Additional Flashcards
Cannulation complication - infiltration`
Diffusion or accumulation of fluid into subcutaneous tissue
See swelling, slow infusion rate, discomfort and coolness of skin
Prevent bu selecting appropriate site and device, and proper stabilisation
Cannulation extravasation
Infused substance damages tissue through irritation
Causes pain, burning stinging, haematoma, reduction in flow rate
Prevented by regular VIP scoring ti avoid occurence. and good site selection
VIP score in cannulation
Visual infusion phlebitis score, 0-5 where 0 is healthy and 5 is extensive damage
oesophagitis
Can have candidiasis.
Dysphagia, inflammation, heartburn, chest pain, acid brash, haematemesis, melaena.
Can occur in excessive reflux, prolonged gastric intubation, irritant ingestion, uraemia, bacterial, viral, fungal infections or post radiotherapy
linitis plastica
Dffuse varient of signet ring cells infiltrating stomach wall, causing rigid, less mobile stomach that can’t expand as much.
Type of gastric cancer
Comparison of CD and UC
Crohn’s can be any part of GI tract, transmural infiltration, skip lesions, strictures, fissuring ulcers, granulomas, fat wrapping, adhesions, perforations and raised cancer risk
UC is colon/rectum, mucosal infiltration, continuous pattern. bowel has thin wall and is dilated. No fissures, strictures are rare. No granulomas, no fat wrapping, no adhesions. Can get haemorrhage,e electrolyte loss, toxic megacolon, systemic effects. High cancer risk
Plummer vinson syndrome
Iron deficiency and webbing of the oesophagus. Pre malignant condition that needs removal. Suspect in older woman with koilonychia and dysphagia
Tpa bladder cancer
Confined to urothelial wall, but doesn’t need to have invaded the BM to be carcinoma in bladder. Can gte flat carcinoma in situ with high grade potential
Lacunar infarct development
HTN causes thickening and inelasticity of small arteries and arterioles. Gives hyanilisation which can cause occlusion.
Commonly in basal ganglia, internal capsule, thalamus, hemispheric white matter
Can also make vessels more prone to rupture siwth haemorrhagic stroke.
Xanthochromia
Yellow CSF found in SAH LP (can only do if CT scan inconclusive and no raised ICP concerns). Fresh blood is not indicator as can be traumatic tap.
Xanthochromia can be confirmed by measuring CSF bilirubin, but needs LFT for comparison
Effects of subfalcine herniation
Local infarction (cingulate gyrus).
Effects of transtentorial herniation
Can compress cerebral peduncle (hemiparesis), stretch occulomotor nerve (loss of pupil reaction), compress posterior cerebral arteries (infarct of visual cortex)
Effect of cerebellar tonsilar herniation
Coning. Compress lower medulla dn causes resp arrest
4-2-1 rule
4 heart related emergencies
ACS, aortic dissection, pericarditis/myocarditis, pericardial effusion/tamponade
4-2-1 Lung pathologies
PE and pneumothorax
4-2-1 oesophagus
Eosophageal perforation
Intrascapular pain
MI pain, MSK pain, gallbladder pain, pancreatic pain
Retrosternal pain
MI pain, percardial pain, oesophageal pain, aortic dissection, PE, mediastinal lesion
Left lower/anterior chest pain
Intercostal neuralia, PE, myositis, pleurisy/pneumonia, splenic infarct, splenic flexure syndrome, subdiaphragmatic abscess, precordial catch syndrome, injury
How long post MI for T wave to invert
Days
Most common coronary occlusion sites
LAD, right coronary artery, circumflex,
Non ischaemic causes of cardiac injury
myocarditis (can be toxic, immune or infectious, cardiomyopathy, radiation induced, iatrogenic via surgery, trauma, sepsis (cytokine mediated), CKD (toxic uraemia, mechanical stress)
Bridging coronary artery
Predisposes to MI in absence of coronary artery disease. Damages subendocardial region
Caseating cardiac deposits
Seen in TB
Non caseating cardiac deposits
Cardiac sarcoidosis. Granulomas. MAcrophage deposits
ARDS
Interstitial lung disorder
Direct lung injury ARDS causes
Pneumonia, gastric content aspiration. Can also be near drowning, fat embolism, inhalation injury,
Indirect ARDS lung injury
sepsis, severe trauma with shock. Can be acute pancreatitis, drug overdose, uraemia
Lung cancer complication: hoarseness
Recurrent laryngeal nerve palsy
Lung cancer complication: Ptosis, miosis , anhidrosis
Horner’s syndrome, pancoast tumour
Lung cancer complication : diarrhoea, flushing, cyanosis, tachycardia, hypotension, wheeze
Carcinoid syndrome, excess 5HT
Lung cancer complication : weight gain, skin hyperpigmentation, hypertension
Cushing’s syndrome though ACTH production
Lung cancer muscle weakness autoantibodies against neuronal calcium channels
Lambert Eaton myasthenic syndrome (LEMS)
Distinguish between LEMS and MG
MG has antibody against AchR, associated with thymic tumours, worsens with movement, Has normal deep tendon reflex,. No autonomic dysfunction. REsponse reduces on repeated stimulation
In LEMS, antibody is against calcium channel, associated with SC lung cancer, improves on exercise, decreased deep tendon reflex, has autonomic dysfunction and also stimulation improves response
Compartment syndrome causes
More commonly due to tibia fracture but also reperfusion injury after tx for acute lower limb ischaemia
Identifying compartment syndrome
Extreme pain, worse on active/passive movement, not alleviated by opioids, pulses present
Indicator of acute mesenteric ischaemia
Severe abdo pain (in absence of clinical findings), metabolic acidosis, bloody diarrhoea.
Should have CT angiogram
Types of mesenteric ischaemia
Acute mesenteric ischaemia, chronic mesenteric ischaemia and colonic ischaemia
Acute mesenteric ischaemia types
Embolic mesenteric ischaemia, thrombotic mesenteric ischaemia and venous mesenteric ischaemia
Most common ischaemic bowel disease
colonic mesenteric ischaemia (and has best prognosis)
Acute mesenteric ischaemia presentation
Sudden onset severe abdo pain, shock (rapid hypvolaemia) and lack ofabdominal clinical signs
Pain often central or RIF. OOP to clinical signs
If occured over hours then ? arterial, if over days then venous
RF for acute mesenteric ischaemia
AF, hypercoagulable state, vasculitis, cocaine use.
Acute mesenteric ischaemia biochem
leukocytosis, metabolic acidaemia, elevated serum amylase
Acute mesenteric ischaemia imaging
Thumbprinting on AXR, mesenteric occlusion on angiography. Pneumoperitoneum if perorated.
Use contrast CT for msesnteric venous thrombosis
Chronic mesenteric ischaemia presentation
Poorly localised pain, insidious. Repeated episodes occuring over months.
Worse after meals.
Chronic mesenteric ischaemia RF
Age, smoking, atherosclerosis, peripheral vascular disease, sitophobia
Diagnosis if chronic mesenteric ischaemia
Angiography.
Colonic ischaemia
Often presents as lower left sided pain and bloody diarrhoea. OFten pyrexial, tachycardia and leukocytosis.
