Acute Medicine Flashcards
1
Q
What is triage?
A
Principle used when casualties > HCWs using rapid A-C assessment
Ensuring the right patient, the right place at the right time
2
Q
Using the Adult Triage Sieve, a patient who is walking is?
A. P1
B. P2
C. P3
D. P4
E. Dead
A
P3
3
Q
Using the Adult Triage Sieve, a patient who is breathing with a respiratory rate of 7 is?
A. P1
B. P2
C. P3
D. P4
E. Dead
A
P1
RR <10 or >30 = P1
4
Q
Using the Adult Triage Sieve, a patient who is breathing at a rate of 34 breaths per minute is?
A. P1
B. P2
C. P3
D. P4
E. Dead
A
P1
5
Q
Using the Adult Triage Sieve, a patient who has a CRT of <2 and a respiratory rate of 10-29 (normal) is?
A. P1
B. P2
C. P3
D. P4
E. Dead
A
P2
6
Q
Using the Adult Triage Sieve, a patient who has a CRT of 3 seconds is?
A. P1
B. P2
C. P3
D. P4
E. Dead
A
P1
CRT > 2s = P1
7
Q
Using the Manchester Triage System, how long should a red patient have to wait?
A. See immediately
B. 10 minutes
C. 1 hour
D. 2 hours
E. 4 hours
A
A
8
Q
Using the Manchester Triage System, how long should a green patient have to wait?
A. See immediately
B. 10 minutes
C. 1 hour
D. 2 hours
E. 4 hours
A
D
9
Q
Using the Manchester Triage System, how long should an amber patient have to wait?
A. See immediately
B. 10 minutes
C. 1 hour
D. 2 hours
E. 4 hours
A
B
10
Q
Using the Manchester Triage System, how long should a yellow patient have to wait?
A. See immediately
B. 10 minutes
C. 1 hour
D. 2 hours
E. 4 hours
A
C
11
Q
Using the Manchester Triage System, how long should a blue patient have to wait?
A. See immediately
B. 10 minutes
C. 1 hour
D. 2 hours
E. 4 hours
A
E
12
Q
State 5 admission factors in acute medicine.
A
Age
Social history
Comorbidities
Access to hospital
Resources available
Condition requiring admission
FU care
Time of presentation
13
Q
Outline the key features of an SBAR.
A
Situation
Background
Assessment
Recommendation
14
Q
Outline the key features of an ATMIST
A
Age
Time
MOI
Injuries
Signs
Treatment
15
Q
What does the primary surgery involve?
A
A systematic method of managing life-threatening conditions. The principles are conducted in order of urgency. Any intervention or change in status requires reassessment starting from A.
Danger – environment, people, surroundings Response – of patient Airway Breathing Circulation Disability Exposure
16
Q
Describe the airway ladder.
A
The airway ladder is a series of steps used to regain airway patency.
- Positioning (c-spine) – MILS
- Chin-tilt (2 fingers) or Jaw thrust (2 fingers at mandible angle)
- OPA (mandible to teeth)/NPA (height)
- SGA (hold like pen and insert)
- ETT
- Cricothyroidotomy
17
Q
Describe the recovery position.
A
Position to protect the airway for an unconscious casualty who is breathing spontaneously
- Straighten both legs
- Place arm nearest you, at right angles to casualty, with elbow bent and palm facing upwards
- Bring furthest away arm across the casualty’s chest and hold the back of that hand against his cheek, on the side of his face nearest you
- With your other hand grasp his far leg just above the knee and pull it up, keeping the foot on the ground
- Keeping his hand pressed against his cheek, pull the bent leg and roll the casualty towards you and onto his side (Use the pelvis as a fulcrum)
- Adjust the upper leg so that both hip and knee are bent at right angles
- Tilt head back to keep the airway open
- Adjust the hand under the cheek, if necessary, to keep head tilted
- Check breathing regularly (reassessing ABC)
18
Q
What aspects make up circulation in an A-E assessment?
A
HR - Rate, rhythm, volume
CRT
IV/IO access
19
Q
What are the usual PaO2 pressures?
A
10-12kPa
20
Q
What is the normal PaCO2 pressure?
A
4.5-6kPa
21
Q
What is the usual pH of blood?
