acute care Flashcards
1
Q
3 sections of glasgow coma scale?
A
eyes
voice
motor
2
Q
total score?
A
15
3
Q
score of what or less than what is coma?
A
8
4
Q
open eyes to verbal stimulus, what score do they get in voice?
A
3
5
Q
open eyes spontaneously, what do they get?
A
4
6
Q
open eyes to pain ?
A
2
7
Q
eyes shut ?
A
1
8
Q
voiceless score?
A
1
9
Q
inappropriate words?
A
3
10
Q
confused/disorientated?
A
4
11
Q
elegant speech?
A
5
12
Q
obscure, incoherent sounds ?
A
2
13
Q
obeys motor?
A
6
14
Q
draws from pain?
A
4
15
Q
no motor?
A
1
16
Q
localises to pain?
A
5
17
Q
pulls away from nail bed pressure - score ?
A
4
18
Q
do you get more points for decorticate or decerebrate position ?
A
decorticate
19
Q
in decerebrate position, are the elbows flexed or extended?
A
extended
20
Q
a GCS score of what or less indicates a person is completely unresponsive?
A
3
21
Q
what are the three mechanisms of secondary brain injury?
A
inflammation (due to loss of BBB)
hypoperfusion (hypoxia, hypercapnia, cerebral oedema)
increased ICP (haematoma or oedema)
22
Q
cerebral perfusion pressure =
A
MAP - ICP
23
Q
what happens when ICP rises
A
cerebral perfusion pressure drops
24
Q
what does drop in cerebral perfusion pressure cause?
A
hypoxia, hypercapnia, and further rise in ICP
25
name of the raise BP following increase in ICP to overcome?
cushings reflex
26
what does cushings reflex cause?
HTN, bradycardia and irregular breathing
27
subconjunctival Hämorrhagie, bleeding out ear and CSF out nose are signs of?
skull fracture
28
panda eyes sign of?
anterior fossa fracture
29
battle sign ?
middle fossae
30
middle fossea fracture encompasses to temporal bone. what can this cause?
SNHL
| facial palsy
31
most common inter cranial haemorrhage?
sub dural and extra dural
32
what does raised ICP normally require ?
neurosurgery
33
what measures can be used in raised ICP
mannitol
| sedation, incububation and hyperventilation
34
tear drop sign?
blow out fracture
35
blow out fracture is fracture of what?
orbital floor
36
what muscle gets trapped in orbital blow out?
inferior rectus
37
what will the eye look like in blow out fracture?
red eye
| recessed eye
38
what signs do you get on blow out fracture?
ipsilateral nose bleed, double vision, can't look up
39
name of procedure to fix septal deviation ?
septoplasty
40
when do you review a broken nose
5 days
41
management of a haemoatoma after broken nose?
urgent incision and drainage
42
important information to tell someone with a blow out fracture
don't blow nose
43
what three things do you give in anapylaxis?
CHA DU RI
chlorphenamine (10mg) chlortenamine
hydrocortisone (200mg)
adrenaline 500mcg IM
44
what do you give in terms of fluid in anaphylaxis?
crystalloid
45
what must you stop in anaphylaxis?
colloid, as it may have caused it
46
why are crystalloids called this?
crystals can form in them
47
examples of crystalloids?
saline and dextrose
48
what do you give in adult bradycardia?
500mcg atropine
49
further treatment of bradycardia?
repeat atropine up to 6 times
50
treatment mnemonic of bradycardia?
```
RIAT
repeat atropine
isoprenaline 5mcg IV
Adrenaline 2--10mcg
transcutaneous wiring
```
51
adult tachycardia
AMAD beta blocker
amiodarone 300mg 10-20 mins
adenosine 6mg IV bolus
beta blocker/CCB rate control possibly AF
52
4 Ts and 4Hs of cardiac arrest ?
hypoxia
hypovolaemia
hypothermia
hypo/hyperkalaemia
Toxins
thrombosis
tamponade
tension pneumothorax
53
breath to compression ratio ?
