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DipIMC > Acute Medical > Flashcards

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
Q

Asthma treatment

A

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
Q

Life threatening signs in the context of bradycardia

A
  • Shock
  • Syncope
  • Myocardial ischaemia
  • Heart failure
27
Q

Life threatening signs in the context of tachycardia

A

Shock
Syncope
Myocardial ischaemia
Severe heart failure

28
Q

Shock - definition

A

Failure of the circulatory system leading to inadequate organ perfusion and tissue oxygenation.

29
Q

4 main types of shock

A

Obstructive
Hypovolaemic
Cardiogenic
Distributive

30
Q

Hateful 8 - identification of patients with life threatening shock

A

Diaphoresis (sweaty/clammy)
Pallor (tongue/lips/palms/soles)
Venous collapse (variable)
LOW ETCO2
Air hunger
Altered mental status
Abnormal heart rate
Hypotension

31
Q

Signs of compensated shock

A

Tachycardia
Tachypnoea
Delayed capillary refill
Pale/cool/clammy peripheries
Reduced pulse pressure
Poor SPO2 trace

32
Q

Pre-hospital haemostatic ladder

A

Wound dressing
Direct pressure and elevation
Indirect pressure
Haemostatics
Tourniquets

33
Q

Medical causes of shock

A

Obstructive
- cardiac tamponade
- PE
- Tension pneumothorax

Cardiogenic
- Arrhythmia
- Infarction
- Heart failure

Distributive
- Anaphylaxis
- Neurogenic
- Sepsis

34
Q

Red flags in Sepsis

A
  • 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
Q

Brudzinski’s and Kernigs

A

Meningicoccal septicaemia

Kernigs: flex hip to 90deg then extend leg = pain

Brudzinkis: flex neck = flexion of pts hips and knees

36
Q

Murphys sign

A

Acute Cholycystitis

Ask the patient to take in and hold a deep breath while palpating the right subcostal area.

37
Q

McBurneys / Psoas / Rovsings

A

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
Q

Sepsis 6

A
  • Oxygen
  • Fluids
  • Antibiotics
  • Take blood cultures
  • Lactate
  • Urine output
39
Q

Normal Ketone level

A

<0.6mmol/L

40
Q

Insulin secreted by:

A

Pancreas

41
Q

DKA Symptoms

A

Tachycardia
Kussmauls resps
Sweet smelling breath (Ketones)
Polydipsia (+Thirst)
Polyuria
Abdo pain
Coma

42
Q

DKA Diagnosis

A

Ketones >3mmol/L
PH <7.3
Hyperglycaemic

43
Q

DKA Treatment

A

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
Q

Cullens sign

A

Pancreatitis

Superficial oedema with bruising in the subcutaneous fatty tissue around the peri-umbilical region

45
Q

Grey Turners Sign

A

Pancreatitis

Ecchymosis of the flanks

46
Q

Treatment of Bradycardia

A

Atropine 500mcg

(Alternative drugs:
- isoprenaline 5mcg
- Adrenaline 2-10mcg)

Transcutaneous pacing

Arrange for transvenous pacing

47
Q

Risk of Asystole in bradycardia

A

Recent Asystole
Mobitz II AV block
Complete heart block
Ventricular pause >3s

48
Q

In tachycardia with life threatening symptoms, treatment if cardioversion unsuccessful

A

Amioderone 300mg
Repeat DC cardioversion

49
Q

Treatment for polymorphic VT

A

Magnesium 2g over 10mins

50
Q

Treatment of pulsed VT without life threatening features

A

Amioderone 300 over 10-60mins

51
Q

DC Cardioversion initial shock

A

120-150J

52
Q

DC cardioversion energy for atrial fibrillation

A

“Start at maximum defibrillator energy setting”

53
Q

DC cardioversion initial energy for atrial flutter

A

70-120J

54
Q

Narrow complex tachycardia (regular) treatment

A

1) vagal manoeuvres
2) Adenosine
- 6mg
Then - 12mg
Then - 18mg
3) Verapamil
4) DC cardioversion

55
Q

IM adrenaline preferred injection site

A

Anterolateral aspect, middle third of the thigh

56
Q

IV fluid in anaphylaxis

A

Adults: 500-1000mls
Children: 10ml/kg

57
Q

Life threatening problems in anaphylaxis

A

Airway - hoarse voice, stridor

Breathing - increased WOB, wheeze, fatigue, cyanosis, spo2 <94%

Circulation - hypotension, signs of shock, confusion, reduced consciousness

58
Q

Wells score

A

PE

59
Q

5 sections of the Abbey Pain Scale for dementia

A

Vocalisation
Facial expression
Body language
Physiological changes
Physical changes

60
Q

Broca formula

A

To calculate ideal body weight

Men = Height (cm) - 100
Women = Height (cm) - 105

61
Q

3 criteria for diagnosis of anaphylaxis

A

1) rapid onset of symptoms
2) life threatening A, B or C problem
3) skin and/or mucosal changes (flushing, urticaria, angioedema)

62
Q

Management of severe HyperKalaemia

A

ABCDE approach
Calcium (if ECG changes)
Salbutamol
Insulin/dextrose infusion
Emergency dialysis

DipIMC (27 decks)

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