Acute Med Flashcards
What is the key principle underpinning Acute Medical treatment?
ABCDE Protocol
Airways
Breathing
Circulation
Disability
Exposure
How do you assess a patient’s airways?
Assess:
Patency, Secretions/Vomit
Look for Obstruction
How would you manage a Patient’s airway?
Airway Manoeuvres
Suction
Airway Adjuncts
How would you assess a patient’s breathing?
RR
Sats
Palpation, percussion auscultation
CXR
Manage with O2
How would you assess a patient’s Circulation?
HR
BP
Cap Refill/Perfusion
Assess for Cyanosis
Auscultation
How would you manage a patient with poor circulation?
Fluids
Bloods/ABG
How does Alcohol Withdrawal present?
Over stimulation of the CNS
Minor - Anxiety, GI Upset, Palpitations, Tremor
Hallucinations (Visual & Tactile)
Seizures (Tonic-Clonic)
Delirium Tremens
What is Delerium Tremens?
Fatal condition occuring 48-72 hours into a case of Severe Alcohol Withdrawal.
Delirium
Severe tremor
Fever
High BP + HR
What else could cause the symptoms of Delirium Tremens?
Acute Liver Failure
Ammonia (Encepalopathy), Albumin (Ascites & Peripheral Oedema)
Bilirubin (Jaundice), Blood Factors (Bruising)
Wernicke’s Encepalopathy
How yould you investigate a suspected case of Alcohol Withdrawal?
Hx of Alcohol Abuse, recent traumatic events followed by stays in hospital.
CAGE/AUDIT Questionnaires
Chronic Liver Disease signs
How would you manage someone with Alcohol Withdrawal symptoms?
Benzodiazepines (eg. Diazepam)
Pabrinex to prevent the development of Wernicke’s
Glucose (If hypoglycaemic)
Then manage dependence
How would you assess the severity of Alcohol Withdrawal?
CIWA-Ar Survey
What is Anaphylaxis?
A Life-threatening, systemix hypersensitivity reaction.
Characterised by airway +/- breathing +/- circulation problems
Associated with Skin/Mucosal changes
What are the most common causes of Anaphylaxis?
0-4 Years
Food
Drugs/Chemicals
Toxins
W/ Hx of Atopy
How does Anaphylaxis present?
Airway - Throat/Tongue swelling, Stridor
Breathing - SOB, Increased RR, Hypoxia
Circulation - Shock - low BP, High HR, decreased consciousness
Skin/Mucosal - Urticaria, Angioedema, Flushing
How would you diagnose an uncertain case of Anaphylaxis?
Serum Tryptase
Plasma Histamine
How would you manage a case of Anaphylaxis?
Remove the Trigger
Lie flat and raise legs
IM Adrenaline 0.5mg 1:1000
ABCDE
IV Chlorphenamie + IV Hydrocortisone
When would you consider using activated charcoal in the treatment of Poisoning/Overdose?
<4 Hours to reduce absorption.
How would you treat Paracetaml Overdose?
>40 Tablets - N-Acetylcysteine
<40 Tablets - Monitor Paracetamol Level, if too high administer N-Acetylcysteine
How does Aspirin Overdose present?
Ear - Tinnitus, Deafness, Dizziness
Hyperpnoea
N&V, Diarrhoea
When is an Aspirin Overdose considered severe?
>500mg/kg
How does a severe Aspirin Overdose present?
Hypotension
Heart Block
Pulmonary Oedema
Low GCS + Seizures
What would you find in the Laboratory findings of a patient who’s overdosed on Aspirin?
Early Respiratory Alkalosis
High Anion Gap Metabolic Acidosis
How would you manage a patient who’s overdosed on Aspirin?
Urine Alkalisation with IV Sodium Bicarbonate
Dialysis
How does Paracetamol Overdose typically present?
Mild Nausea and Vomiting
Lethargy
RUQ Pain
Hepatomegaly
Acute Liver Failure
How does Opiate overdose typically present?
Respiratory Depression
Bradycardia, Hypotension
Pinpoint Pupils
Low GCS/Coma
How would you manage someone who overdosed on Opiates?
IV Naloxone
What are the main complications associated with the insertion of a catheter?
UTI - Only treat if symptomatic (Replace Catheter, Antibiotics)
Blockage - (Can be due to Proteus mirabilis infection), bladder wash out & catheter replacement
How do you test for transfusion compatibility?
G&S - Identifies Blood Type
X-Match - Checks for compatibility with donor blood
When are Packed Red Cells indicated?
Hb <70g/L
1 unit increases Hb by 10-15 g/L
When are Platelets and Fresh Frozen Plasma indicated?
Platelets - <20*109/L
FFP - To correct clotting defects
What are the complications of transfusion that occur within 24 hours?
Anaphylaxis
Acute Haemolytic Reaction
Bacterial Infection
Febrile non-Haemolytic Reaction
Transfusion associated circulatory overload/lung injury
What are the late complications that can occur due to Transfusion?
Delayed Haemolytic Reaction
Infection
Transfusion associated graft vs Host Disease
Iron Overload
What are the complications that may occur during an Epidural?
Dural Puncture
Vessel Puncture
Hypoventilation
Epidural Haematome or Abscess
