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clinical prac 3 > all > Flashcards

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1
Q

asthma patho

A

Allergen is inhaled and causes an inflammatory response in the lower airways. Mast cells release histamine which causes bronchoconstriction, mucosal oedema.

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2
Q

asthma signs/symptoms

A

SOB, increased WOB, cough, wheeze, accessory muscle use

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3
Q

asthma drugs used

A

Salbutamol, ipratropium bromide, dexamethasone, adrenaline

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4
Q

asthma tx adult mild/moderate

A

Salbutamol in pMDI + spacer, 4-12 doses, 4 breaths per dose, repeat 20 minutes.

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5
Q

asthma tx adult severe

A

Salbutamol 10mg (5mL) nebulised, ipratropium bromide 500mcg (2mL) nebulised. Repeat salbutamol 5mg (2.5mL) every 5 minutes.

Dexamethasone 8mg IV/oral

Adrenaline 500mcg IM, repeat 5-10 minute intervals, max 1.5mg (3 doses)

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6
Q

COPD patho

A

Group of respiratory disorders characterised by increased mucous production and secretion, airway inflammation and reduced lung elasticity. Irreversible and progressive.

Chronic bronchitis - obstructed airflow due to increased mucous production/secretion and inflamed bronchioles due to exposure to irritants.

Emphysema - permanent enlargement of the airways and damaged alveolar walls due to toxins inhaled, reduced area for gas exchange.

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7
Q

COPD signs/symptoms

A

Productive cough, SOB, increased WOB, sputum increase

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8
Q

COPD drugs used

A

Oxygen therapy, salbutamol, ipratropium bromide, dexamethasone

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9
Q

COPD treatment

A

Salbutamol 10mg + Ipratropium bromide 500mcg nebulised

Dexamethasone 8mg IV/oral

Oxygen therapy, nasal prongs

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10
Q

asthma tx paed mild/moderate

A

Salbutamol pMDI + spacer, 4 breaths each dose, repeat at 20 minutes
6+ = 4-12 doses
1-5 = 2-6 doses

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11
Q

asthma tx paed severe

A

Salbutamol nebulised, repeat at 20min intervals
2-4 = 2.5mg (1.25mL)
5-11 = 2.5-5mg (1.25-2.5mL)

Ipratropium bromide 250mcg (1mL) nebulised

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12
Q

asthma tx paed critical

A

Salbutamol nebulised 10mg (5mL)
Ipratropium bromide nebulised 250mcg (1mL)

Adrenaline 10mcg/kg IM, repeat at 5-10mins, max 3 doses

Dexamethasone 600mcg/kg oral (max 12mg)

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13
Q

APO patho

A

When the left ventricular muscle weakens or fails, there’s a reduction in cardiac output. Causes back flow into the pulmonary arteries and capillaries. Due to the pressure difference, fluid moves into the pulmonary interstitial space and the alveolar.

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14
Q

APO signs/symptoms

A

Crackles, pink sputum, SOB, feelings of drowning, chest pain

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15
Q

APO drugs used

A

GTN, CPAP, furosemide

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16
Q

APO treatment

A

GTN 50mg patch, GTN 600mcg every 5 minutes (300mcg if elderly/frail)

CPAP

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17
Q

ACS patho

A

When an artery is blocked causing the heart muscle to become ishcaemic and weaken/breakdown.

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18
Q

Unstable angina vs normal angina

A

Unstable is constant with no relief, lasts longer than 10 minutes

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19
Q

STEMI vs NSTEMI/UA

A

STEMI is when there is complete occlusion, NSTEMI is when there is partial occlusion

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20
Q

ACS drugs used

A

GTN, aspirin, anti-nausea

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21
Q

ACS treatment (normal)

A

Aspirin 300mg
GTN 50mg patch
GTN 600mcg every 5 minutes (300mcg for elderly and frail)

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22
Q

ACS treatment (STEMI)

A

Aspirin, if inferior STEMI BP <160mmHg then no GTN. Defib pads on immediately and notify hospital.

23
Q

cardiac arrest patho

A

Heart is not in a normal sinus rhythm

24
Q

cardiac arrest signs/symptoms

A

No response, unconscious, no breathing, no pulse

25
Q

cardiac arrest treatment

A

High performance CPR, adrenaline administration 1mg (1mL) every 2 minutes

26
Q

stroke patho

A

When a part/parts of the brain isn’t receiving adequate blood supply and oxygen, due to a clot or haemorrhage, causing focal injury of the brain

27
Q

TIA

A

Momentary blood flow obstruction causing a brief episode of neurological dysfunction. Usually only lasts 1-24 hours, no damage caused.

28
Q

stroke signs/syptoms

A

Facial droop, low GCS, severe headache, nausea vomiting, slurred speech, motor deficits.
ICH - more likely to have severe headache, nausea and vomiting, quick fall in GCS, bradycardia
Left side - slow mobility
Right side - perceptual disturbances

29
Q

Stroke mimics

A 
S - syncope
S - sepsis
S - subdural haematoma 
S - seizures
H - hypoxia
I - intoxication
I - inner ear disturbance
T - tumour (brain)
M - migraine
M - multiple sclerosis 
E - electrolyte disturbance
30
Q

stroke/TIA treatment

A

Suspected stroke or TIA should always be transported. Oxygen therapy if SpO2 <92%.
ICH suspected: if awake/responding transport to nearest stroke hospital, if unconscious then nearest neurosurgical centre

MASS +, ACT-FAST - , >12 hours = non urgent transport
MASS +, ACT-FAST -, <12 hours = Non ECR eligible stroke. IV access, pre-notify hospital
MASS +, ACT-FAST + = possible ECR eligible stroke. IV access, pre-notify hospital, urgent.

31
Q

seizures patho

A

Sudden uncontrolled episodes of electrical activity in the brain. Neurons rapidly fire, and depending on where in the brain, can cause movements, sensations, altered consciousness etc.

32
Q

seizure types

A

Focal: starts in one part of the brain, may spread

  • simple partial (aware)
  • complex partial (unaware)

Generalised: both sides or the brain simultaneously

  • absence (disconnected)
  • clonic tonic (sudden jerking)
  • myoclonic (twitch jerk)
  • tonic (limp)
33
Q

seizure signs/symptoms

A

Altered conscious state, convulses

34
Q

seizures treatment

A

Oxygen and ventilations (OPA or NPA if trismus)

Move head so it’s protected, laterally for tongue

Midazolam 10mg (IM) (5mg for elderly, repeated 5min)

Repeat once more if unsuccessful (adults, not elderly)

35
Q

pain relief

A

Morphine IV 5mg, repeat every 5 minutes, consult after 20mg

Fentanyl IV 50mcg, repeat 5 minutes, consult after 200mcg

IN fentanyl 100-200mcg repeat every 5 minutes, up to 200-400mcg

Methoxyflurane 3mL inhaled, only 2 doses

36
Q

atherosclerosis

A 
deposits in arteries
risks:
- diabetes
- obesity
- smoker
- gender
- high cholesterol
- hypertension
37
Q

Nausea and vomiting

A

Ondansetron = 4mg orally (repeat at 5-10 minutes if needed, max 8mg)

Prochlorenzepane = 12.5mg in 1mL single dose

38
Q

Hypothermia treatment

A

Remove wet clothes, pat dry the patient, heater on, remove from cold environment, thermal wrap over and under.

Warm normal saline IV 20mL/kg

39
Q

Hyperthermia treatment - environmental

A 
Remove from warm environment, strip, spray, fan
Cold fluids (normal saline IV) 20-40mL/kg
40
Q

Hyperthermia treatment - drug induced

A

Remove from environment
Perform cooling techniques (not very effective)
Cooled normal saline IV (20-40mL/kg)

41
Q

Opioid overdose - heroin

A

Manage/maintain airway and ventilations

Naloxone 1.6-2mg single dose IM

42
Q

Opioid overdose - other opioids

A

Manage/maintain airway and ventilations
Naloxone 100mcg IV every 2 minutes, (max 2mg)
Naloxone 400mcg IM if IV unavailable

43
Q

Psychostimulant overdose

A

Remove from environment
Check for hyper/hypothermia
Manage agitation or seizures

44
Q

Autonomic Dysreflexia

A

Try to remove/fix stimulus that caused episode

GTN (no patch) 300mcg/600mcg every 10 minutes

45
Q

Sepsis

A

Assessment (at least 2), call MICA

Normal salin 20mL/kg over 30 minutes (if chest is clear)

46
Q

Sepsis assessment

A
  • temperature >38º or <36º
  • resp rate >20
  • heart rate >90
  • blood pressure <90
47
Q

Meningococcal treatment

A

IV access: Ceftriaxone 1g - dilute with water for injection to make 10mL - administer in 2 minutes
No IV access: Ceftriaxone 1g IM diluted in 3.5mL 1%Lig

48
Q

Meningococcal symptoms

A 
Typical purpuric rash
Septicaemia signs: 
- fever, rigor, joint pain
- cold hands/feet
- tachycardia/hypotension 
- tachypnoea 
Meningeal signs:
- headache, photophobia
- neck stiffness
- nausea and vomiting 
- altered conscious state
49
Q

Hypoglycaemia treatment

A

<4, responding to commands:
15g of glucose oral if conscious

<4, not responding to commands:
Dextrose 10% 15g (150mL) IV with 10mL flush
Repeat 10g (100mL) IV after 10 minutes

If no IV access: Glucagon 1(IU) IM

50
Q

Hyperglycaemia treatment

A

Normal saline 20mL/kg

51
Q

Agitation assessment

A

responsiveness and speech

52
Q

Agitation treatment +2

A

Midazolam 5-10mg IM, 2.5-5mg for elderly/frail

Repeat after 10 minutes if needed

53
Q

Agitation treatment +3

A

Ketamine IM

clinical prac 3 (9 decks)

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