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yr3 > Acute care + trauma > Flashcards

Acute care + trauma Flashcards

1
Q

Acute respiratory distress syndrome (ARDS) - acute and persistent lung inflammation with increased vascular permeability.
Characterised by…

A
  • acute onset
  • bilateral infiltrates consistent w/ pulmonary oedema
  • hypoxaemia
  • no clinical evidence for increased L atrial pressure (pulmonary capillary wedge pressure <18)
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2
Q

Aspirin overdose (10g-20g) clinical features

A 
Resp alkalosis
Met acidosis
Hyperventilation (resp failure)
HypoK+ (high HCO3- and K+ excretion)
High lactic acid
CNS depression

(flushed appearance, sweating, confusion, lethargy, deafness)

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3
Q

Investigations for aspirin overdose

A

Blood: salicylate levels, FBC, U+Es (hypoK+), clotting screen (high PT)
ECG: hypoK+

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4
Q

Alcohol dependence CAGE screening questions

A

Cut down on intake?
Annoyed by criticism of drinking?
Guilty about how much you drink?
Eye-opener - drink when you wake up?

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5
Q

Alcohol withdrawal symptoms

A 
Nausea+vomiting
Sweating, fever
Restlessness/tremor
Hallucination
Confusion
Seizures
Deliriums tremens
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6
Q

Alcohol dependence is characterised by 3 or more of…

A 
Withdrawal on cessation
Tolerance
Compulsion
Time spent only on alcohol
Neglects other interests
Continued despite problems
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7
Q

Patient presents with acute onset on symptoms on exposure to allergen: wheeze, SOB, sensation of choking, swelling of lips and face, pruritis, rash

A

Anaphylaxis

Complications: resp failure, shock, death

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8
Q

Anaphylaxis treatment

A 
ABCDE, 100% O2
Treat with IM 0.5mg adrenaline
IV antihistamine, steroids
IV colloid to maintain BP
Treat bronchospasm with salbutamol ±ipratropium inhaler. IV aminophilline may be required.
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9
Q

Types of burns include thermal (scalds), airway, chemical, electricity and radiation burns. Classification into…

A

Superficial
Partial thickness
Full thickness (3rd degree)
Full thickness to bone (4th)

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10
Q

Sepsis 6 management

A
  1. High flow O2
  2. IV antibiotics
  3. IV fluid resuscitation
  4. Blood cultures
  5. Check lactate (ABG/VBG)
  6. Urine output (catheter)
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11
Q

SIRS definition

A 
2 or more of:
Temperature <36 or >38
HR >90bpm
RR >20 or pCO2 <4.3
WCC >12000 or <4000/mm3
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12
Q

Sepsis definition

A

SIRS + infection

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13
Q

Severe sepsis definition

A

Sepsis + end organ damage or hypoperfusion or hypotension

±DIC

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14
Q

Septic shock definition

A

Severe sepsis + hypotension

despite adequate fluid resuscitation. BP <90mmHg

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15
Q

After suspected anaphylaxis, what should be measured acutely

A

Mast cell tryptase 1-6hr after suspected diagnosis of anaphylaxis

It is the most abundant mediator stored in mast cells released alongside histamine.

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16
Q

3 pathological stages of acute resp distress syndrome (ARDS)

A
  1. exudative
  2. proliferative
  3. fibrotic
17
Q

Anaphylaxis after the attack investigations

A

Allergin skin testing

IgE immunoassays

18
Q

Alcohol withdrawal aetiology

A

Abrupt alcohol cessation leads to overactivation of the excitatory NMDA system relative to the GABA system

19
Q

Alcohol withdrawal Rx

A 
IV vitamin B
Benzodiazepine/carbamazepine
Reducing doses of chlordiazepoxide
Lactulose + phosphate enemas to avoid encephalopathy
Lorazepam for seizures

Monitor dehydration, electrolyte imbalances, infections, nutrition

20
Q

Paracetamol overdose (>8g/day) can result in…

A

hepatic necrosis (>12g)

0-24hr - asymptomatic. N+V
24hr-72hr - RUQ pain, hepatomegaly, tender, N+V
>72hr - encephalopathy, jaundice, hypoglycaemia, coagulopathy, renal angle pain

21
Q

A 17yr old woman presents with wheeze and marked perioral swelling. PaO2 7.0kPa on 28% oxygen, PACO2 4.1kPa. What is the likely diagnosis and appropriate treatment?

A

This is a presentation of acute anaphylaxis

e.g. a type I IgE-mediated hypersensitivity reaction. Treat with 0.5ml adrenaline IM

22
Q

A 45yr old man has an accident with an open fracture of the tibia. He is in severe pain and the lower left limb is cold and pulseless. The muscles of the distal limb are brownish-black in colour. What is the likely diagnosis and causative organism?

A

Gas gangrene - due to Clostridium perfringens

Thrives in relative anaerobic conditions of necrotic tissue. Lethal and can lead to hypotension. Severe pain is present. Will change to a blue-black colour eventually and blebs will secrete discharge (watery fluid and blood).

23
Q

Acute asthma attack Rx

A

O2
Nebulised salbutamol
Prednisolone
(±nebulised ipratropium bromide, IV magnesium sulfate)

Monitor HR, PEF, O2 sats, K+, glucose. Do ABG

24
Q

Severe asthma attack includes

A

PEFR <50%
HR >110
RR >25
Cannot complete sentences

25
Q

Life-threatening asthma attack includes

A 
PEFR <33%
Silent chest
Cyanosis
Bradycardia
Hypotension
Confusion
Coma

yr3 (19 decks)

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