acute care incorrect Flashcards
what are indications for a chest drain for PTX?
for someone who has responded poorly to diuretics and remains breathless and hypoxaemic in acute HF, what do you give next?
CPAP for pts with respiratory failure
who gets abx for COPD exacerbation?
Those with purulent sputum or clinical signs of pneumonia.
what can long term mechanical ventilation in trauma patients result in?
features?
tracheo-oesophageal fistula formation
features - productive cough and choking after feeds and is now acutely with aspiration pneumonia
how do you confirmed meningococcal diagnosis with raised ICP?
whole blood PCR and blood cultures
features of legionella pneumonia?
flu-like symptoms including fever (present in > 95% of patients)
dry cough
relative bradycardia
confusion
lymphopaenia
hyponatraemia
deranged liver function tests
pleural effusion: seen in around 30% of patients
what is a common complication of type A aortic dissection?
aortic regurgitation
what markers can you use to determine a diagnosis of pancreatitis?
Amylase tends to peak in the first 12 hours
Lipase remains elevated for 7-14 days
what can cause malignant hyperthermia with inhaled anaesthetic use? (eg sevoflurane or suxamethonium)
Autosomal dominant mutation in ryanodine receptor 1
increases calcium levels in the sarcoplasmic reticulum and increases metabolic rate
what fluid is used for pts with severe dehydration?
Normal saline (0.9% sodium chloride) - isotonic crystalloid fluid
what fluid is used for severe hyponatraemia?
3% sodium chloride - hypertonic solution
what are criteria for haemofiltration?
where do you do needle decompression for tension PTX?
Wide-bore cannula into the left 5th intercostal space in the mid-axillary line
what are the fasting rules prior to surgery?
Patients can drink clear fluids (fruit juice without pulp, coffee, tea without milk, water) up to 2 h before their operation. They are meant to fast from non-clear liquids and foods for a minimum of 6 h before surgery.
RF for post operative n+V?
female
history of motion sickness or PONV
non-smoking status
the use of postoperative opioids.
what airway adjunct in contraindicated in a basilar skull fracture?
Inserting a nasopharyngeal airway (NPA) in a patient with a suspected basilar skull fracture is contraindicated because it can potentially enter the cranial vault through a fractured cribriform plate, causing further injury.
what levels of carboxyhemoglobin indicate CO poisoning?
what’s different in smokers?
Carboxyhaemoglobin of 10% or more is usually indicative of carbon monoxide poisoning
In smokers 5-10% is normal (heavy smokers can tolerate up to 15%)
what is the daily amount of glucose when prescribing fluids?
When prescribing fluids, the glucose requirement is 50-100 g/day irrespective of the patient’s weight
absolute constraindicatio to TIPS in upper GI bleed?
HF
what fluids do you give to patients with burns >15%
HARTMANN’S
The fluid requirement is calculated using the Parkland formula:
Weight (kg) x Burn TBSA (%) x 4
which anaesthetic causes rise in K+ level?
Suxamethonium and other depolarising muscle relaxants cause the release of potassium from cells. Inducing paralysis during anaesthesia can result in a rise of plasma potassium of up to 1 mmol/l.
what airway mx should initially be done for a pt with basil skull fracture?
Head tilt chin lift should never be done in a trauma patient at risk of a C-spine injury, as it can make any damage worse and cause further instability of the spinal cord
