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Quick Recall > Acute Care > Flashcards

Acute Care Flashcards

1
Q

4 Hs

A

Hypoxia Hypovolaemia Hyper/hypo kalaemia, calcaemia (metabolic) hypothermia

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2
Q

4 Ts

A

Thrombosis (coronary/pulmonary) Tension pneumothorax Tamponade (cardiac) Toxins

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3
Q

Non Shockable rhythms

A

asystole PULSELESS electrical activity (except VT)

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4
Q

Shockable rhythms

A

VF pulseless VT

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5
Q

What do you give if non-shockable rhythm?

A

Adrenaline 1mg IV

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6
Q

What dose amiodarone given after 3 shocks?

A

300mg

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7
Q

What do you do if spontaneous movement/breathing efforts return during CPR

A

Check for pulse (carotid)

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8
Q

Treatment of tension pneumothorax

A

wide bore needle decompression (wide bore/grey cannula) 2nd intercostal space mid-clavicular line Then insert chest drain 5th intercostal space mid-axillary line (but can also decompress here)

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9
Q

What constitutes to hyperkalaemia?

A

K+ > 6.5 mmol/l

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10
Q

What constitutes to hypokalaemia?

A

K+ < 2.5 mmol/l

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11
Q

Hyperkalaemia ECG Changes

A
  • tall ‘tented’ T waves in precordial leads
  • decreased/flattened P waves and widened QRS (moderate)
  • progressive widening of QRS, axial deviation, BBB (severe)
  • QRS will evertually become so big that may merge with T wave -> sine wave pattern
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12
Q

PE ECG changes

A
  • often no changes
  • S waves in lead I (S dips below baseline)
  • Q waves in lead III (Q dips below baseline)
  • inverted T waves in lead III

S1, Q3, T3

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13
Q

Type 1 respiritory failure definition and example causes

A

->Hypoxic

usually cause by processes resulting in direct damage to lungs/interuption of blood flow e.g. pneumonia, ARDS, pumonary oedema, fibrosis, PE

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14
Q

Type 2 respiritory failure and example causes

A

-> hypercapnia (+/- hypoxia)

caused by things which limit air flow into the lungs e.g. coma, neuromuscular disorders, COPD, asthma, pneumothorax and restrictive aspect of pulmonary fibrosis

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15
Q

GCS motor response 6

A

Obeying commands

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16
Q

GCS motor response 5

A

localising to pain

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17
Q

GCS motor response 4

A

withdrawing to pain

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18
Q

GCS motor response 3

A

flexor response to pain

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19
Q

GCS motor response 2

A

extensor respose to pain

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20
Q

GCS motor response 1

A

no response to pain

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21
Q

GCS verbal response 5

A

orientated to time, place and person

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22
Q

GCS verbal response 4

A

confused conversation

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23
Q

GCS verbal response 3

A

innapropriate speech

24
Q

GCS verbal response 2

A

incomprehensible sounds

25
Q

GCS verbal response 1

A

none

26
Q

GCS eye opening 4

A

spontaneous eye opening

27
Q

GCS eye opening 3

A

in response to speech

28
Q

GCS eye opening 2

A

in response to pain

29
Q

GCS eye opening 1

A

none

30
Q

Below what GCS is airway protection needed?

A

8 (some sources say 7)

31
Q

Sepsis 6 bundle

A

O2

IV fluid

IV Abx

Lactate

urine output

blood cultures (preferably before abx)

32
Q

initial emergency of anaphylaxis

A

O2/secure airway

Adrenaline IM 0.5mg

-repeat every 5 mins, guided by BP, pulse resp. function

33
Q

additional treatment for anaphylaxis

A
  • chlorophenamine (antihistamine) 10mg IV
  • hydrocortisone 200mg IV
  • if wheeze present, also treat for asthma
  • admit to ICU if hypotensive, normal ward if not. Measure serum tryptase
34
Q

when may IV adrenaline be used in anyphalaxis

A

when there is no pulse

(if insufficienct circulation then IM will be useless)

35
Q

STEMI emergency treatment

A

Aspirin 300mg

CLopidogrel 600mg

(i.e. 2x antiplatet)

5000 units Heparin IV
+PCI!