A
7.35-7.45
22
Q
What is the usual concentration of bicarbonate?
A
22-24mmol/L
23
Q
Outline how you would interpret a CXR.
A
Mnemonic: DR ABCDE
Details: Patient/Setting/AP vs PA/ Rotation/Inspiration/Picture/ Exposure
Airway: Trachea -> Carina -> Bronchi -> Hilar; Mediastinal width (=8cm)
Breathing: Lung fields in an S-shape and pleura
Circulation: Aortic knuckle; Heart; Borders
Diaphragm: costophrenic angles; gastric bubble; free air?
Everything else: Bones; soft tissues; other iatrogenic aspects
24
Q
State 5 types of injuries you may encounter.
A
RTA Pedestrian Falls Burns Lacerations Sporting Blast injuries Gunshot
25
How may you assess for a C-spine injury?
Mnemonic: NSAID (from NEXUS criteria)
```
Neuro deficit
Spinal midline tenderness
Alertness
Intoxication
Distracting injury
```
26
How may you stabilise a C-spine injury?
1) MILS
2) Cervical collar
3) Triple immobilisation (hard collar + head block + tape)
27
Give 5 signs of an obstructed airway.
```
Accessory muscle recruitment
Distress
Pallor/Cyanosis
Paradoxical chest movements
Reduced consciousness
```
Absent breath sounds
Stridor
Snoring/Gurgling
28
What might an indication for suction?
Audible secretion
Noisy crackles of secretions
Ineffective cough and physical deterioration
29
What is the name of the forceps which use twin-bladed forceps at an oblique angle to prevent obstruction of view?
Magill Forceps
30
When may you not give an OPA or NPA?
Mandible fracture
Oral trauma
Trismus
31
How do you size an OPA?
front teeth to angle of mandible
32
How does insertion of an OPA differ in children vs adults?
- In adults, insert pointing up and rotate 180 degrees.
| - In children, insert directly pointing downwards
33
How do you insert an NPA?
- Insert with bevel pointing towards septum
34
What are the indications for definitive airway management?
```
Apnoea
Airway protection from aspiration
Unconsciousness (GCS <8)
Faciomaxillary fractures
Risk of obstruction
Impending airway compromise e.g. burns or anaphylaxis
```
35
How do you assess a patient's breathing in the acute setting?
Mnemonic: RIPA
RR (12-20)
Inspection: Cx deformity; accessory muscle recruitment; skin colour; injuries; previous surgeries; tracheal position)
Palpation: Tracheal position; Cx expansion; Surgical emphysema
Percussion: Resonant vs Hyper resonant vs Hyporesonant
Auscultation: Air entry; breath sounds
36
What are the potential interventions in Breathing in an acute situation?
```
Mouth to mouth
Pocket mask
Bag valve mask
±
SGA or ETT
```
37
What is the physiology behind exercising caution when oxygenating CO2 retainers with COPD?
V-Q mismatch: COPD patients develop V-Q mismatching by hypoxic vasoconstriction to underperfused regions to optimise GE. Excess oxygen overcomes high leads to blood flow to poorly ventilated alveoli with increased physiological dead space
Haldane effect: Oxygen can induce RHS shift of CO2 dissociation curve thus greater CO2 retention known as the Haldane effect
38
How is a needle thoracostomy conducted?
14-16G IV cannula placed in 2nd ICS at MCL over third rib
39
How is a chest drain inserted?
Identify triangle of safety (MAL + pec border + nipple line)
Inject 10-20mL of 1% Lidocaine above rib (in triangle of safety)
Blunt dissect down to level of pleura and puncture pleura with scissors or forceps
Advance drain slowly, stopping if you hit serious resistance
Attach other end of drain to underwater seal
Request CXR to check drain placed correctly
40
What are the major sites of bleeding in the body?
Mnemonic: 4 and the floor
Thorax
Abdomen
Pelvis
Long bones
Externally (the floor/surrounding)
41
What are the ways to manage a catastrophic haemorrhage in the acute setting?
Direct pressure and elevation
Windlass technique
Tourniquet
Activate major haemorrhage protocol
- Call 2222
- Respond: Control bleed; Venous access; Warm fluids; Blood tests
- Blood tests: FBC; Crossmatch; Coag screen; Biochemistry; ABG
- Request Group O- blood; Group specific blood; Platelets; FFP
42
How much does 1 unit of blood raise Hb by?
