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General Med > Acute med > Flashcards

Acute med Flashcards

1
Q

Signs of cardiac tamponade

A
  1. Becks triad
  2. Kussmaul’s paradox
  3. Pulsus paradoxus
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2
Q

Becks triad (not psych)

A

Hypotension
Raised JVP
Muffled heart sounds

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3
Q

Kussmaul’s Sign (nb not breathing)

A

Reduced JVP on inspiration

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4
Q

Pulsus Paradoxus

A

Faded pulse on inspiration

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5
Q

Causes of cardiac tamponade

A 
Pericarditis (therefore all its causes...)
Trauma
Drugs
Pneumopericardium
Aortic dissection
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6
Q

Thrombolysis CI

A 
AGAINST
Aortic dissection
GI bleed 
Allergic reaction
Iatrogenic (major surgery <14 days)
Neuro (CVA Hx)
Severe HTN >200/120
Trauma (inc.  CPR)
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7
Q

Severe asthma features

A

PEFR <50%
RR>25
HR>110
Difficulty finishing sentences

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8
Q

Life threatening asthma features

A 
PEFR <33%
pO2 <92%
Cyanosis
Hypotension
Exhaustion
Silent chest
Tachyarrhythmias 
(nb rising pCO2 +/- decrease pH bad sign)
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9
Q

Mx of acute asthma

A

Sit up + 100% O2 15l non-rebreath bag
Back to back Salbutamol 5mg + ipratropium 0.5mg nebs (if possible pre and post PEFR)
100mg hydrocortisone IV +/- 50mg PO prednisolone
NO IMPROVEMENT - inform ITU
IV MgSO4 2g over 20 mins
IV salbutamol 3-20micrograms/min (monitor HR + K)
Consider aminophylinline 5mg/kg over 20 mins

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10
Q

Mx IECOPD

A

Sit up + 24% O2 venturi mask (target SaO2 88-92%)
Air driven salbutamol 5mg and ipratropium 0.5mg nebs
Hydrocortisone IV 200mg, 40mg PO prednisolone 7-14 days
Doxycycline 200mg PO stat + 100mg OD 5 days
NIV/BiPAP if pH <7.35, RR >30

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11
Q

Acute GI bleed

A

Risk assessment: Rockall score + Glasgow blatchford
Mx:
- Resus (100% O2, IV cannulae + fluids)
- Variceal bleed - IV terlipressin, prophylactic Abs (cipofloxacin), correct coagulopathy + Thiamine if EtOH
- Urgent endoscopy
- life threatening bleed - Seng

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12
Q

Acute GI bleed

A

Risk assessment: Rockall score + Glasgow blatchford
Mx:
- Resus (100% O2, IV cannulae + fluids)
- Variceal bleed - IV terlipressin, prophylactic Abs (cipofloxacin), correct coagulopathy + Thiamine if EtOH
- Urgent endoscopy if unstable
- life threatening bleed - Sengstaken-blakemore tube + Transjugular intrahepatic portosystemic shunts

  • Non-vareceal bleed - endoscopy + mechanical/thermal coagulation + adrenaline/fibrin or thrombin + adrenaline

Post endoscopy - NBM 24 hrs, daily bloods, PPI, H pylori testing

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13
Q

Encephalitis Mx

A 
Ix: 
Blood cultures, viral PCR, malaria thick + thin
Imaging: contrast CT
LP
EEG
Mx: IV acyclovir 10mg/kg ASAP
Treat cause
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14
Q

Status epilepticus Ix Mx

A

Ix: glucose, ABG, U&E, FBC, Ca2+, ECG + tox screen
Mx: ABC
Rectal diazepam 10mg or bucal midazolam 10mg
IV lorazepam 2-4mg (x2 doses if no response within xmins)
Call anaesthetics (?consider theophylline)
phenytoin 18mg/kg at 50mmg/min
Consider IV dexamethasone IV 10mg if vasculitis/cerebral oedema

