assess PCI or fibrinolysis contraindications
4. Aspirin 300mg PO + prasugrel (if no contra) + LMWH
5. Morphine 5-10mg IV + metoclopramide 10mg IV
6. Is PCI available within 120 mins?
	a. Yes - pci
	b. No- Fibrinolysis (tPA) with rescue PCI if not successful

Acute Treatment (MONA):
• M - Morphine + metoclopramide
• O - Oxygen (if O2 <94%)
• N - Nitrates (if hemocompromised DO NOT USE)
• A - Antiplatelets (aspirin + prasugrel)

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21
Q

Post MI prevention and depression tx

A 
Post MI prevention:
	• Lifelong therapy of:
		○ Aspirin
		○ Antiplatelet eg clopidogrel
		○ Beta blocker
		○ ACEi
		○ Statin
	• Lifestyle advice:
		○ Mediterranean diet
		○ Exercise - until slight breathlessness
		○ Sex 4 weeks post uncomplicated MI.
	• Depression:
		○ Treat with sertraline
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22
Q

Contraindications to PCI for MI

A 
Contraindications to PCI:
	• Due to antiplatelets
	• High risk of bleeding
	• Allergy 
	• Uncontrolled HT
	• Stroke 
	• Bleeding disorders
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23
Q

PE tx - how long treatment?

A

Anticoagulant:
• Enoxaparin used until the diagnosis confirmed
• Then switch to warfarin after INR in target range. There will be drug overlap.

Length of anticoag:
• If PE precipitated by known event - 3 to 6 months
• If due to unknown event - 6 months minimum.
• If due to malignancy - 6 month anticoag

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24
Q

S&S of tension pneumo. tx

A

Examination:
• Pt looks ill
• Mediastinal shift
• Haemodynamic instability as tension compresses mediastinum

ABCDE + immediate large bore cannula 2nd ICS MCL

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25
Q

S&S of aortic dissection

A 
S&amp;S:
	• Tearing pain, sudden onset
	• Radiates into back
	• Hypertension
	• Blood pressure difference between arms greater than 20 mmHg
	• Neurological deficits
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26
Q

Ix for aortic dissection

A

Investigations:
• CXR - widened mediastinum, abnormal aortic knob, tracheal and oesophageal deviation
• CT angiography of thoracic aorta
• MRI angiography

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27
Q

RFs for aortic dissection

A 
RFs:
	• Hypertension
	• Trauma
	• Collagen deficiency - marfans, ehlers danlos
	• Turners and noonans syndrome
	• Pregnancy
28
Q

Severity scoring of pneumonia and what score means?

A

Severity assessed with CURB-65:
• Confusion = 1
• Urea > 7 = 1
• Respiratory rate > 30 breaths per minute= 1
• Systolic blood pressure < 90 mmHg / Diastolic < 60 mmHg = 1
• Age > 65 = 1

Score >2 admit to hospital.
Score >4 (30% mortality) consider ICU.

29
Q

Define HAP

A

onset of sx 48 hrs post admission

30
Q

Organisms causing community acquired pneumonia

A

1) strep pneumoniae
2) H influenzae
3) staph aureus

31
Q

Tx of pneumonia, HAP and CAP

A

Management:
• Low/moderate severity - oral amoxicillin. Add macrolide if admitted to hospital
• high severity CAP: intravenous co-amoxiclav + clarithromycin OR cefuroxime + clarithromycin
• HAP - Gentomycin IV and cephalosporin

PT follow up with pneumococcal vaccine and flu vaccine with CXR 6 weeks later

32
Q

HAP organisms

A

Staph aureus, gram neg enterobacteria, pseudomonas aeruginosa

33
Q

Abdo pain differential generalised

A

Generalised:

1. Peritonitis
2. AAA
3. Ischemic bowel
4. Medical causes (DKA, pneumonia, MI, Addisonian crisis)
34
Q

RUQ abdo pain differentials

A

Hepatitis, cholecystitis

35
Q

LUQ abdo pain differentials

A

LUQ:

1. Peptic ulcer
2. Pancreatitis
36
Q

abdo pain ix

A

BOXES

Bloods:
	• FBC, CRP, U&amp;E
	• LFTs, amylase
	• INR
	• Glucose
	• VBG (lactate)

Orifice tests:
• Urine dip
• Urine beta HCG

Xrays:
• Erect CXR
• AXR if SBO

ECG

Special test:
• FAST scan for AAA
• USS/CT abdo

37
Q

AAA ruptured S&S

A

syncope, shock, abdo and back pain, vomiting, pulsatile mass in abdo

38
Q

Tx of ruptured AAA

A

A-E
Management:
• High flow O2, IV access
• Bloods - FBC, U&E, clotting, cross match
• Fluids and O- Blood. Keep systolic below 100mmHg (permissive hypotension)
• Unstable pt - immediate open surgical repair
• Stable pt - CT angiogram to see if EV repair is possible

39
Q

Small bowel obstruction abdo pain causes

A

Hernia, adhesions

40
Q

S&S of small bowel obstruction abdo pain

A

S&S:
• Colicky abdo pain - True waxing and waning
• Vomiting - Gastric contents –> bile –> feces
• Abdo distension
• Absolute constipation - no flatus or feces
• Tinkling or absent bowel sounds
• Tympanic (hollow) sound on percussion
• FOCAL TENDERNESS = ISCHEMIA