1 unit of blood raises Hb by 10g/L
43
Give 3 contraindications to an intraosseous injection?
```
Inability to locate landmark
Fractures in targeted bone
PMHx surgery in targeted bone
Infection at target site
Previous failed IO access within 24 hours in targeted bone
```
44
How should fluid be administered in the acute scenario?
Give fluid via cannulas in 250mL boluses should radial pulse be impalpable. Continue to fluid resus until radial pulse returns (≈ > 80mmHg). Choice of fluid should be isotonic saline.
45
Give the causes of cardiac arrest (collapse)?
Mnemonic: 4Hs and 4Ts
Hypoxaemia
Hypovolemia
Hyperkalaemia
Hypothermia
Tension pneumothorax
Tamponade
Toxin
Thrombosis
46
Outline the chain of survival.
Early recognition and call for help
Early CPR
Early defibrillation
Post resuscitation care
47
Outline the adult life support algorithm.
Recognise patient is unresponsive and not breathing normally
Look for dangers
Call for help
CPR at 30:2 (attach defibrillator)
Assess rhythm
Either:
1) Shockable rhythm thus 1 shock and continue CPR for 2 minutes then reassess
2) Non-shockable rhythm thus CPR for 2 minutes
3) Return of spontaneous circulation
48
How can consciousness be assessed in the acute setting?
1) AVPU
| 2) GCS
49
Outline how GCS is scored.
GCS scored out of 15 (E4, V5, M6)
```
Eyes:
1 = not open
2 = open to pain
3 = open to speech
4 = open
```
```
Verbal:
1 = none
2 = incomprehensible
3 = inappropriate - random speech patterns with no conversational speech
4 = confused and disorientated
5 = orientated
```
```
Motor:
1 = none
2 = extends to pain
3 = abnormal flexion to pain
4 = flexion to pain
5 = localising to pain or touch
6 = obeys commands
```
50
How can you grade motor power in a neuro exam. Differentiate between the scores.
```
0 = no contraction
1 = flicker
2 = movement but not against gravity
3 = movement against gravity
4 = movement against resistance
5 = normal strength
```
51
How can you score reflexes?
Can be scored from 0-5
```
0 = absent
1 = trace response
2 = normal
3 = brisk
4 = non-sustained clonus
5 = clonus
```
52
How do you take a brief history in an acute situation?
Mnemonic: SAMPLE history
```
Signs and symptoms
Allergies
Medications
PMHx
Last Eaten
```
53
How do you manage a tension pneumothorax?
Needs thoracostomy
then Chest drain for definitive management
54
How do you manage an open pneumothorax?
One-way valve adhesive dressing
+
Chest drain
55
How do you manage a massive haemothroax/
Chest drain
56
How do you manage a flail chest?
Analgesia
+
Splintage
57
How do you manage a cardiac tamponade?
Pericardiocentesis
58
What is the Beck Triad?
Muffled heart sounds + Raised JVP + Hypotension
59
What are the features of moderate acute asthma?
Increasing symptoms
PEF >50-75% best or predicted
No features of acute severe asthma
60
What are the clinical features of acute severe asthma?
PEF 33-50%
RR >25/min
HR >110/min
Inability to complete sentences in one breath
61
What are the clinical features of life threatening asthma?
```
Cannot speak
Cyanosis
PEF <33%
Altered consciousness level
Silent chest
Poor respiratory effort
Hypotension
SpO2 <92%
PaO2 <8kPa
Normal PaCO2 (4.5-6kPa)
```
62
How do you treat an acute exacerbation of asthma?
Mnemonic: O SHIT MAn
```
Oxygen
+
Salbutamol 5mg
+
Ipratropium 5mcg
```
```
±
IV Hydrocortisone
/
Theophylline
/
Magnesium sulphate
/
Anaesthetist Needed
```
63
What are the components of Virchow's triad?
Endothelial damage
Hypercoagulability
Venous stasis
64
How do you treat a PE?
Stable = DOAC
Unstable = Intravenous thrombolysis
65
How should you manage a PE in a patient with a eGFR of 10?