30:2
54
how deep should compressions be ?
5-6cm
55
what energy at shocks delivered at?
150J
56
the two shockable rhythms?
VF and pulseless VT
57
unshockable rythyms ?
pulseless electrical activity, asystole
58
blood pressure = _____ x CO
TPR
59
what does failure to maintain MAP ultimately lead to?
slow flow
thrombus formation
inadequate perfusion
lactate formation
60
why high lactate in bowel ischaemia
anaerobic producing lactate
61
lactic accumulation causes
acidosis
62
lactic acidosis causes?
decreased tissue function, necrosis and organ failure
63
confusion, mottling, agitation and oliguria. high lactate, increased resp rate and low BP and tacky. signs of
shock
64
why do you need to be careful in fluid resucitation in shock?
risk of acute heart failure and fluid overload
65
causes of obstructive shock
PE
tension pneumothorax
cardiac tamponade
66
what happens when you get reduced pre load ?
reduced contractility and output
67
what would JVP and neck veins be like in obstructive ?
raised JVP and distended neck veins
68
how could you get hypovolaemic shock?
dehydration, vomiting, burns, adesonian crisis, pancreatitis
69
presentation of hypovolaemic shock?
cool, cold peripheries
dry mucous membranes
thready pulse
Low JVP
70
causes of distributive shock?
sepsis
anaphylaxis
cord damage
71
what would someone with distributive shock present like
```
decreased blood pressure
increased cardiac output
fever
flushed peripheries
increased cap refill
bounding pulse
```
72
what do you start in distributive shock?
sepsis 6
73
where is paracetamol metabolised?
in the liver
74
how many pathways are there for the metabolism of paracetamol?
2
75
what is a metabolite of paracetamol which is toxic to the liver
NAPQI
76
how is NAPQI usually handled?
handled via glutathione
77
in overdose, what is there an increase in ?
NAPQI
78
what is the maximum dose of paracetamol per day?
4 g
79
what is paracetamol over dose classed as?
over 4g per day
80
what is an acute over dose classed as?
over 4g in last hour
81
toxic overdose of paracetamol classed as?
over 150mg/kg
82
if the patient is over 110kg what do you use as the weight
110kg
83
how would someone present early with paracetamol overdose?
nausea, vomiting and abdo pain
84
how would paracetamol overdose late present?
liver damage, jaundice, hypoglycaemia, encephalopathy
85
what liver marker is most likely to be raised and when does this happen?
AST
| 18-24 hours
86
when is the earliest a paracetamol level can be checked?
4 hours after
87
when is paracetamol level no longer accurate ?
after 24 hours
88
what is given in paracetamol overdose?
n acetyl cysteine (parvolex)
89
what does acetyl cysteine do?
mops up NAPQI
90
how is the treatment decided?
amount they took and how long ago they took it
91
what can be used t decide this and what is the cut off?
graph of amount taken against time. 100mg is cut off
92
if they present within 8 hours of overdose - management?
if over 150kg. wait 4 hours to send off paracetamol level s
93
present 8-24 hours
send urgent level
treat blindly based on assumption they've taken >150mg/kg
can then continue/discontinue based on paracetamol level
94
how do you treat after 24 hours?
treat if serum levels >5mg
if INR normal but ALT more than double
INR >1.3 but ALT less than 2x normal
also treat if symptomatic
95
treatment of opiod overdose?
400mcg bolus naloxone
96
BZD overdose?
flumazenil
97
aspirin overdose?
no tx - bicarbonate infusion if acid
98
salbutamol overdose treatment
nil
| potassium infusion
99
beta blocker overdose
glucagon
100
TCA overdose ?
nil
| potassium infusion
101
anti freeze overdose?
fomepozil
102
CO overdose?
oxygen
103
amphetamine overdose management?
nil
