Acute medicine Flashcards
What is the target INR for a patient with recurrent VTE who is already on warfarin?
3.0-4.0, lifelong anticoagulation
What does CHADSVASC stand for?
Congestive heart failure Hypertension Age >75 (2) or >65 (1) Diabetes Stroke/ TIA Vascular disease Sex category - female
How do you manage upper GI bleed in patient on warfarin?
Stop warfarin, administer IV vitamin K, PCC
Give IV lansoprazole
Arrange urgent endoscopy
What are some side effects of massive blood transfusion?
Red blood cells - may lead to fall in platelet concentration if this is not replaced
Hyperkalemia - regular VBGs
Hypothermia
Fluid overload - consider furosemide
What are some transfusion reactions to know?
ABO incompatibility Haemolytic reactions Allaergic reactions TACO TRALI Transfusion-related infections Post-transfusion purpura
What are signs of raised ICP?
Cushing’s reflex occurs due to attempt to increase cerebral perfusion when ICP >MAP, leading to reflex bradycardia, hypertension, irregular breathing (Cushing’s triad)
What causes SIADH?
Malignancy, head injury, (subdural/ extradural), antidepressants, antiepileptics, antipsychotics, cortical bone fractures
What does.a pseudobulbar palsy look like vs. bulbar palsy?
Pseudobulbar palsy - gag reflex normal, spastic dysarthria
Bulbar palsy - gag reflex reduced, flaccid dysarthria
What are some side effects of rapid Na+ replacement? (aim for 8-10mmol/24h)
Osmotic demyelination syndrome (ODS)/ central pontine myelinolysis may result in pseudobulbar palsy, spastic quadraparesis, drop in GCS, coma/ death (2-3 days after correction)
How would you treat new onset SOB following MI?
Acute pulmonary oedema - treat with IV furosemide bolus of 40mg, and reassess
What can cause thrombocytopenia?
Heparin (more common unfractionated), ITP, TTP, DIC
What electrolyte abnormality is common in HHS?
Pseudohypernatraemia. Due to high osmolality, serum sodium appears falsely raised.
