Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine Year 3 > Acute Care and Trauma and Mental Health > Flashcards

Acute Care and Trauma and Mental Health Flashcards

1
Q

Acute Respiratory Distress Syndrome (ARDS)

A

Acute Lung injury caused by direct lung injury or occur secondary to severe systematic illness.

Lung damage and release of inflammatory mediators cause increased capillary permeability and non-cardiogenic pulmonary oedema, often accompanied by multi-organ failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ARDS

A

Acute and persistent lung inflammation with increased vascular permeability.

  • acute onset
  • bilateral Pulmonary infiltrates
  • hypoxaemia
  • non-cardiac
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ARDS risk factors

A

Pulmonary:
pneumonia, gastric aspiration, injury

Other: sepsis, septicaemia, haemorrhage, burns/trauma, multiple transfusions, transplantation, drug overdose/reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ARDS history and exam

A

Rapid deterioration of respiratory function
Dyspnoea
Respiratory distress
cough

cyanosis
tachypnoa
tachycardia
Widespread inspiratory crepitations 
hypoxia refectory to oxygen treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ARDS Investigations

A

CXR: Bilateral alveolar and interstitial shadowing

Blood: FBC, U&E, Plasma BNP <100pg/ml may distinguish ARDS/ALI from heart failure, but if high BNP does not exclude either.

Echocardiography: May point to cardiac problem instead of ARDS

Pulmonary artery catheterisation: PCWP <18 mmHg

Bronchoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pulmonary infiltrate

A

Substance denser than air, such as pus, blood, or protein.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Alcohol dependence

A

3 or more of:

  • withdrawal on cessation of alcohol
  • tolerance
  • Compulsion to drink
  • Persistent desire to cut down or control use
  • Time is spent obtaining, using, or recovering from alcohol
  • neglect of other interest
  • continued use despite physical and psychological problems

common problem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Recommended limits for Females

A

14 units a week
(1 unit = 8 grams of alcohol)
1 glass wine or 0.5 pint of beer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Recommended limits for males

A

21 units a week
(1 unit= 8 grams of alcohol)
1 glass of wine or 0.5 pint of beer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Alcohol withdrawal

A

Alcohol enhances inhibitory GABA activity and inhibits excitatory glutamate transmission.
Chronic exposure results in compensatory reduction in GABA receptor function and up-regulation of the glutamate NMDA receptors.
ONLY the constant presence of alcohol preserves homeostasis.
Abrupt alcohol cessation leads to over-activation of the excitatory NMDA system relative to the GABA system.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Alcohol dependence history

A

Alcohol history: suggest drinking diary

CAGE screening questions:
Cut-down
Annoyed
Guilt 
Eye-opener
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Acute alcohol intoxication

A 
Amnesia 
Ataxia
Dysarthria
Disorientation
Palpitations
Flushing
Coma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Symptoms of withdrawal

A 
Nausea
Sweating and tremor
Restlessness
Agitation
Visual hallucinations
Confusion
Seizures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Alcohol dependence exam

A

Signs of chronic alcohol abuse: Palmar erythema, bruising, spider naevi, facil mooning, gynacomastia

Signs of complication: Alcoholic hepatitis and liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Alcohol dependence investigations

A

Blood:
Increased MCV, GGT, AST, ALT

Acute overdose: Blood alcohol, glucose, ABG, U&E, toxic screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Management alcohol withdrawal

A
  • IV Vitamin B complex (Pabrinex)
  • Reducing doses of Chlordiazepoxide (benzo)
  • Close attention to dehydration, electrolyte imbalance, and infections
  • Nutritional support important as often malnourished
  • Lactulose and phospate enemas may help with encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Alcohol withdrawal complications

A 
Fits
Delirium tremens (48-72 hours after cessation - coarse tremor, agitation, fever, tachycardia, confusion, delusions, hallucinations)

Chronic complications: cerebral atrophy and dementia, cerebellar degeneration, optic atrophy, peripheral neuropathy

Indirect effects cause encephalopathy, thiamine deficiency leading to Wernicke’s encephalopathy or Korsakoff’s psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Anaphylaxis

A

Acute life-threatening multi system allergic reaction.