PE treatment but patient has severe renal impairment thus
LMWH as <15 - follow local guidance
66
How long should a patient continue anticoagulation for following a PE?
3 months
Active cancer = 6 months
Unknown cause = 12 months +
67
How do you manage acute pulmonary oedema?
Mnemonic: LMNOP
```
- Loop diuretic: Furosemide 40mg
+
- Morphine
+
- Nitrate: Nitroprusside
+
- Oxygen: High-flow O2 non-rebreathable mask targeting 94% <
+
- Position: Upright
```
68
What are the features of the CURB65 score?
Confusion
Urea >7
RR > 30
BP <90mmHg
65 years old
69
What type of shock is caused by haemorrhage?
A. Hypovolaemic
B. Cardiogenic
C. Obstructive
D. Distributive
A
70
What type of shock is caused by severe mitral regurgitation?
A. Hypovolaemic
B. Cardiogenic
C. Obstructive
D. Distributive
B
71
What type of shock is caused by an SVCO?
A. Hypovolaemic
B. Cardiogenic
C. Obstructive
D. Distributive
C
72
What type of shock is caused by sepsis?
A. Hypovolaemic
B. Cardiogenic
C. Obstructive
D. Distributive
D
73
A patient has lost 10% of blood volume. What class of haemorrhagic shock have they experienced?
Class I
74
A patient has lost 15% of blood volume with tachycardia and tachypnoea. What class of haemorrhagic shock is this?
Class II
75
A patient presents with 32% EBL, tachycardia, tachypnoea and hypovolaemia.
What class of haemorrhagic shock is this?
Class III
76
A patient presents with 45% EBL, tachycardia, hypovolaemia, tachypnea and anuria. What class of haemorrhagic shock is this?
Class IV haemorrhagic shock
77
How is Hypoglycaemia managed in the acute setting?
- Tx cause
+
- Glucose 10-20g
If unconscious: Glucose 75mL of 20% IV over 10 minutes
78
How is a DKA managed?
Follow the DKA protocol
Insulin: 0.1U/kg/hour
+
IV Fluids: 1L 30 mins; 1L 1 hour; 1L 2 hours; 1L 4 hours
± Hypotension
IV Colloids
± Hypokalaemia
IV Fluids: Add KCl (10mmol/L if 3-5mmol/L or 20 if <3.5mmol/L)
± Glucose <14mmol/L
IV Glucose 10%
79
What is the main difference between management of HHS and DKA regarding insulin?
In DKA use 0.1U/kg/hr cf in HHS use 0.05U/kg/hr
80
Describe the process of syncope.
Transient, self-limited loss of consciousness with an inability to maintain postural tone followed by a spontaneous recovery.
81
Give 5 causes of syncope.
```
Neural:
Vasovagal faint
Carotid Sinus Hypersensitivity
Situational faint
Trigeminal neuralgia
Glossopharyngeal neuralgia
```
Orthostatic:
Orthostatic hypotension
Hypovolaemia
```
Cardiac:
Arrhythmia
Valvular disease
Cardiomyopathy
Aortic dissection
Pericardial disease
Cardiac tamponade
PE
Subclavian steal syndrome
```
82
What is important to ask regarding a falls history?
When did it happen?
Has this happened before?
How many times in last year?
```
What were you doing at the time?
Did you get any symptoms before?
Do you remember hitting the ground?
Did you hit any parts of your body?
Did you get up by yourself?
How long were you on the ground for?
How did you feel after?
```
83
Describe what a TIA is?
Interruption of blood supply to focal part of brain causing a loss of neurological function with symptoms lasting < 24 hours without infarction
84
What can be used to assess risk of a stroke after a TIA?
ABCD2 score
Age >60
Blood pressure >140/90mmHg
Clinical features: Unilateral weakness; speech disturbance without weakness
Duration of TIA: >60; 10-59; <10 minutes
Diabetes Mellitus
Score of 4-5 = 4.1%
Score of 6-7 = 8.1%
85
How do you manage a TIA?
Secondary stroke prevention...
• Supportive: Lifestyle advice; RF modification; control of RFs
+
• Antiplatelets: Aspirin: Clopidogrel: 300mg (loading) then 75mg OD (if intolerant of aspirin)
+
• Statins: Simvastatin 40mg OD (Cl > 3.5mmol/L or LDL > 2.5mmol/L)
+ Tx any causes or risk factors
86
What is a stroke?
