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acute care > acute care > Flashcards

acute care Flashcards

1
Q

3 sections of glasgow coma scale?

A

eyes
voice
motor

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2
Q

total score?

A

15

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3
Q

score of what or less than what is coma?

A

8

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4
Q

open eyes to verbal stimulus, what score do they get in voice?

A

3

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5
Q

open eyes spontaneously, what do they get?

A

4

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6
Q

open eyes to pain ?

A

2

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7
Q

eyes shut ?

A

1

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8
Q

voiceless score?

A

1

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9
Q

inappropriate words?

A

3

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10
Q

confused/disorientated?

A

4

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11
Q

elegant speech?

A

5

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12
Q

obscure, incoherent sounds ?

A

2

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13
Q

obeys motor?

A

6

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14
Q

draws from pain?

A

4

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15
Q

no motor?

A

1

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16
Q

localises to pain?

A

5

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17
Q

pulls away from nail bed pressure - score ?

A

4

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18
Q

do you get more points for decorticate or decerebrate position ?

A

decorticate

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19
Q

in decerebrate position, are the elbows flexed or extended?

A

extended

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20
Q

a GCS score of what or less indicates a person is completely unresponsive?

A

3

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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)

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22
Q

cerebral perfusion pressure =

A

MAP - ICP

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23
Q

what happens when ICP rises

A

cerebral perfusion pressure drops

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24
Q

what does drop in cerebral perfusion pressure cause?

A

hypoxia, hypercapnia, and further rise in ICP

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25
Q

name of the raise BP following increase in ICP to overcome?

A

cushings reflex

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26
Q

what does cushings reflex cause?

A

HTN, bradycardia and irregular breathing

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27
Q

subconjunctival Hämorrhagie, bleeding out ear and CSF out nose are signs of?

A

skull fracture

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28
Q

panda eyes sign of?

A

anterior fossa fracture

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29
Q

battle sign ?

A

middle fossae

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30
Q

middle fossea fracture encompasses to temporal bone. what can this cause?

A

SNHL

facial palsy

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31
Q

most common inter cranial haemorrhage?

A

sub dural and extra dural

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32
Q

what does raised ICP normally require ?

A

neurosurgery

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33
Q

what measures can be used in raised ICP

A

mannitol

sedation, incububation and hyperventilation

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34
Q

tear drop sign?

A

blow out fracture

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35
Q

blow out fracture is fracture of what?

A

orbital floor

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36
Q

what muscle gets trapped in orbital blow out?

A

inferior rectus

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37
Q

what will the eye look like in blow out fracture?

A

red eye

recessed eye

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38
Q

what signs do you get on blow out fracture?

A

ipsilateral nose bleed, double vision, can’t look up

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39
Q

name of procedure to fix septal deviation ?

A

septoplasty

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40
Q

when do you review a broken nose

A

5 days

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41
Q

management of a haemoatoma after broken nose?

A

urgent incision and drainage

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42
Q

important information to tell someone with a blow out fracture

A

don’t blow nose

43
Q

what three things do you give in anapylaxis?

A

CHA DU RI
chlorphenamine (10mg) chlortenamine
hydrocortisone (200mg)
adrenaline 500mcg IM

44
Q

what do you give in terms of fluid in anaphylaxis?

A

crystalloid

45
Q

what must you stop in anaphylaxis?

A

colloid, as it may have caused it

46
Q

why are crystalloids called this?

A

crystals can form in them

47
Q

examples of crystalloids?

A

saline and dextrose

48
Q

what do you give in adult bradycardia?

A

500mcg atropine

49
Q

further treatment of bradycardia?

A

repeat atropine up to 6 times

50
Q

treatment mnemonic of bradycardia?

A 
RIAT 
repeat atropine 
isoprenaline 5mcg IV 
Adrenaline 2--10mcg 
transcutaneous wiring
51
Q

adult tachycardia

A

AMAD beta blocker
amiodarone 300mg 10-20 mins
adenosine 6mg IV bolus
beta blocker/CCB rate control possibly AF

52
Q

4 Ts and 4Hs of cardiac arrest ?

A

hypoxia
hypovolaemia
hypothermia
hypo/hyperkalaemia

Toxins
thrombosis
tamponade
tension pneumothorax

53
Q

breath to compression ratio ?

