Acute Care Flashcards
what are teh indications for central venous catheter insertion
monitoring of central venous pressure
venous acces for haemodialysis
venous access for cardiac pacing
administration of inotropes, cytotoxic agents or parenetral nutrition
what are teh 4 main sites for central venous catheter insertion
internal jugular
subclavian
femoral
antecubital fossa
what is the correct placement of a central venous catheter
tip sitting in the right atrium
what is an inotrope
a substance that affects the force of muscular contraction either positively or negatively
what is a vasopressor
a substance which increases the systemic vascular resistance
what is the lebel of care 0
stabel patient on routine ward
what is teh level of care 1
at risk of deteriorating
what is the level of care 2
HDU - NIV or support for single organ failure
what is teh level of care 3
ICU - advanced resp support or multiorgan failure
how do you calculate an anion gap
(Na+K) - (Cl + HCO3)
what is the normal anion gap
12+/-4
what are the causes of a raised anion gap metabolic acidosis
MUDIPLES
methanol ; uraemia; DKA/ alcoholic ketoacidosis; paraldehyde; isoniazide; lactic acidosis; ethylene glycol; salicylate
what are the red flag symptoms to look for in head injury
cushings response - hypertension bradycardia and irregular breathing (raised ICP reduced cerebral blood flow)
when do you intubate
GCS < 8
How are head injuries grades
by GCS
13-15 - MILD
9-12 - Moderate
3-8 - Severe
what are the main signs of a basillar skull fracture?
haemotympanum battles sign (back of ear 12 hours post injury) racoon eyes (tarsal plate sparing)
discuss the main indications for CT
- GCS <12
- confusion or drowsiness (failure to imporve within 1 hr of admission of 2 hrs of injury )
- base of skill or depressed skull fracture +/- suspected penetrating injuries
- decreased LOC / new focal neuro signs
- GCS 15 but severe and persistent headache or two episodes of vomitting
- a histoyr of coagulopathy (warfarin etc), loss of consciousness, amnesia or any neurological signs
brainstem death requires confirmation by how many doctors
two
describe mechanical invasive ventillation
perfomred via an endotracheal tube or other airway device (commonly a tracheostomy)
describe mechanical non invasive ventilation
performed via a tight fitting mask (CPAP Or BIPAP)
how do you measure the % of burns
rule of 9s - (4.5 for front and back of arm each and rest 9 but needs to count front and back)
when should hypoglycamia be treated urgently
<3.5
treat hypoglycaemia
100mls 10% glucose IV immediately
only restart metformin after surgery if
good renal function as has a risk of lactic acidosis
in a diabetic on the morning before teh op commence what
IV glucose and insulin
WHEN AFTER THE OP DO DIABETICS GET CHANGED TO SUBCUT INSULIN
when eating normally (but continue IV insulin infusion for the first 60 mins after the first dose of subcut insulin)
how should diabetics fast
fast till midnight and omit the norning insulin
finger prick before and after procedure
what is the sequence of anaestehtci
premeds induction maintenance reversal recovery
post op nausea give
ondansetron first line
cyclizine second line
what investigation is most important in patients with RA prior to surgery
C spine XRAY to check for atlantoaxial subluxation as important for anaesthesia
what is given in the shock pack
4 units rbcs 4 units 1 pool of platelets