Interruption of blood supply to focal part of brain (haemorrhage or infarction) causing a loss of neurological function with symptoms lasting > 24 hours or leading to death with no apparent cause other than vascular origin
87
What is the most common type of stroke?
Ischaemic stroke
88
What classification system can be used for strokes?
Bamford/Oxford Classification of Stroke
TACS = 3/3
- Unilateral weakness/sensory deficit
- Homonymous hemianopia
- Higher cerebral dysfunction (dysphagia, visuospatial disorder)
PACS = 2/3
```
POCS = 1 of the following
- Cranial nerve palsy and contralateral motor/sensor deficit
Bilateral motor/sensory deficit
Conjugate eye movement
Cerebellar dysfunction
Isolated homonymous hemianopia
```
LACS = 1 of the following
- Pure sensory stroke
- Pure motor stroke
- Sensori-motor stroke
- Ataxic hemiparesis
89
How long do you have from when a stroke patient presents to conduct thrombolysis?
< 4.5 hours to give Alteplase + Aspirin
90
How long do you have once occlusion of circulation is identified in a stroke?
24 hours
91
Give 5 causes of metabolic acidosis with an high anion gap.
Mnemonic: MUD PILES
Methanol
Uraemia
DKA
```
Paraldehyde
Iron/Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
```
92
How can you classify head injuries?
- Mild head injury: 13-15
- Moderate head injury: 9-12
- Severe head injury: 3-8
93
What is the criteria for a CT-head in a trauma situation?
```
GCS < 15 at 2 hours after injury
GCS <13
Suspected skull fracture
Signs of basal skull fracture
Post-traumatic seizure
Focal neurological deficit
2+ episodes of vomiting
```
94
How are burns classified?
- 1st Degree (epidermis only) -> dry and painful
- 2nd Degree (epidermis and upper dermis) -> wet and painful
- 3rd Degree (epidermis and dermis and appendages) -> dry and insensate
- 4th Degree (subcutaneous tissue, tendon or bone)
95
Give 3 types of burns.
- Thermal
- Electrical
- Chemical
- Non-accidental (the above but abuse or neglect)
96
How can you calculate the amount of fluids to give in a patient with burns?
Use the Parkland formula
4ml/kg x VSA = volume in 24 hours
97
Give 3 causes of J waves (Osborn waves)?
```
Hypothermia
Hypercalcemia
Brain injury
SAH
Sedation (and cardiopulmonary arrest)
Vasospastic angina
Ventricular fibrillation
```
98
How do you manage hypothermia?
- Supportive: shelter, warm drinks, ABCDE, fluids, remove wet clothing, stop nephrotoxic drugs (medicine reconciliation)
‘passive rewarming’
± Moderate Hypothermia (28-32ºC)
- Transfer to hospital + CPR (5:5) + measure [K+] ? <8mmol/L
± Severe Hypothermia (<28ºC)
- Definitive airway management: SGA/Intubation
+
- Transfer to hospital ± Cardiopulmonary bypass
99
What makes up the sepsis 6?
Mnemonic: BUFALO
Give 3 and take 3
```
Bloods
Urine output
Fluids
ABG
Lactic acid
Oxygen
```
100
What are the signs of NAI?
* Vague account
* Incongruent stories
* Story incompatible to injury
* Delay in seeking help
* Parent does not reflect level of caring: Too little or Too much
* Child’s affect: Sad/Withdrawn/Fearful/Trusting in strangers
101
What are the signs of neglect?
* Inadequately fed
* Poor dress
* Poor hygiene
* Deprived of satisfactory contact with parents/guardian
* Deprived of social contact with friends and children
* Failure to meet milestones
102
What are the clinical features of schizophrenia?
```
Tangentiality/ Thought processing
Hallucinations (auditory/visual)
Reduced reality (Delusions)/Repetition of words (Verbigeration)
Emotional control: Incongruous effect?
Arousal
Disorganised/ Catatonic Behaviour
```
```
Loss of volition/social settings/ Pleasure
Emotional flatness (Affective Blunting)
Speech reduced (Alogia)
Slowness in thought (cognitive deficit)/Somatisation (physical Sx – expressed in body)
```
103
How do you manage Schizophrenia?
