Acute Medicine Flashcards
What is the pathophysiology of a DVT ?
Venous thrombi can form in the deep veins of the legs due to a stasis of the blood which could be due to an extended period of immobility.
Risk factors of DVT ?
Increased age
Pregnancy
Surgery
Past DVT
Cancer
Obesity
Immobility
What are the signs of a DVT ?
Calf warmth
Tenderness
Swelling
Erythema
Mild fever
Pitting oedema
Investigations when suspecting a DVT ?
D-dimer ( not specific to a DVT )
USS
Thrombophilia tests
Urine dipstick
FBC
What preventative measures can be put in place for a DVT ?
Stop the pill
Mobilise early
Low molecular weight heparin / Fondaparinux
Compression stockings
What treatment options are there for a DVT ?
Low molecular weight heparin ( enoxaparin ) or Fondaparinux
Stop heparin when INR is 2-3
What is used to assess the probability of a DVT forming ?
The well’s score
What should always be suspected if there is a sudden collapse 1-2 weeks after surgery ?
PE
How do PE’s occur ?
Venous thrombi, usually from a DVT, pass into the pulmonary circulation and block blood flow to the lungs.
What are the risk factors of a PE ?
Malignancy
Surgery
Immobility
COCP
Previous thromboembolism or inherited thrombophilia
Signs and symptoms of a PE ?
Acute dyspnoea
Pleuritic chest pain
Haemoptysis
Syncope
Hypotension
Tachycardia
Increased JVP
Tachypnoea
Investigation for a PE ?
U & E
FBC
ECG - can be normal or sinus tachycardia
CXR - often normal
ABG
Serum D dimer
CT pulmonary angiography
What is the management of a large PE ?
Oxygen if hypoxic
Analgesia
Start low molecular weight heparin
If stable BP start warfarin loading regime
Signs and symptoms of sepsis
Slurred speech or confusion
Extreme shivering or muscle pain
Not passing urine
Severe breathlessness
Skin mottled or discoloured
Risk factors for sepsis
Age ( under 1 or over 75 )
Cancer - chemotherapy
Diabetes
Splenectomy
Immunosuppressants
Recent surgery
Breach of skin integrity
Indwelling lines or catheters
What should be assessed for suspected sepsis ?
Temp
HR
RR
BP
O2 sats
Consciousness level
Any breaches of the skin
Non-Blanching rash
Cyanosis of the skin
What is the treatment for sepsis ?
The sepsis 6 bundle
- give oxygen
- take a blood culture
- give IV antibiotics ( meropenem )
- give fluids
- measure lactate ( do a blood gas )
- measure urine output
What is shock ?
Circulatory failure that results in inadequate organ perfusion.
Signs of shock
Low GCS
Pallor
Cool peripheries
Tachycardia
Slow capillary refill
Tachypnoea
Oliguria
How does sepsis cause shock ?
An infection from any organism can cause acute vasodilation from inflammatory cytokines.
What can cause inadequate cardiac output causing shock ?
Hypovolaemia - bleeding ( trauma, GI bleed, ruptured aortic aneurysm), vomiting, diarrhoea, burns
Pump failure - cardiogenic shock ( arrhythmias, aortic dissection ), PE, cardiac tamponade, pneumothorax
What should be done for shock in the ABCDE assessment ?
Large bore IV access
ECG
If there is a raised JVP which shock is indicated ?
Cardiogenic
What should be looked for in a general review of someone with shock ?
Cold and clammy skin or warm skin
Signs of anaemia
Signs of dehydration
Pulse - bounding or weak
Tachycardia
Abdomen