Inflammatory mediators cause increased capillary permeability and decreased vascular tone, resulting in tissue oedema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Common allergens leading to anaphylaxis

A 
drugs (penicillin)
radiological contrast agents 
latex
insect stings 
egg
peanuts 
shell fish
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Anaphylaxis history

A

Acute onset of symptoms on exposure to allergy:

  • wheeze, SOB, sensation of chocking
  • swelling of lips and face
  • Pruritus and rash

May have other hypersensitivity disorders (asthma, allergic rhinitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Anaphylaxis exam

A

Wheeze, cyanosis, tachypnea, swollen upper airways and eyes, rhinitis, rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Anaphylaxis

A

Diagnosis clinically

After attack: Allergen skin testing

23
Q

Management of anaphylaxis

A 
Stop any suspected drugs 
Resuscitation according to A,B,C
Secure airway and give 100% oxygen
Adrenaline IM 
Antihistamine IV 
Steroids IV 
IV crystalloid or colloid 
Treat bronchospasm with  salbutamol +/-ipratropium inhaler
Advice: How to use IM adrenaline pen and how to avoid allergen
24
Q

Anaphylaxis complications and prognosis

A

Respiratory failure, shock, death

Good prognosis if prompt treatment is given

25
Q

Arterial blood gas

A

Used to determine gas exchange levels in the blood related to respiratory, metabolic, and renal function.

26
Q

Indications of ABG

A
  • to identify acid/base disorders, with or without compensation (may present with SOB, difficulty breathing, confusion, nausea)
  • Perform when suspecting kidney failure, heart failure, uncontrolled diabetes, haemorrhage, chemical poisoning, drug overdose, shock
27
Q

ABG complications

A

Local hematoma
Artery vasospasm
Infection at puncture site
feeling faint

28
Q

Interpreting ABG

A

Step 1: Look at the pH

Normal (7.35-7.45)

> 7.45 alkalaemia
<7.35 acidaemia

Step 2: Look at the PaCO2

Normal (4.7-6 kPa)
>6 acidifying
<4.7 alkalinising

Align step 1 with step 2. If they both align then the problem is respiratory.

E.G.
Step 1: pH low
Step 2: PaCO2 high
=resp. acidosis

Step 3: Look at the bicarbonate or base excess

Base excess normal (-2 to +2)

Bicarbonate normal (22-26 mmol/L)

E.G. 
pH low
PaCO2 high
Bicarb. high
Respiratory acidosis, partially compensated
29
Q

PH low & PaCO2 high

A

Respiratory acidosis

Step 1 and step 2 align

30
Q

pH high & PaCO2 low

A

Respiratory alkalosis

Step 1 and step 2 align

31
Q

Aspirin overdose

A

Excessive ingestion of aspirin causing toxicity.

Ingestion of 10-20 grams causes moderate to severe toxicity in adults

32
Q

Aspirin overdose

A

Increases respiratory rate and depth
by stimulating CNS.

Hyperventilation produces respiratory alkalosis in the early phase.

Body compensates: Increase in urinary bicarbonate and K+ excretion
-> dehydration and hypokalaemia

Loss of bicarbonate together with build up of lactic acid lead to metabolic acidosis

Severe: CNS depression and resp failure

33
Q

Hyperventilation

A

Excess CO2 excretion -> hypocapnia

->alkalosis

34
Q

Aspirin Overdose
epi.
history
exam

A

one of the most common drug overdoses

Early: Flushed appearance, fever, sweating, hyperventilation, dizziness, tinitus, deafness

Late: Lethargy, confusion, convulsions, drowsiness, respiratory depression, coma

exam:
fever
tachycardia
hyperventilation
epigastric tenderness
35
Q

Aspirin overdose investigations

A

blood: salicylate levels in the blood,
Potassium levels

abg: may show metabolic acidosis and respiratory alkalosis

ECG: hypokalaemia (small t waves, u waves)

36
Q

Burns

A
  1. Assess thickness (epidermis, partial, full thickness)
  2. Assess Body surface area covered by burn
  3. Assess location
  4. Mechanism of injury
37
Q

Epidural

A

Injection of a local anesthetic into the space outside the dura mater of the spinal cord in the lower back region to produce loss of sensation below the waist.