• Anti-psychotic medication: Aripiprazole
+
• Psychological Interventions: Family/CBT/Social-skills training
104
What is the difference between Bipolar I and Bipolar II Disorder?
- Bipolar I Disorder (At least 1 manic/mixed episode)
| - Bipolar II Disorder (At least 1 hypomanic + 1 major depressive disorder)
105
What are the signs of opiate intoxication?
* Sedation
* Nausea
* Vomiting
* Mood change: Euphoria/Intense pleasure
* Analgesia
* Pupillary constriction
* Respiratory depression
* Bradycardia (Decreased SNS outflow)
* Hypotension (Decreased SNS outflow)
* Hypothermia
* Cough reflex suppression
* Analgesia
106
What is the reversal agent of Morphine overdose?
Naloxone
107
What are the clinical features of amphetamine overdose?
* Euphoria
* Hyperarousal: Energy + Alertness
* Self-confidence
* Reduced inhibitions + Impulsive behaviour
* Reduced appetite (Appetite suppression)
* Pupillary dilation
* Blurred vision
* Dry mouth
* Tachycardia
* Arrhythmia
* Hypertension
* Hyperthermia
* Hyperhidrosis
* Tremor
* Dehydration -> Xerostomia
* Agitation
108
What can be used to treat a patient with an amphetamine overdose in an acute setting?
Benzodiazepines
109
What are the clinical features of cocaine overdose?
* Euphoria
* Hyperarousal: Energy + Alertness
* Self-confidence
* Reduced inhibitions + Impulsive behaviour
* Reduced appetite (Appetite suppression)
* Pupillary dilation
* Blurred vision
* Tachycardia
* Arrhythmia
* Hypertension
* Hyperthermia
* Hyperhidrosis
* Tremor
* Dehydration
* Agitation
110
How can you manage a patient with cocaine overdose in an acute setting?
• Benzodiazepines: Lorazepam/Diazepam
+
• CBT
111
What are the clinical features of a patient with MDMA intoxication?
* Euphoria
* Nausea
* Vomiting
* Hallucinations: Visual + Auditory
* Insomnia
* Impulsivity
* Anorexia
* Weight loss
* Psychological Sx: Anxiety/Paranoia/Psychosis Suicidal feelings
* Low mood (come down)
* Dilated pupils
* Blurred vision
* Dry mouth
* Teeth grinding
* Jaw tightening (bruxism)
* Tachycardia
* Hypertension
* Tachypnoea
* Hyperthermia
* Hyperhidrosis
* Dehydration
* Tremor
* Psychomotor activity increased
* Agitation
112
What are the clinical features of a patient with LSD intoxication?
* Hallucinations: Visual + Auditory
* Illusions
* Micropsia/Macropsia
* Synaesthesia
```
At higher doses, sympathomimetic effects
• Dilated pupils
• Tachycardia
• Hypertension
• Hyperreflexia
• Hyperthermia
```
113
What are the clinical features of ketamine intoxication?
* Hallucinations/Near-death
* Out-of-body experience: Derealisation/Depersonalisation
* Psychosis
* Emergence phenomena
* Cognitive impairment
* Synaesthesia
* Hypersalivation
* Tachycardia
* Hypertension
114
What are the clinical features of magic mushrooms?
* Hallucinations: Visual + Auditory
* Illusions
* Micropsia/Macropsia
* Synaesthesia
* Panic
* Amnesia
* Psychosis
* Mydriasis
* Acute stuporous state
115
What is the reversal agent for benzodiazepine overdose?
Flumazenil
116
What are the clinical features of Benzodiazepine toxidrome?
* Impaired mental status: Attention; Memory; Inappropriate behaviour
* Drowsiness
* Slurred speech
* Ataxia
* Respiratory depression
* Coma
* Decreased deep tendon reflexes
* Nystagmus
117
What are the clinical features of cannabis intoxication?
* Euphoria
* Increased appetite
* Sedation
* Perceptual awareness
* Hallucinations -> Psychosis
* Tachycardia
* Hypertension
* Bronchodilation
118
What questions can be used in suspected Eds?