36
Q

NSEMI emergency treatment

A

Morphine 5-10mg IV
O2

GTN

aspirin 300mg

rising troponins or risk factors/already poor cardiac function/high GRACE score -> second antiplatelet e.g. ticagrelor, IV nitrate, bisoprolol, cardio review/ angiography

lower GRACE score, low/no toponins -> send home, outpatient appt. for further Ix

above may be candidates for cabbage or coronary stenting

37
Q

emergency management of pulmonary oedema

A
  • O2
  • ensure to monitor ECG
  • diamorphine 1.25-5mg IV (caution in COPD, liver failure)
  • furosemide 40-80mg IV
  • GTN (unless BP low)

consider CPAP

38
Q

Investigations for suspected pulmonary oedema

A
  • CXR (fluid, kerley B lines etc.)
  • ECG (rule out MI, monitor for arrythmias)
  • U&E, troponins, ABG
  • echo
  • BNP (hight negative predictive value)
39
Q

common causes of broad complex tachycardia

A
  • Hypokalaemia
  • Hypomagnesaemia
40
Q

useful drug for ventricular tachycardia

A

amiodarone 200mg IV

41
Q

good drug for supraventricular tachycardias

A

Adenosine 6mg IV

(first try vagal manouvres before drugs)

42
Q

good drug for bradycardias

A

atropine 500mcg IV

(only give if adverse sighs e.g. shock)

43
Q

Emergency treatment of asthma

A

O2

salbutamol 5mg nebs (not will need to turn flow of O2 down to about 6 to give this)

Ipratropium 0.5mg

Hydrocortisone 100mg IV OR pred 40-50mg PO

repeat nebs ever 15-30 mins, consider MgSO4

44
Q

PEF in sever asthma attack

A

33-50% predicted

-unable to complete sentences in one breath

45
Q

PEF in sever asthma attach

A

<33% of predicted/best

arrythmias, hypotension, exhaustion, confusion, coma

46
Q

Acute exacebation of COPD emergency management

A

salbutamol 5mg neb, ipratropium 500mcg neb

O2 (venturi mask) ajust according to ABGs

Hydrocortisone 200mg IV or pred 30mg OD

if evidence of infection give Abx

if not responding/need to blow off lots of excess CO2 consider Bipap or resp. stimulants

47
Q

When is a chest drain NOT needed in pneumothorax?

A

when rim of air on CXR <2cm of CXR or over 2cm but sucessfully aspirated

48
Q

PE emergency management

A

IV LMWH/fondaparinux

49
Q

When would you do rapid sequence induction?

A
  • patient who needs to be intubated but is not fasted like in elective surgery
  • useful in emergency setting as likely contents in stomach which pose risk to airway
  • patient with low/lowering GCS who needs airway protection (if gag reflex still present may push up intracranial pressure)
50
Q

Drugs commonly used in rapid sequence induction

A
  • thiopentone or Etomidate, sometimes propafol but not ideal due to vasodilatory effects (induction)
  • ruconium (muscle relaxant/paralysis)
  • fentanyl (pain)

note other drugs will be needed to aintain anaesthesia

51
Q

What is the function of cricoid pressure?

A

prevents gastric contents coming up when attempting to intubate patient

52
Q

Info needed around paracetamol overdose

A
  • how many tablets
  • what strength
  • form of tablet (combination tablet)
  • how long ago
  • patients weight
  • Note get LFTs and paracetmol level (if over 1h) sent off quickly
53
Q

drug used in treatment of paracetamol overdose

when do you decide to use it?

A

acetyl cysteine

  • treatment threshold based off blood paracetamol levels and how long its been since tablet ingestion
  • if been less than 1h since ingestion consider activated charcoal
54
Q

Older man with back/loin pain differentials

A

mechanical

disc tear

renal calculi

AAA -> USS

55
Q

Where can you look up management for overdose of any drug?

A

toxbase

56
Q

management of opioid overdose

A
  • supportive
  • naloxine ->TENTATIVELY

otherwise push patients into withdrawal and can become agressive or worsen outcomes

-also note short half life of naloxone, patients may slip back into resp. depression

57
Q

what is Rosving’s sign?

A

palpation of the LLQ increases pain felt in the RLQ

-sign of appendicitis

Quick Recall (3 decks)

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