Acute Medicine Flashcards by Clare Dempsey

O2 therapy should NOT be given routinely when?

MI/ACS
Stroke
Obstetric emergencies
Anxiety-related hyperentilation
Type 2 Resp Failure

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What are the features of hypercalcaemia?

Bones, stones, groans and psychic moans
Corneal calcification
Short QT interval
HTN

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How do you manage hyperkalaemia?

Calcium gluconate (to stabilise heart)
Insulin (to make K go into cells)
Dextrose (to stop hypoglycaemia)

Can give salbutamol to relax airway muscles

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Management of hypercalcaemia

IV saline
IV bisphosphonates (Eg Pamidronate or Zoledronate)

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What is the standard dose of FFP?

15ml/kg

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When do you give FFP?

If a pt is bleeding and their PT or APTT is abnormal at all

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What is the critical level of fibrinogen in an acute bleed?

2g/L

*NOTE: keep the levels above this using 2 pools of cryoprecipitate

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What do you give to inhibit fibrinolysis?

Tranexamic acid 1mg IV

Give early, often given immediately after childbirth

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What do you give to reverse warfarin in life/limb threatening bleeding?

Prothrombin complex concentrate (works in minutes)

Also vit K (works over a few hrs)

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In major haemorrhage, when do you transfuse platelets?

Below 75 to maintain above 50

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How do you diagnose hypoperfusion?

If 1+ of the following are present after pt given 30ml/kg IV fluids or pt has serum lactate >4mmol/L:

systolic BP <90
mean arterial pressure <65
drop of >40 in pt’s usual BP that persists

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How do you differentiate between bacterial and viral infection based on WCC?

Bacterial = neutrophilia
Viral = lymphocytosis

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What do atypical lymphocytes indicate?

Infectious mononucleosis

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What does eosinophilia indicate?

Invasive parasitic infection

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What are the Sepsis 6?

Give:

high flow oxygen via reservoir bag
blood cultures (before abx)
IV Abx within 1hr
IV Fluids (crystalloids/0.9% saline)
Serial lactate and haemoglobin
Hourly urine output (aim for >0.5ml/hr)

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What is the pathophysiology of DKA?

DKA is uncontrolled lipolysis (not proteolysis) which = excess free fatty acids that are converted to ketone bodies

What are the most common precipitating factors of DKA?

Infection
Missed insulin
MI

Px of DKA?

Abdo pain
Polyuria, polydipsia, dehydration
Kussmaul breathing (deep hyper-ventilation)
Acetone-smelling breath (pear drop smell)

What is the diagnostic criteria of DKA?

Glucose >11mmol/L or known DM
pH <7.3
Bicarb <15mmol/L
Ketones >3mmol/L or urine ketones ++

Management of DKA?

Fluid replacement with isotonic saline (NaCl)
Insulin IV 0.1 unit/kg/hr
5% Dextrose
K+ infusion if K+ falls <3.5

*NOTE: long and short acting insulin should be stopped

What are the complications of DKA?

Gastric stasis
Thromboembolism
Arrhythmias 2* to hyperkalaemia
Acute respiratory distress syndrome
AKI

*NOTE: can also have complications due to incorrect fluid therapy, such as cerebral oedema (kids v vulnerable), hypokalaemia, hypoglycaemia.

What is the management of an acute asthma exacerbation?

O SHIT ME

Oxygen
Salbutamol nebuliser
Hydrocortisone IV
Ipatropium Bromide nebuliser
Thiophalline IV
Magnesium sulphate IV 2mg
Escalate for care

Management of acute exacerbation of COPD?

O SHIT

Oxygen
Salbutamol nebuliser
Hydrocortisone IV
Ipatropium Bromide nebuliser
Thiophalline IV

What is the management of anaphylactic shock?

Hydrocortisone 200mg
Adrenaline 500mg (300mg for children)
Anti-histamines (Eg Chlorophenamine)

What drugs do you stop in AKI?

Stop the DAMN drugs Diuretics ACE-i/ ARBs/Aminoglycasides Metformin NSAIDs (including aspirin)

What is Hyperosmolar Hyperglycaemic State (HHS)?

A complication of T2DM, usually in the elderly. It comes on over many days, unlike DKA (which comes on in hours), and consequently the dehydration and metabolic disturbances are more extreme.

What are the features of Hyperosmolar Hyperglycaemic State?

- Fatigue, lethargy, nausea, vomiting. - Altered consciousness level, headache, papilloedema, weakness - Hyperviscosity (MI, stroke, peripheral arterial thrombosis) - Dehydration, hypotension, tachycardia

What is the diagnostic criteria of HHS?

1. Hypovolaemia 2. Marked hyperglycaemia (>30mmol/L) w/o ketonaemia or acidosis 3. V raised serum osmolarity (>320mosmol/kg)

Management of HHS?

1. Normalise osmolality (gradually) using normal saline 2. Replace fluid and electrolyte losses 3. Normalise blood glucose (gradually)

How do you treat mild hyponatraemia (130-134mmol/L)?

Fluid restriction | Loop diuretics

How do you treat moderate hyponatraemia (120-129mmol/L)?

Hypertonic saline in first 3-4hrs to increase Na Fluid restriction Loop diuretics

How do you treat severe hyponatraemia?

- Bolus of hypertonic saline until symptom resolution +/-conivaptan (ADH receptor antagonist)

What complication can occur due to over-correction of severe hyponatraemia?

Central Pontine Myelinolysis (Osmotic demyelination syndrome). Symptoms occur after 2 days + are usually irreversible. Px = dysarthria, dysphagia, paraparesis or quadraparesis, seizures, confusion, + coma. Locked - In Syndrome can occur (pt awake but unable to move or communicate). Usually occurs in alcoholics and the malnourished.

How do we avoid Central Pontine Myelinolysis?

Raise Na levels by 4-6mmol/L in 24hrs during severe hyponatraemia.

Which drugs cause Hypokalaemia?

``` BAD FIT B - B2 agonists or Bendrofluamethiazide A - Amphotericin D - Digoxin F - Furosemide I - Insulin T - Thiazide diuretcs eg Indapamide ```

What drugs cause hyponatraemia?

``` PPIs SSRIs ACE-i Thiazide diuretics Carbamazepine ```

What is the initial therapy for ACS?

MONA M - Morphine O - O2 (if O2 sats <94%) N - Nitroglycerin (for pain - if on anti-coags, give Clopi) A - Aspirin

What drugs cause hypernatraemia?

SO SAD S - Sodium Chloride/Sodium bicarb O - Oestrogen S - Steroids A - Androgens D - Diuretics

What drugs cause hyperkalaemia?

THANKS CYCLE ``` T - Trimethoprim H - Heparin A - ACE-i /ARBs and Amiloride N - NSIADs K - K Sparing diuretics Eg Spironolactone S - Suxamethonium Cycle - Cyclosporin ```