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Acute Medical Flashcards

1
Q

Hypothermia Classifications

A

Hypothermia is a temperature less than 35oC;

mild 32-35oC
moderate 29-32oC
severe <29oC

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2
Q

Internally, the abdomen can be divided into three layers. What are they?

A

The peritoneum
The retroperitoneum
The pelvic cavity

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3
Q

HAPE Symptoms

A

Crackles/Rales on lungs
Dyspnea
Cough
Tachypnea
Orthopnea
Mild pyrexia
Decrease exercise tolerance
Pink sputum

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4
Q

HAPE Treatment

A

Descend
O2
Nifedipine
Salbutamol
C-PAP
Hyperbaric chamber

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5
Q

AMS Symptoms

A

Headache
Loss of appetite
Nausea/Vomiting
Dyspnea on exertion
Fatigue
Dizziness

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6
Q

AMS Treatment

A

Stop - Acclimate
Acetazolamide
Consider Decent
Consider O2
Consider dexamethasone

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7
Q

What altitude may AMS start to develop?

A

8500 Feet (2500 meters)

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8
Q

HACE Symptoms

A

Headache
Confusion
Ataxia
Cyanosis
Seizures

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9
Q

Coronary arteries and where they supply…

A

Right Coronary Artery - RA (SA & AV node)

Left Cornary Artery splits into:

1) Left Anterior Descending - LV, Septum, RV

2) Left circumflex - LA & LV

3) Left Marginal - LV

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10
Q

Modifiable risk factors for ACS

A
  • Obesity
  • Smoking
  • Hypertension
  • Diabetes
  • Hyperlipidemia
  • Drug use e.g. cocaine
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11
Q

Non-Modifiable risk factors for ACS

A
  • Age
  • Family history
  • Male
  • Ethnicity
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12
Q

Myocardial Infarction Symptoms

A
  • Chest pain (heavy/dull)
  • can radiate to Jaw/arm/shoulder
  • Back or epigastric pain
  • Dysponea
  • Nausea/vomiting
  • Diaphoresis
  • Palpitations
  • Lightheadedness
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13
Q

ECG diagnosis criteria of STEMI

A

ST elevation of >1mm in 2 continuous leads

Except If in V2 or V3 where:
In females >1.5mm
I’m males >2mm

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14
Q

Troponin

A

Cardiac enzyme
Normal < 14ng/L
Elevated in MI 2 hours post onset
Peak between 12-48 hours

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15
Q

Sgarbossa criteria

A
  • Concordant ST elevation > 1mm in leads with a positive QRS complex (score 5)
  • Concordant ST depression > 1 mm in V1-V3 (score 3)
  • Excessively discordant ST elevation > 5 mm in leads with a -ve QRS complex (score 2)
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16
Q

ECG MI patterns/areas by leads

A

V1-V4 = Anterior & Septal (LAD)
I, AVL = high lateral (Lt Cfx)
V5, V6 = Low lateral
II, III, AVF = Inferior (RCA)

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17
Q

Anaphylaxis treatment

A

1) Remove the trigger
2) IM Adrenaline (500mcg)
3) O2
4) Do not stand up a hypotensive pt
5) Fluids

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18
Q

Type 1 respiratory failure

A

Hypoxaemic
Alveolar failure
O2 ⬇️
CO2 ⬇️
E.g. pneumonia, ARDS,

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19
Q

Type 2 respiratory failure

A

Hypercarbic
Ventilatory failure
O2 ⬇️
CO2 ⬆️
E.g. depression of respiratory Centre, opioid od, COPD,

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20
Q

Classifications of Asthma severity

A

Moderate acute
Acute severe
Life-threatening
Near fatal

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21
Q

Moderate acute asthma

A

Increasing symptoms
PEF >50-75% of best predicted
No features of acute severe

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22
Q

Acute severe asthma

A

Any one of:
- PEF 33-50% of best predicted
- RR >25
- HR >110
- inability to complete sentences

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23
Q

Life threatening asthma

A

Any one of:
CLINICAL SIGNS
- altered conscious level
- silent chest
- exhaustion
- hypotension
- cyanosis
- poor respiratory effort
- arrhythmias

