Acute Care Flashcards
What are the complications to be aware of when prescribing NSAIDs regarding the following…
GI
Respiratory
Renal
Bleeding
Allergy
GI - peptic ulceration, risk is greater in fasting patients
Respiratory - NSAIDs can cause bronchospasm in a minority of asthmatic patients
Renal - NSAIDs may cause renal failure, especially in patients with renal or hepatic insufficiency, or even in healthy patients with hypovolaemia
Bleeding - NSAIDs inhibit normal platelet action and can therefore affect intra- and post-operative bleeding
Allergy - allergy to NSAIDs is common
When setting up a Patient Controlled Analgesia (PCA) pump, what are the standard settings?
Loading dose
Bolus dose
Duration
Lockout
Concentration
Background
Loading dose - zero
Bolus dose - 1mg/ml
Duration - stat
Lockout - 5 mins
Concentration - 1mg/ml
Background - zero
What are some of the complications associated with opioids?
Nausea and vomiting
Over sedation
Hypotension
Respiratory depression - manage with giving O2 and naloxone if patient is very drowsy and help is not immediately available
Spinal/epidural opioids may cause late respiratory depression - rare but dangerous, can happen up to 24 hours after administration. Spinal and epidurals may also cause itch (pruritus) and nausea
How long does peripheral nerve blockade (PNB) last?
Are there many side effects?
Lasts for 12-24 hours
Very few side effects, and should be used in conjunction with pain ladder management
When would Epidural Infusion Analgesia (EIA) be used?
What are some of the potential side effects?
Used after major surgery/patients with cardioresp disease/patients that can’t use PCA effectively
Hypotension
Respiratory depression
Pruritus
Urinary retention
Motor block
Inadequate analgesia
Define the following terms…
Allodynia
Hyperalgesia
Dysaesthesia
Allodynia - pain from a stimulus that otherwise wouldn’t cause pain
Hyperalgesia - increased pain, more than expected
Dysaesthesia - unpleasant sensory symptoms, either spontaneous or provoked
What are the 3 arms of ‘balanced’ anaesthesia?
Depress consciousness (sleep)
Block painful stimuli (analgesia)
Relax skeletal muscle (relaxation)
What are the 4 main types of shock?
Hypovolaemic
Cardiogenic
Vasogenic
Neurogenic
What conditions might cause hypovolaemic shock?
Loss of blood, either external (e.g. trauma) or internal (e.g. ruptured aneurysm)
Severe burn injuries resulting in loss of plasma
GI obstruction causing third space loss of fluid
What conditions might cause cardiogenic shock?
Pump failure e.g. following MI
Severe arrhythmias
Flow obstruction (PE, Tension pneumothorax)
What conditions might cause vasogenic shock?
Anaphylaxis
Severe sepsis
What conditions might cause neurogenic shock?
High cord transection
Vasovagal attack (fainting)
What are the 5 brainstem reflexes that need to be assessed when determining brain death?
No pupillary response to light
Absent corneal reflexes
Absent caloric responses
No motor responses in the distribution of the cranial nerves
No cough or gag reflexes
What specific examinations would you perform in someone suffering head trauma?
GCS
Pupils
Ears
External signs of head trauma
Neuro exam
C-spine
GCS is broken down into eyes (4), verbal (5) and motor (6).
What are the 4 stages of ‘eyes’?
Eyes open spontaneously - 4 points
Eye opening to verbal command - 3 points
Eye opening to pain - 2 points
No eye opening - 1 point