41
Q

Ix for SBO

A 
Investigations:
	• ABG - serum lactate
	• Routine bloods - high urea and hypokalaemia may be present
	• AXR:
		○ Dilated bowel >3cm
		○ Visible valvulae conniventes
		○ Erect xray for free gas
	• CT abdo - find cause of obstruction
42
Q

Ischemic red flags of SBO

A

ISCHEMIC RED FLAGS:
• FOCAL TENDERNESS
• PAIN WAS COLICKY NOW CONSTANT

43
Q

Tx of SBO

A 
Tx:
	• Conservative - first line if no ischemia:
		○ NBM
		○ IV fluids + catheter
		○ Analgesia + metoclopromide
	• Laparotomy indicated for:
		○ Ischemia
		○ SBO in virgin abdomen
		○ No improvement in 48 hrs
44
Q

Causes of abdo distension

A 
Abdo distension Causes - 6Fs:
	• Fluid
	• Fat
	• Flatus
	• Feces
	• Fetus
	• Fucking big tumour
45
Q

Precipitating factors of a DKA

A

Precipitating factors:
• Infection
• Missed insulin doses
• MI

46
Q

Ix of DKA

A 
Ix:
	• Glucose >11
	• pH <7.3
	• Bicarb <15mmol
	• Ketones >3mmol or urine ketones ++
47
Q

S&S of DKA

A 
S&amp;S:
	• Abdo pain
	• Polyuria, polydipsia, dehydration
	• Deep hyperventilation - Kussmaul resp
	• Pear drop smelling breath
48
Q

Tx of DKA

A 
Tx:
	• VBG, BM, U&amp;E
	• Saline fluids
	• Insulin IV infusion - 0.1u/kg/h
	• Correct hypokalaemia (due to insulin)
49
Q

Addisonian crisis occurs in what pts?

A

Occurs in pts on LT steroids that suddenly stop or not increased during illness

50
Q

Tx of addisonian crisis

A 
Tx:
	• Bloods for cortisol and ACTH. U&amp;Es (high K and low Na)
	• Hydrocortisone 100mg IV stat
	• Support BP
	• Monitor BMs.
51
Q

Tx of cholecystitis

A

Management:
• Antibiotics - IV coamox and metronidazole
• Fluid resus pathway if signs of sepsis evident
• NG tube if pt vomiting
• Cholecystectomy necessary

52
Q

Tx of pancreatitis

A 
Management:
	• High flow O2
	• IV fluids - 500ml/hr of crystalloid
	• Nasogastric tube if pt vomiting
	• Catheterisation to monitor urine output
	• Opioid analgesia
53
Q

Ix of pancreatitis

A

Investigations:
• Serum amylase - 3x upper limit of normal
• LFTs - gallstones can cause pancreatitis
• Serum lipase
• Imaging - USS AP and CT scan

54
Q

Red flag sx of sepsis?

A 
Red flag symptom + suspected infection:
	• Systolic BP <90mm or >40mmhg fall from baseline
	• UO <0.5ml/kg/h
	• HR >130 bpm
	• RR >25 per min
	• AVPU = V, P, or U
55
Q

Signs of TCA OD?

A 
Severe poisoning features:
	• Arrhythmia
	• Seizures
	• Metabolic acidosis
	• Coma
56
Q

Tx of TCA OD

A

Management:
• IV bicarb
• IV lipid emulsion

57
Q

S&S of amphetamine OD and TX?

A 
S&amp;S:
	• Dilated pupils
	• HTN
	• Tachycardia
	• Skin pallor
	• Hyperexcitable
	• Paranoia

Tx:
• Sedate with BZD if agitated
• Cool if necessary
• Monitor HTN

58
Q

S&S of BZD OD

A 
S&amp;S:
	• Drowsiness
	• Slurred speech
	• Hypotension
	• Resp depression
59
Q

Tx of BZD OD

A

Tx:
• Gastric lavage if recent ingestion
• Flumazenil

60
Q

antidote to digoxin posioning

A

Antidote - Digoxin immune fab

61
Q

Tx of status epilepticus

A

Tx:
• 1st line - IV lorazepam
• 2nd line - BZD ineffective within 10 mins –> IV phenytoin, sodium valproate, or levetiracetam
• 3rd line - 30 mins of SE –> general anasthesia

62
Q

Ix of hypoglycaemia

A

Ix:

• BM <2.5mmol

63
Q

Tx of hypoglycaemia

A

Tx:

1. Conscious - 250ml of lucozade, 3 glucose tablets, glucogel
2. IV glucose 200 ml of 10% solution in 50 ml aliquots
3. Repeat glucose testing every 10 mins until stable
4. Review reasons for hypoglyc
64
Q

S&S of hyperosmolar hyperglycaemia state

A 
S&amp;S:
	• Focal CNS signs - tremors, motor or sensory impaired
	• Decreased GCS
	• Reduced BP
	• DIC
	• Leg ischemia
65
Q

Ix of HHS

A 
Ix:
	• Low BP - dehydration
	• Osmolality >320mOsmol/kg
	• >30mmol BM
	• pH >7.3
	• Bicarb >15mmol
66
Q

Tx of HHS

A 
Tx:
	• LMWH
	• Saline fluids
	• Replace potassium
	• ONLY USE INSULIN IF BM NOT FALLING WITH ABOVE
67
Q

Tx of bites?

A

Tx:

1. Clean with soap and water
2. Check tetanus status
3. Ppx against infection eg co-amox
4. Consider risk of HIV or hep B if human bite

Z IPE (15 decks)

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