A

30:2

54
Q

how deep should compressions be ?

A

5-6cm

55
Q

what energy at shocks delivered at?

A

150J

56
Q

the two shockable rhythms?

A

VF and pulseless VT

57
Q

unshockable rythyms ?

A

pulseless electrical activity, asystole

58
Q

blood pressure = _____ x CO

A

TPR

59
Q

what does failure to maintain MAP ultimately lead to?

A

slow flow
thrombus formation
inadequate perfusion
lactate formation

60
Q

why high lactate in bowel ischaemia

A

anaerobic producing lactate

61
Q

lactic accumulation causes

A

acidosis

62
Q

lactic acidosis causes?

A

decreased tissue function, necrosis and organ failure

63
Q

confusion, mottling, agitation and oliguria. high lactate, increased resp rate and low BP and tacky. signs of

A

shock

64
Q

why do you need to be careful in fluid resucitation in shock?

A

risk of acute heart failure and fluid overload

65
Q

causes of obstructive shock

A

PE
tension pneumothorax
cardiac tamponade

66
Q

what happens when you get reduced pre load ?

A

reduced contractility and output

67
Q

what would JVP and neck veins be like in obstructive ?

A

raised JVP and distended neck veins

68
Q

how could you get hypovolaemic shock?

A

dehydration, vomiting, burns, adesonian crisis, pancreatitis

69
Q

presentation of hypovolaemic shock?

A

cool, cold peripheries
dry mucous membranes
thready pulse
Low JVP

70
Q

causes of distributive shock?

A

sepsis
anaphylaxis
cord damage

71
Q

what would someone with distributive shock present like

A 
decreased blood pressure 
increased cardiac output 
fever 
flushed peripheries 
increased cap refill 
bounding pulse
72
Q

what do you start in distributive shock?

A

sepsis 6

73
Q

where is paracetamol metabolised?

A

in the liver

74
Q

how many pathways are there for the metabolism of paracetamol?

A

2

75
Q

what is a metabolite of paracetamol which is toxic to the liver

A

NAPQI

76
Q

how is NAPQI usually handled?

A

handled via glutathione

77
Q

in overdose, what is there an increase in ?

A

NAPQI

78
Q

what is the maximum dose of paracetamol per day?

A

4 g

79
Q

what is paracetamol over dose classed as?

A

over 4g per day

80
Q

what is an acute over dose classed as?

A

over 4g in last hour

81
Q

toxic overdose of paracetamol classed as?

A

over 150mg/kg

82
Q

if the patient is over 110kg what do you use as the weight

A

110kg

83
Q

how would someone present early with paracetamol overdose?

A

nausea, vomiting and abdo pain

84
Q

how would paracetamol overdose late present?

A

liver damage, jaundice, hypoglycaemia, encephalopathy

85
Q

what liver marker is most likely to be raised and when does this happen?

A

AST

18-24 hours

86
Q

when is the earliest a paracetamol level can be checked?

A

4 hours after

87
Q

when is paracetamol level no longer accurate ?

A

after 24 hours

88
Q

what is given in paracetamol overdose?

A

n acetyl cysteine (parvolex)

89
Q

what does acetyl cysteine do?

A

mops up NAPQI

90
Q

how is the treatment decided?

A

amount they took and how long ago they took it

91
Q

what can be used t decide this and what is the cut off?

A

graph of amount taken against time. 100mg is cut off

92
Q

if they present within 8 hours of overdose - management?

A

if over 150kg. wait 4 hours to send off paracetamol level s

93
Q

present 8-24 hours

A

send urgent level
treat blindly based on assumption they’ve taken >150mg/kg
can then continue/discontinue based on paracetamol level

94
Q

how do you treat after 24 hours?

A

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
Q

treatment of opiod overdose?

A

400mcg bolus naloxone

96
Q

BZD overdose?

A

flumazenil

97
Q

aspirin overdose?

A

no tx - bicarbonate infusion if acid

98
Q

salbutamol overdose treatment

A

nil

potassium infusion

99
Q

beta blocker overdose

A

glucagon

100
Q

TCA overdose ?

A

nil

potassium infusion

101
Q

anti freeze overdose?

A

fomepozil

102
Q

CO overdose?

A

oxygen

103
Q

amphetamine overdose management?

A

nil

acute care (2 decks)

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