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15
Q

CT head guidance

A

BANGS LOC
Break - open/depressed/base of skull fracture
Amensia >30mins retrograde
Neuo deficit or seizure
GCS <13 at any time or <15 2hrs post injury
Sickness

LoC

Consider if >65yrs, dangerous mechanism of injury and coagulopathy

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16
Q

Raised ICP

A

Signs: headache, N&V, seizures, drowsiness, papilloedema
Cushings reflex (HTN, bradycardia, irregular breathing)
6th nerve palsy
Mx: ABC, elevate bed to 40 degrees, treat seizures + correct hypotension
Neuroprotective ventilation - anaesthetist
Mannitol or hypertonic saline

17
Q

Causes and complications of AKI

A

Pre-renal - any hypoperfusion of kidney (hypotension, hypovolaemia, sepsis, cardiogenic)

Renal - glomerulonephritis, drugs, vasculitis

Post-renal - obstruction (prostate, stones, strictures, infections)

Complications: Hyperkalaemia, pulmonary oedema

18
Q

Nephrotoxic drugs

A 
NSAIDs
ACEI + ARBs
Gentamicin + vancomycin 
New drugs
Herbal remedies 
OTC mediciations
19
Q

AKI Mx

A

Fluid assessment and resuscitation (0.9% NaCl)
Treat complications - Pulmonary oedema, hyperkalaemia
Monitor - cardiac monitor + catheterise
Treat causes - Urological/renal referral
Renal replacement therapy if:
- Acidosis <7.2
- Electrolytes Hyperkalaemic >7
- Intoxicants eg aspirin
- Oedema
- Uraemic symptoms

20
Q

Features of AKI

A

RIFLE or KIDGO scoring systems
Suspect if:
- Rise in serum creatinine of 26 micromol/l or greater within 48 hours
- 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
- fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than 8 hours in children and young people
- 25% or greater fall in eGFR in children and young people within the past 7 days.

21
Q

DKA Mx

A

Fluids 1L 0.9% NaCl over 1 hr, then 2L over 4 hrs, then 1L 4hrs
Potassium replacement 2nd bag of fluid 40mmol/l
Insulin
VTE prophylaxis
Monitor: catheter, NGT if vomiting/reduced GCS, Hrly cap glucose + ketones, VBG at 1 hr 2hr and every 2hr, plasma electrolytes every 4 hrs

22
Q

HONK Mx

A

T2DM, Dehydration, glucose >35, reduced GCS
Mx 0.9% NaCl over 48 hrs, wait 1 hr before starting insulin
Complications: Thombosis (LMWH)
Ix and Mx precipitant (MI, infection, bowel infarct)

23
Q

Hypoglycaemia Mx

A

Causes: insulin (exogenous or endogenous), liver failure and addinsons
Mx:
Alert and orientated - Oral carb (lucozade)
Drowsy + intact swallow - buccal hypostop + IV access
Unconscious or swallow concerns - IV dextrose 100ml 20%
Deteriorating - 1mg glucagon IM

24
Q

Thyroid storm Mx

A 
Resus + fluid resusitation + NGT
Bloods
 - Propranolol PO/IV
 - Carbimazole (lugol's iodine 4hr later to inhibit thyroid)
 - Hydrocortisol 
Rv cause - infection, MI, trauma
25
Q

Myxoedema coma

A 
Looks - hypothermia, hypoglycaemia, bradycardia, hypotensive, seizures, coma
Mx
- Correct hypoglycaemia 
 - T3/T4 IVslow infusion
 - Hydrocortisone 100mg IV
26
Q

Addinsonian crisis

A

Bloods - cortisol, ACTH, U&E (hyperkalaemia, hyponatraemia)
Hydrocortisone 100mg IV STAT (then 100mg/8hr)
- change to oral after 72 hrs
IV fluid bolus
Monitor glucose
Abx of infection concerns

27
Q

Hypertensive crisis

A

Mx
2-5mg phentolamine (short acting alpha blocker)
10mg/24hr PO phenoxybenzamine (long acting alpha blocker)
Beta blocker - propranolol to control tachycardia, MI

General Med (17 decks)

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