Mnemonic: SCOFF Qs
```
Sick
Control
One stone
Fat
Food
```
119
What does the Hip 6 bundle comprise of?
Analgesia
Monitoring (EWS)
Delirium screen
FBC
Iv fluids
Pressure area management
120
What is the landmark for a fascia iliaca block?
Locate inguinal ligament
2cm inferior
2cm lateral from Femoral Artery (approx. 2/3 laterally)
Pierce two fascial compartments (fascia lata then iliaca fascia)
121
What is an orbital blow out fracture?
Fracture in an orbital wall however orbital rim remains intact
122
List 3 types of seizures.
Generalised
Focal
Absence
Febrile
Infantile spasms (West Syndrome)
Lennox Gastuat Syndrome (LGS)
123
What are the differences between West Syndrome and Lenox-Gustaut Syndrome?
West Syndrome occurs in 4-8 months years old, commonly in males with salaam attacks (flexion of head, trunk and arms with extension of arms). These last 1-2 seconds and occur up to 50 times.
EEG shows hypsarrhythmia and CT shows diffuse or localised brain disease in 70%
Lenox-Gustaut Syndrome features numerous seizure types with tonic and atonic seizures. Often a background of behavioural problems, hyperactivity, agitation, aggression and autism.
EEG shows background slowing and slow spike-wave bursts. In sleep, generalised paroxysmal fast activity is seen.
124
How quickly should a stroke thrombolysis be given?
4.5 hours from stroke symptoms
125
What may contraindicate a patient to stroke thrombolysis?
ICH
SAH
Stroke/TBI past 3/12
Seizure at time of stroke
GI haemorrhage in past 3/52
Pregnancy
Oesophageal varices
Uncontrolled hypertension (>200/120mmHg)
126
How quickly should thrombectomy be offered following a stroke?
Offer thrombectomy following IV thrombolysis within 6 hours of symptom onset
127
What are the clinical features of an orbital blowout fracture?
Enophthalmos
Hypoglobus
Diplopia
Orbital emphysema
Malar region numbness (infraorbital nerve palsy)
128
What is an Orthopantomogram (OPG)?
When may you use it?
Panoramic XR of upper and lower jaws
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Look for:
Fractures
Dislocated jaw
Infection
Dentition
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129
How do you calculate the expected PaO2 in relation to FiO2?
FiO2 - 10kPa = PaO2
Thus if a patient is on 40% Oxygen, PaO2 is expected to be 30kPa
130
Oxygen via a nasal cannula delivers how what FiO2 at which rate?
Rule of 4...
1L/min = 24%
2L/min = 28%
3L/min = 32%
4L/min = 36%
131
Discuss the oxygen delivery devices and their usefulness in delivering oxygen.
Numerous oxygen delivery devices may be utilised: nasal cannulae, simple face masks, non-rebreathers and Venturi face masks.
Nasal cannulae deliver Oxygen between 1-4L/min with FiO2 ranging from 24-36%
Simple face mask gives a FiO2 at 40-60% at a flow-rate of 15L/min.
Reservoir mask (non-rebreather) gives flow rate of 10-15L/min at FiO2 of 60-90%.
Venturi mask gives a FiO2 at 24, 28, 35, 40 and 60%. Useful in patients at risk of carbon dioxide retention
132
Outline the differences between type 1 and type 2 respiratory failure?
Type 1 Respiratory Failure = hypoxaemia (PaO2 <8kPa) with normocapnia
T1RF due to V/Q mismatch as volume of air in and out of lungs incongruent with perfusion. Rise in PaCO2 results in increased alveolar ventilation which blows of CO2 but not allowing adequate oxygenation
- Pulmonary oedema
- PE
Type 2 Respiratory Failure = hypoxaemia (<8kPa) AND hypercapnia (>6kPa)
T2RF = alveolar hypoventilation preventing patient from adequately oxygenating and eliminating CO2 from blood
- COPD
- Pneumonia
- Rib fractures
- Obesity
- Guillain-Barré
- Motor neurone disease
- Opiates
- BZD
133
How do you calculate an anion gap?
Na+ - (Cl- and HCO3-)
134
Give 3 causes of a high anion gap metabolic acidosis.
Mnemonic: MUD PILES
Methanol
Uraemia
DKA
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Paraldehyde
Iron/Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
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