Acute Care Flashcards
MI R/Fs?
HTN, Diabetes, hypercholesterolaemia, Smoking FH
If young: cocaine use
MI ECG findings?
2mm ST elevation in consecutive chest leads (1-6)
1mm in the limb leads (1-3 & avF)
MI diagnostic criteria?
ST elevation in correct leads
Reciprocal changes in opposite leads
New LBBB (W)
O/E someone with a PE?
RR will be increased, HR may be increased.
Chest sounds will be normal.
Abdo pain differential?
- Ectopic pregnancy
- abdo aortic aneurysm
- Pancreatitis
- testicular torsion
- hernias (inguinal, femoral and paraumbilical)
- Volvulus
- Appendicitis
- Ruptured ovarian cyst
Chest pain differential?
- STEMI
- NSTEMI
- Unstable angina
- PE
- Aortic dissection
- Pericarditis
- GORD
- Trauma
Headache differential?
- SAH
- Meningitis
- Temporal Arteritis
- Intracerebral venous thrombosis
- Extra dural haem
- subdural haem
- SOL
- Acute closed angle glaucoma
What should you administer with morphine?
Ondansetron - antiemetic
What are you really trying to avoid/worst complication of a PE?
Cardiac arrest
Precipitating events for DKA?
4 I’s
Infection
infarction
Intercurrent medical problems
Insulin lock up (forgot to take)
What are the potassium changes in DKA?
Insulin drives potassium into cells so in DKA when resuscitating, need to give K+
Types of Heart Block?
1st degree: fixed prolonged PR interval (>5ss)
Mobitz 1: PR interval slowly creeps up and up then a qrs is dropped
Mobitz 2: Fixed PR interval, with occassional dropped beats (these occur in regular patterns i.e. 2:1, 3:1)
Complete: P waves are not associated with QRS at all
What blood test result gives you one of the best predictors of arteritis?
ESR (>100)
Normal urine output?
> 1ml/kg per hour
Some things that may cause metabolic acidosis?
DKA
Poisoning
AKI
What is an anion gap, normal range?
Essentially the difference between the bloods cations and anions.
Generally subtract Chloride and bicarb from soidum and potssium (sometimes not included)
10-20 when including K+
8-16 when not
Causes of an abnormal anion gap?
MUDPILES
M - Methanol U - Uraemia D - DKA P - Paracetamol/antfreeze (propolene glycol) I - Iron L - Lactic acidosis E - Ethanol/ethylene glycol (antifreeze) S - Salicylates - aspirin
Changes to the WCC, Neutrophils and temp in bacterial and viral infections/
Neutropaenia in Viral
Decreased WCC in Viral
Increased WCC in bacterial
Spiking temp in both, but maybe more in Viral
Causes of a raised urea:creatinine ratio?
Dehydration
GI haemorrhage
Raised protein diet
Causes of a lowered urea:creatinine ratio?
Liver dysfunction
SIADH
Malnutrition
Unstable angina presentation?
Comes on rapidly - crescendo angina (as in suddenly getting worse)
What may you see on a CXR in a PE?
Not much really:
You may see blacker lungs (radiolucent)
Pleural effusion
Infarct (wedge shaped)
ECG changes in PE?
S wave in T1
RBBB
Inverted T waves
Sinus tachy
What may cause people to have hypoglycaemia in diabetes?
They have probably taken too much insulin