38
Q

Epidural indication

A

Epidurals can be used during childbirth, including caesareans, during surgery, and after surgery

39
Q

Epidural complications

A 
Inadequate pain relief 
headache
Nerve damage 
low BP
loss of bladder control
40
Q

Anxiety disorder

A

Excessive fear and worry, triggered by internal or external events, interferes with normal daily activity, and leads to impairment of functioning.

Genetic factors play a role. Heritability estimated at approximately 30%

co-morbidity with other anxiety disorders is common

41
Q

Depressive disorders

A

Persistent sad, anxious, or empty mood
Feelings of hopelessness or pessimism
Feelings of guilt, worthlessness, or helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
Decreased energy, fatigue, being “slowed down”
Difficulty concentrating, remembering, or making decisions
Insomnia, early morning awakening or oversleeping
Appetite and/or weight loss, or overeating and weight gain
Thoughts of death or suicide, suicide attempts
Restlessness, irritability
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders and chronic pain

42
Q

Extradural Hemorrhage (epidural)

A

Suspect this if, after head injury, conscious levels falls or is slow to improve, or there is a lucid interval.

  • no loss of consciousness followed by decreasing loss of consciousness
  • After initial slight drowsiness seems fine
43
Q

Lucid interval

A

Temporary improvement in a patient’s condition after a traumatic brain injury, after which the condition deteriorates.

Indicative of an Epidural haematoma

44
Q

Extradural haemorrhage

A

May last a few hours to a few days before the bleed declares itself by decreased GCS from rising ICP.

Increasingly severe headache, vomiting, confusion, and fits follow.
(+/- brisk reflexes, up going plantars, hemiparesis)

Bleeding continues: Ipsilateral pupil dilates, coma deepens, bilateral limb weakness develops, breathing deep and irregular (brainstem compression)

Death follows a period of coma and is due to respiratory arrest.

45
Q

Extradural haemorrhage

A

CT: Haematoma (round,
lens-shaped)

Skull x-ray: Looking for fractures (increases risk of EH massively)

Lumbar puncture is contraindicated

46
Q

Multi-organ dysfunction syndrome

A

Systemic, dysfunctional inflammatory response that requires long ICU stay and has a high mortality.

47
Q

Sepsis

A

Spectrum from mild to severe:

  • SIRS
  • Sepsis
  • Septic Shock
  • MODS
48
Q

Systemic Inflammatory Response Syndrome

A 
2 out:
-Temperature >38 or <36
-Heart rate >90
-RR >20 or PaCO2 <32 (Normally 40)
-WCC >12000 or <4000
or >10% band cells (immature WCC)
49
Q

Sepsis

A

SIRS and confirmed infection

50
Q

Septic Shock

A

Sepsis and hypotension that does not go away

51
Q

MODS

A

Multiple Organ Dysfunction Syndrome

Sever septic shock+ organ failure

52
Q

Opiate Overdose

A

Opioid overdose triad: pinpoint pupils + unconsciousness+ respiratory depression

Can lead to respiratory depression and death

Combining opioids with alcohol and sedative medication increases the risk of respiratory depression and death

53
Q

Risk factors for opioid use

A
  • people with opioid dependence, in particular following reduced tolerance
  • people who also drink alcohol and sedative medication
54
Q

Paracetamol overdose

A
  • commonest overdose
  • first 24 hours asymptomatic
  • after 24 hours hepatic necrosis begins (elevated transaminases, RUQ pain, and jaundice) and can progress to acute liver failure

Medicine Year 3 (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions