Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr 6 PACES knowledge > Acute station > Flashcards

Acute station Flashcards

1
Q

Define acute AF? How would you approach the management?

A

AF that started <48 hours ago

1) are they haemodynamically stable? If no –> emergency cardioversion (2nd line = amiodarone)

If yes –>

1) Rate control = b-blocker or diltiazem
2) Rhythm control (ONLY if <48h) = DC cardioversion or amiodarone
3) Start LMWH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define paroxysmal AF?

How would you manage it?

A

DEF: self limiting + lasts <7 days

Mx: Anticoagulate + pill-in-pocket + ?rate/rhythm control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mx of Ventricular tachycardia

A

Pulseless? –> CPR

Adverse signs (unstable, chest pain, HF) –> sedate + synchronised cardioversion!

No adverse signs –> correct electrolyte abnormalities + Amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ECG changes in hypokalemia

A

Prominent U waves
PR prolongation
T wave inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

TIA - best brain imaging?

A

Diffusion weighted MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

TIA - management? 5 aspects

A
  1. Antiplatelet: aspirin + clopidogrel
  2. If cardiac emboli –> Warfarin!
  3. RF control (anti-HTN, statin, glucose, smoking)
  4. Assess risk for next stroke = ABCD2 score
  5. F/U in clinic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What scoring system is used to determine risk of stroke in TIA patients?

A 
ABCD2
Age >60
BP >140/90
Clinical Fx: unilateral weakness (2), speech disturbance w/o weakness (1)
Duration
Diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Fluid resuscitation formula in burns?

Which fluid?

A

Parkland formula

4 x wt x % surface area

Give half in first 8 hours

HARTMANN’S, warmed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How to determine % BSA involvement in burns?

A 
1 arm: 9%
Head and neck : 9%
Front torso: 18%
Back torso: 18%
1 leg: 18%
Perineum: 1%
1 hand: 1%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Tx of burns (exc fluid resus)

A
  1. Analgesia
  2. Dressing; silver sulfadiazine + sterile film
  3. Cadaveric skin
  4. Split thickness skin grafts
  5. Tangential excision
  6. Escharotomy (to prevent compartment syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

DKA management summary

A

FLUIDS: SBP<90 = NS 1L stat
SBP>90 = NS 1L over 1hr
–> add K+ to 2nd bag if <5.5 (40mM/L)

INSULIN: 0.1u/kg/hr Actrapid
–> Aim ketones reduction >0.5mM/hr

LMWH!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Definition of DKA

A

pH<7.3
glucose>11.1
ketones>3.0 (or 2+ on dip)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Definition and Mx of HONK

A

Hyperglycemia (>35) w/o ketones

Fluids
Potassium in 2nd bag of fluids
LMWH

?consider insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In upper GI bleed, how is a pt managed AFTER endoscopy

A

NBM + stop NSAIDs
IV omeprazole
Daily bloods
H. pylori testing + eradication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ABCDE approach: How would you assess the airway?

A

If speaking –> patency assumed
Look –> for airway secretions, angioedema
Listen –> gurgling BS or stridor
Feel –> for expired air

  • Any evidence that airway is not patent –> HEAD TILT + CHIN LIFT (Jaw thrust if C-spine injury)
  • Consider airway adjuncts eg Guedel or nasopharyngeal airway
  • If still not achieved –> check pulse + periarrest call!!!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ABCDE approach: How would you assess breathing?

A

OBS –> Sats, RR, administer 15L 02 non-rebreather mask
Inspection –> accessory muscle breathing, nasal flaring
Palpate –> Tracheal deviation, equal chest expansion
Percussion –> dullness?
Auscultate –> equal air entry, wheeze, crackles

ABG + CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

ABCDE approach: assessment of circulation?

A

Obs: CRT, pulse - rate and rhythm, BP in both arms
Ask nurse to help w 12 lead ECG

  • 2 large bore IV cannulae
  • Bloods: FBC, U+Es, glucose, CRP, Xmatch, G+S, clotting, blood cultures, troponin
  • if hypotensive: 500mL 0.9% saline bolus, then reassess BP. Call for help if still hypotensive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

ABCDE approach: assessment of disability?