MEASUREMENTS
- PEF <33% of best predicted
- SPO2 <92%
- normal paCO2

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24
Q

Near fatal asthma

A

Raised paCO2 requiring mechanical ventilation with raised inflation pressures

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25
Asthma treatment
1) Oxygen 2) nebulised Salbutamol (beta agonist) (5mg) 3) nebulised ipratropium bromide (500mcg) 4) IV hydrocortisone (100mg) 5) Continuous salbutamol nebulisers 6) IV magnesium (1.2g)
26
Life threatening signs in the context of bradycardia
- Shock - Syncope - Myocardial ischaemia - Heart failure
27
Life threatening signs in the context of tachycardia
Shock Syncope Myocardial ischaemia Severe heart failure
28
Shock - definition
Failure of the circulatory system leading to inadequate organ perfusion and tissue oxygenation.
29
4 main types of shock
Obstructive Hypovolaemic Cardiogenic Distributive
30
Hateful 8 - identification of patients with life threatening shock
Diaphoresis (sweaty/clammy) Pallor (tongue/lips/palms/soles) Venous collapse (variable) LOW ETCO2 Air hunger Altered mental status Abnormal heart rate Hypotension
31
Signs of compensated shock
Tachycardia Tachypnoea Delayed capillary refill Pale/cool/clammy peripheries Reduced pulse pressure Poor SPO2 trace
32
Pre-hospital haemostatic ladder
Wound dressing Direct pressure and elevation Indirect pressure Haemostatics Tourniquets
33
Medical causes of shock
Obstructive - cardiac tamponade - PE - Tension pneumothorax Cardiogenic - Arrhythmia - Infarction - Heart failure Distributive - Anaphylaxis - Neurogenic - Sepsis
34
Red flags in Sepsis
- altered mental state - Systolic BP ≤ 90 mmHg (or drop of >40 from normal) - Heart rate ≥ 130 per minute - Respiratory rate ≥ 25 per minute - Needs O2 to keep SpO2 ≥ 92% (88% in COPD) - Non-blanching rash / mottled / ashen / cyanotic - Lactate ≥ 2 mmol/I - Recent chemotherapy - Not passed urine in 18 hours (<0.5ml/kg/hr if catheterised)
35
Brudzinski's and Kernigs
Meningicoccal septicaemia Kernigs: flex hip to 90deg then extend leg = pain Brudzinkis: flex neck = flexion of pts hips and knees
36
Murphys sign
Acute Cholycystitis Ask the patient to take in and hold a deep breath while palpating the right subcostal area.
37
McBurneys / Psoas / Rovsings
Appendicitis McBurney's: tenderness with palpation of McBurney's point, which is located at one-third of the distance from the anterior superior iliac spine to the umbilicus Psoas: lying on their left side while their right thigh is flexed backward. Rovsings: pressure over the person's left lower abdominal quadrant causes pain in the right lower abdominal quadrant.
38
Sepsis 6
- Oxygen - Fluids - Antibiotics - Take blood cultures - Lactate - Urine output
39
Normal Ketone level
<0.6mmol/L
40
Insulin secreted by:
Pancreas
41
DKA Symptoms
Tachycardia Kussmauls resps Sweet smelling breath (Ketones) Polydipsia (+Thirst) Polyuria Abdo pain Coma
42
DKA Diagnosis
Ketones >3mmol/L PH <7.3 Hyperglycaemic
43
DKA Treatment
Fluid management Adults Not shocked - 1 L Sodium Chloride over 60 mins Shocked - 1L over 15mins Children Shocked - 20ml/kg (15mins) Not shocked - 10ml/kg (60 mins)
44
Cullens sign
Pancreatitis Superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region
45
Grey Turners Sign
Pancreatitis Ecchymosis of the flanks
46
Treatment of Bradycardia
Atropine 500mcg (Alternative drugs: - isoprenaline 5mcg - Adrenaline 2-10mcg) Transcutaneous pacing Arrange for transvenous pacing
47
Risk of Asystole in bradycardia
Recent Asystole Mobitz II AV block Complete heart block Ventricular pause >3s
48
In tachycardia with life threatening symptoms, treatment if cardioversion unsuccessful
Amioderone 300mg Repeat DC cardioversion
49
Treatment for polymorphic VT
Magnesium 2g over 10mins
50
Treatment of pulsed VT without life threatening features
Amioderone 300 over 10-60mins
51
DC Cardioversion initial shock
120-150J
52
DC cardioversion energy for atrial fibrillation
“Start at maximum defibrillator energy setting”
53
DC cardioversion initial energy for atrial flutter
70-120J
54
Narrow complex tachycardia (regular) treatment
1) vagal manoeuvres 2) Adenosine - 6mg Then - 12mg Then - 18mg 3) Verapamil 4) DC cardioversion
55
IM adrenaline preferred injection site
Anterolateral aspect, middle third of the thigh
56
IV fluid in anaphylaxis
Adults: 500-1000mls Children: 10ml/kg
57
Life threatening problems in anaphylaxis
Airway - hoarse voice, stridor Breathing - increased WOB, wheeze, fatigue, cyanosis, spo2 <94% Circulation - hypotension, signs of shock, confusion, reduced consciousness
58
Wells score
PE
59
5 sections of the Abbey Pain Scale for dementia
Vocalisation Facial expression Body language Physiological changes Physical changes
60
Broca formula
To calculate ideal body weight Men = Height (cm) - 100 Women = Height (cm) - 105
61
3 criteria for diagnosis of anaphylaxis
1) rapid onset of symptoms 2) life threatening A, B or C problem 3) skin and/or mucosal changes (flushing, urticaria, angioedema)
62
Management of severe HyperKalaemia
ABCDE approach Calcium (if ECG changes) Salbutamol Insulin/dextrose infusion Emergency dialysis

DipIMC (27 decks)

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