Acute Care and Trauma Flashcards
Define ARDS
A syndrome of acute and persistent lung inflammation with increased vascular permeability
What is a pulmonary infiltrate?
A substance, thicker than air (eg pus/blood) lingering in the parenchyma.
Recall the characteristics of ARDS
A - Absence of raised capillary wedge pressure
R - Reduced blood oxygen (hypoxaemia)
D - Double-sided infiltrates (bilateral infiltrates)
S - sudden onset (acute)
Explain the aetiology of ARDS
Severe insult to lungs
Inflammatory mediators released
Capillary permeability increases
Results in pulmonary oedema, reduced gas exchange and reduced lung compliance.
(Injury, inflammation, increased permeability)
Recall some causes of ARDS
TOAST crumbs and apple PIPs can make you choke - Transfusion Overdose of drugs Aspiration Sepsis Transplantation
Pneumonia
Injury/burns
Pancreatitis
Recall the pathological stages of ARDS
Exudative
Proliferative
Fibrotic
Recall the signs of ARDS
Think SMURF: fast, blue, noisy: Cyanosis Tachypnoea Tachycardia Widespread crepitations Hypoxia refractory to oxygen treatment (Usually bilateral)
Identify appropriate investigations for ARDS
Bloods
Imaging = CXR to look for bilateral infiltrates
ECG - to look for mitral valve dysfunction (=valve beneath LA: dysfx –> build up of pressure in lungs)
PAC to check PCWP (pressure in left atrium)
Recall the presenting symptoms of ARDS
Cough Sometimes Decreases Respiratory Function - Cough Symptoms of cause Dyspnoea Respiratory distress Functional deterioration
Why does alcohol withdrawal cause symptoms?
Body has increased sensitivity to glutamate in alcoholics so when alcohol consumption stops there are excitatory symptoms
Recall the presenting symptoms of alcohol withdrawal
HAD A PINT
Headache
Anxiety
Depression
Anorexia
Palpitations
Insomnia
Nausea
Tremor
What is the acute confusional state caused by alcohol withdrawal called?
Delirium tremens
Recall the features of delirium tremens
Sweating
Hallucinations
Tremor
What is the management plan for alcohol withdrawal
*ABCDE* Amobarbital B1 vitamin (thiamine) Chloro- Diaz- Epoxide
What is the reason for fatality in alcohol withdrawal?
Seizures (generalised tonic-clonic)
Distinguish immunogenic and non-immunogenic anaphylactic shock
Immunogenic involves IgE and immune complexes, non-immunogenic = mast cell/basophil degranulation without Ig involvement
Recall some symptoms of anaphylaxis
Symptoms of anaphylaxis will make the patient SOB:
Skin (rash, pruritis)
Oedema (lips, face)
Breathing (short, wheezing)
Recall the signs of anaphylaxis
URTICARIA: Urticaria Reduced BP Tachypnoea Infected conjunctiva Cyanosis Audible wheeze Rhinitis Increased heart rate Airway swelling
Recall an appropriate management plan for anaphylaxis
Oxygen Can Help Anaphylaxis: Oxygen Chloropheniramine Hydrocortisone Adrenaline (IM)
Recall the pathophysiology of aspirin overdose
Really High Aspirin Consumption Does Harm Always Resp centre stimulation Hyperventilation Alkalosis (respiratory) Compensation by kidneys: urine bicarb and K+ increased Dehydration Hypokalaemia Acidosis (metabolic)
Recall the presenting symptoms of aspirin overdose
OVERDOSE Over- Ventillation Ears ringing Red-faced Dizziness Overtired Sweating Epileptic-looking
Recall the signs of aspirin OD on physical examination
Fever
Tachycardia
Hyperventillation
Epigastric tenderness
Recall the appropriate investigations for aspirin OD
Bloods (including salicylate and ABG to show acidosis/alkalosis)
ECG (to look for hypokalaemia)
Recall the 3 severities of burns injury and the approx healing time for each of these
Superficial - 7 days
Deep - 21 days
Full thickness - requires skin graft
What is it important to check for in burns injury that you might forget?
Inhalational njury
What investigations should be done in an electrical burn case?
CK
ECG
Urine myoglobin
Which is the most commonly injured artery in extradural haemorrhage?
Middle meningeal artery
Recall the characteristic progression of extradural haemorrhage
Temporary loss of consciousness –> lucid phase –> deterioration of GCS
Recall the signs of extradural haemorrhage
Mnemonic: Sudden damage can result in haemorrhage Scalp trauma Deteriorating GCS Raised ICP Headache
What is indicative of extradural haemorrhage on CT?
Shift in midline that shows raised ICP
Define multi-organ dysfunction syndrome
Affects 2 or more organ systems and is induced by variety of insults including sepsis
How is MODS measured?
It is scored 1-4
Summarise the 4 MODS scores
1: Mild respiratory alkalosis and hyperglycaemia
2: Hypoxia + tachypnoea, liver dysfunction
3: Acid-base disturbance, azotaemia, coagulation abnormalities (due to liver dysfunction)
4: Lactic acidosis, ischaemic colitis, vasopressor dependent
What is the main investigation in MODS
ABG - need to asses where they are in the alkalosis –> acidosis spectrum
Recall the symptoms of opiate overdose
Mnemonic: Codeine Never Softens Anyone's Crap Constipation Nausea Sedation Anorexia Cravings
Recall the signs of opiate overdose
Pinpoint pupils
Tachycardia with hypotension
Respiratory depression
What drug is used to combat opiate overdose?
Naloxone
What is the result of paracetamol overdose?
Hepatic necrosis
After how many hours does paracetamol overdose begin to really show symptoms
24 hours
What are the symptoms of paracetamol OD?
RUQ pain and jaundice, develops into jaundice and encephalopathy
Recall the necessary investigations in paracetamol OD (think about liver fx)
FBC U&E, LFT Clotting Glucose ABG Salicylate