A
  • Pupils: equal + reactive to light?
  • GCS: if <8 (or AVPU = P), call for an anaesthetist
  • GLUCOSE
  • Gross neuro assessment: plantar reflexes, sensation, power, grip
  • Drug chart + possessions for evidence of OD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Causes of shock

A

CHOD
CARDIOGENIC: MI, arrhythmia

HYPOVOLEMIC:

  • Haemorrhage
  • Endocrine: DKA, addisonian crisis
  • Excess loss: burns, diarrhoea
  • 3rd spacing: pancreatitis

OBSTRUCTIVE:

  • PE
  • Tension pneumothorax

DISTRIBUTIVE:

  • Sepsis
  • Anaphylaxis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of hypovolemic shock:

A
  • Haemorrhage
  • Endocrine: DKA
  • 3rd spacing: Pancreatitis
  • Excess loss: burns, diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How to differentiate between cardiogenic vs hypovolemic shock?

A 
Cardiogenic = high JVP
Hypovolemic = low JVP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How to differentiate between septic shock vs hypovolemic shock

A

septic = warm peripheries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pathophysiology of anaphylaxis

A

Type 1 IgE mediated hypersensitivity reaction

Mast cell degranulation –> histamine release
–> inc vascular permeability + bronchoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Dose of adrenaline in anaphylaxis?

A

IM adrenaline 500micrograms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How often can you repeat IM adrenaline in anaphylaxis?

A

every 5 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Define a pneumothorax

A

Accumulation of air in the pleural space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Classification of a pneumothorax

A

Open: defect in chest wall: communication btw PTX + exterior
Closed: chest wall is intact. air from lung –> pleural cavity
Tension: one way valve –> mediastinal compression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Causes of pneumothorax

A

SPONTANEOUS: primary (no underlying lung disease) or secondary (Marfan’s, COPD, pulmonary fibrosis)

TRAUMA: penetrating or blunt trauma w rib #s

IATROGENIC: Central line insertion, CPAP, transbronchial biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How on earth can PTX lead to surgical emphysema

A

Broken rib –> damaged pleura –> air from lung enters pleural space –> air in pleural space enter subcut tissue

30
Q

Ix for suspected pneumothorax

A

Basic obs
ABG
CXR
USS (more sensitive than supine CXR!)

31
Q

Mx of tension pneumothorax

A

No CXR!

10L oxygen through non-rebreather mask

Large bore cannula in 2nd ICS, MCL (just above the rib!)

32
Q

Mx of pneumothorax in pt with no underlying lung disease (or<50yo)?

A

If the patient SOB or PTX>2cm —> needle aspiration

  • if aspiration fails -> chest drain

If pt is not SOB + <2cm –>10L oxygen + observation

33
Q

Mx of secondary pneumothorax

A

If pt is SOB or >2cm: CHEST DRAIN

If pt is asymptomatic:
<1cm: admit for 24hrs + 10L oxygen

1-2 cm: needle aspiration (+ chest drain if this fails)

34
Q

Causes of surgical emphysema

A

Rib fracture
Iatrogenic: CPAP, any chest surgery, thoracotomy
Infection

35
Q

safe triangle for intercostal drain

A
  • Lat border of pec major
  • Ant border of lat doors
  • 5th ICS (level of nipple)
36
Q

Asthma attack: Mx?

A

Basic obs

Breathing: ABG + O2 via non-rebreathe mask
- 5mg salbutamol nebs
(order CXR)

Circulation: FBC, U+Es, CRP, blood cultures.
+/- fluid resus
- Oral pred 50mg/IV hydrocort 100mg

37
Q

Nebs in acute asthma - how frequently?

A

Salbutamol: 15 mins
Iptropium: 4-6 hourly

38
Q

Monitoring in acute asthma

A
  • Sats>92%
  • PEFR every 15-30 mins
  • ABG if the initial PCO2 is normal or high
39
Q

Acute COPD exacerbation: you have already given SABA and SAMA nebs + steroids. What can you do next if they’re not responding?

