Acute Care Flashcards
One essential investigation for chest pain
ECG
Indications for a CT chest (4)
Large PE
Aortic Dissection
Oesophageal Rupture
Major Trauma
Scoring System in PE
Well’s Scoring System
Three characteristics of acute pain
Sudden onset
Known cause
Usually responds well to analgesics
Oxygen taken in per minute (70kg man)
250ml/min
Triad of anaesthesia
Hypnosis
Paralysis
Analgesia
What is the functional residual capacity (average)?
2L - contains 400ml oxygen
Aspirin
Problem with surgery
Protocol before surgery
Blocks platelets irreversibly
Need to stop 7 days before surgery (half life of a platelet)
Warfarin
Protocol before surgery
AF - stop 5 days before surgery
Multiple DVTs or metal heart valve - consider bridging therapy: stop 5 days before and on day 3 onward give 24 hourly LMWH
Head Injury Grading
Graded according to GCS
13-15 mild
9-12 moderate
3-8 severe
AVPU ‘P’ response equates to…
GCS of 8
Need to consider intubation
Cushing’s Triad
= bradycardia, hypotension and irregular breathing
A CT head should be performed within 1 hour after risk factor being identified (7)
GCS <13 on initial assessment GCS <15 more than 2 hours after injury Suspected skull fracture Any sign of base of skull fracture Post traumatic seizure Focal neurological deficit >1 episode of vomiting
A CT head should be performed within 8 hours of head injury if (4)
> 65 years old
Any history of bleeding or clotting disorders
Dangerous mechanism of injury
30 minutes retrograde amnesia
Suspected STEMI needing PCI anti-coagulant measures
5000 units heparin IV
Ticagrelor
Investigation of suspected appendicitis
Kids
Adults
Kids - USS
Adults - CT
NSAIDs good in what kind of pain
Renal colic
Musculoskeletal
Paracetamol antidote
Delivery
N-acetylcysteine
Given as three infusions across 20 hours: 1st infusion is a bolus over 1 hour
Co-prescribe an anti-emetic
Tricyclic antidepressants antidote
Sodium bicarbonate
Beta blockers antidote
Glucagon
Opioids antidote
Naloxone
When should assessment for effects of paracetamol overdose be done?
> 75mg/kg
Effects are unlikely to be seen unless >150mg/kg
Presentation of paracetamol overdose
Acute - nausea, vomiting
Late - abdominal pain, jaundice, encephalopathy
Contra-indication for nasopharyngeal airway
Base of skull fracture
Oropharyngeal airway =
Guedel airway
What level do you apply a pelvic binder at?
Greater trochanters
Eye Opening GCS
Out of 4 4 - spontaneous eye opening 3 - open eyes to sound 2 - open eyes to firm pressure 1 - doesn't open eyes
Verbal Response GCS
Out of 5 5 - spontaneous, orientated speech 4 - confused conversation 3 - inappropriate speech 2 - incomprehensible sounds 1 - no response
Motor Response GCS
Out of 6 6 - obeying commands 5 - localising to firm pressure 4 - normal flexion to pressure 3 - abnormal flexion to pressure 2 - abnormal extension to pressure 1 - no movement
Findings in anti-cholinergic toxidrome
Increased heart rate Increased temperature Dilated pupils Decreased bowel sounds Decreased sweating
Anti-cholinergic antidote
Physostigmine
Examples of cholinergics (3)
Organic compounds
Pilocarpine
Mushrooms
Cholinergic antidote
Atropine
Pralidoxime
Benzodiazepines
Findings in sympathomimetic toxidromes
e.g. caffiene, cocaine, metamphetamines, LSD
Increased heart rate
Increased temperature
Increased respiratory rate
Dilated pupils
Sympathomimetics management
Benzodiazepines
Benzodiazepines management
Flumenazil
Biochemical abnormalities in aspirin poisoning
Initial respiratory alkalosis - due to hyperventilation
Metabolic acidosis
Blood on CT scan
Old - black
New - white
Fragility pelvic fractures
- Seen in
- Main ones (2)
Women
Superior and inferior pubic ramus
Intracapsular fracture
Increased rib spacing on CXR
Hyperinflation e.g. COPD
Shockable rhythms
Ventricular Fibrillation
Ventricular Tachycardia
Management of anaphylaxis
IM adrenaline 0.5ml of 1:1000
IV fluid challenge (saline or Hartmann’s)
IV/IM 10mg chlorphenamine
IV/IM 200mg hydrocortisone
Treatment of symptomatic bradycardia
- 1st line
- 2nd line
1: 500 micrograms atropine IV
2: transcutaneous pacing
Management of tachycardia
- 1st line
- 2nd line
1: initially attempt vagal manoeuvres
2: adenosine 6mg IV bolus
BZD used for sedation and amnesia
Midazolam
Is lidocaine a short acting or long acting anaesthetic?
Short acting
Examples of numbing creams (2)
EMLA
Ametop
Purpose of premedication (2)
- Prevention of parasympathetic effects of anaesthesia
2. Reduction of anxiety or pain
Examples of benzodiazepines used
Temazapam
Midazolam
Examples of other hypnotics
Zopiclone
Zolpidem
Zaleplon
Anti-emetic often used with anaesthesia
Droperidol
Analgesic often used with anaesthesia
Fentanyl
Common induction agent with anaesthesia
Propofol
