Acute med Flashcards
Signs of cardiac tamponade
- Becks triad
- Kussmaul’s paradox
- Pulsus paradoxus
Becks triad (not psych)
Hypotension
Raised JVP
Muffled heart sounds
Kussmaul’s Sign (nb not breathing)
Reduced JVP on inspiration
Pulsus Paradoxus
Faded pulse on inspiration
Causes of cardiac tamponade
Pericarditis (therefore all its causes...) Trauma Drugs Pneumopericardium Aortic dissection
Thrombolysis CI
AGAINST Aortic dissection GI bleed Allergic reaction Iatrogenic (major surgery <14 days) Neuro (CVA Hx) Severe HTN >200/120 Trauma (inc. CPR)
Severe asthma features
PEFR <50%
RR>25
HR>110
Difficulty finishing sentences
Life threatening asthma features
PEFR <33% pO2 <92% Cyanosis Hypotension Exhaustion Silent chest Tachyarrhythmias (nb rising pCO2 +/- decrease pH bad sign)
Mx of acute asthma
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
Mx IECOPD
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
Acute GI bleed
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
Acute GI bleed
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
Encephalitis Mx
Ix: Blood cultures, viral PCR, malaria thick + thin Imaging: contrast CT LP EEG Mx: IV acyclovir 10mg/kg ASAP Treat cause
Status epilepticus Ix Mx
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
CT head guidance
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
Raised ICP
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
Causes and complications of AKI
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
Nephrotoxic drugs
NSAIDs ACEI + ARBs Gentamicin + vancomycin New drugs Herbal remedies OTC mediciations
AKI Mx
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
Features of AKI
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.
DKA Mx
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
HONK Mx
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)
Hypoglycaemia Mx
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
Thyroid storm Mx
Resus + fluid resusitation + NGT Bloods - Propranolol PO/IV - Carbimazole (lugol's iodine 4hr later to inhibit thyroid) - Hydrocortisol Rv cause - infection, MI, trauma