A

Repeat nebs
?IV aminophylline
?BIPAP

40
Q

ECG changes in hyperkalemia

A

Tented T waves
Small p waves
widened QRS

41
Q

Causes of hyperkalemia

A
  • AKI
  • Drugs: ACEIs, spironolactone, ARBs, Heparin!!
  • Rhabdomyolysis
  • Addison’s
  • Metabolic acidosis
    (Haemolysed sample)
42
Q

stages of AKI

A

stage 1: Creatinine 0.5-1x normal (oliguria for 6 hours)
stage 2: creatinine 1-2x normal (oliguria for 12 hours)
stage 3: creatinine >2x normal (olig for 24 hours/anuria)

43
Q

Investigations for pneumonia

A

Sputum MC+S, cytology
Urine: cold agglutinins

FBC (wcc), U+Es (Na, urea), CRP (trend), LFTs (mycoplasma, legionella),
Blood cultures
ABG

CXR, ECG

44
Q

Management of pneumonia

A

O2, fluids, analgesia, antibiotics

F/u:
CXR @ 6 weeks
if >65 –> pneumovax
Smoking cessation

45
Q

Complications of pneumonia

A
  1. Septic shock
  2. Parapneumonic effusion –> empyema
  3. Respiratory failure
  4. Abscess
46
Q

Def of Hospital acquired pneumonia

A

> 48 hrs after hospital admission

47
Q

Commonest causative organisms of hospital acq pneumonia

A

Pseudomonas

MRSA

48
Q

Anatomical classification of pneumonia? which one is more common?

A

Bronchopneumonia (patchy, in diff lobes) vs lobar pneumonia

Bronchopneumonia = atypical

49
Q

Commonest causative organisms of community acq pneumonia

A

Strep pneumonia
Mycoplasma
Viral

50
Q

Mx of hospital acquired pneumonia

A

Co-amoxiclav or taz+vanc

51
Q

Commonest causative organisms of atypical pneumonia

A

Mycoplasma, Legionella, Chlamydia

52
Q

CURB 65

A

Confusion
Urea>7
RR>30
BP<90

> 65yo

53
Q

Define SIRS

A

Inflammatory response with >=2 of:

HR: >90
Temp: >38 or <36
RR: >20 or PaCO2<3.6
WCC: >12 or <4

54
Q

Shockable rhythms vs non-shockable rhythms

A

non-shockable: PEA, asystole

shockable: VF, pulseless VT

55
Q

Mx of asystole

A

cannot shock!

CPR 2 mins + IV adrenaline 1mg
- repeat adrenaline at every other cycle

56
Q

management of pulseless VT

A

CPR
1 shock
CPR 2 mins

IV adrenaline 1mg + amiodarone 300mg after 3rd shock

Repeat adrenaline at every 3rd cycle

57
Q

Crucial Ix in patient with an unprovoked DVT

A

CT abdo pelvis

  • look for malignancy!!!
58
Q

Features of benzodiazepine OD? Mx?

A

Respiratory depression
Reduced GCS

Mx = flumazenil

59
Q

beta blocker OD - fx? mx?

A

Fx: bradycardia + hypotension
Mx: fAtropine

60
Q

Carbon monoxide poisoning - fx?

A

Fx: dizziness, nausea, headache

PaO2 is low but sats are high
Metabolic acidosis

61
Q

Digoxin OD - 3 fx? mx?

A

Arrhythmia
Yellow green halos
Reduced GCS

Mx: anti-digoxin antibodies

62
Q

Mx of Heparin OD?

A

Protamine

63
Q

Lithium OD - fx?mx?

A

Fx: coarse tremor, confusion, N+V, POLYURIA

Mx: Saline

64
Q

Mx of organophosphate poisoning?

A

Atropine

65
Q

Fx of amitriptyline (TCA) overdose?

A

Anticholinergic: hyperthermia, palpitations
Metabolic acidosis
PROLONGED QT - CARDIAC MONTOR

66
Q

Mx of amitriptyline overdose

A

IV sodium BICARBONATE (they have met acidosis)

67
Q

Mx of warfarin overdose

A

IV vitamin K

Prothrombin complex

68
Q

AKI - Initial Mx

A

ABC - O2 + large bore cannula + CATHETER + fluid monitoring

Routine bloods, ABG, Urine dip, ECG/cardiac monitor!!!
CXR, US kidneys
CHECK DRUG CHART (NSAIDs, ACEis, vanc, gent, contrast)

  • correct instability w fluid bolus
69
Q

Life threatening complications of AKI

A

Hyperkalemia
Pulmonary oedema
Acidosis

70
Q

Clearing the C-spine - what is it? how?

A

ensuring pt doesn’t have a C-spine fracture

1) ensure pt is in stiff neck collar
2) CLnical assessment:
- Neuro deficit
- Spinal tenderness
- Altered GCS
- Intoxication
- Distracting injury (eg long bone #)

3) if any of th above: do X ray
4) if X-ray is abnormal, do CT

Yr 6 PACES knowledge (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions