amk teach Flashcards
70yr old man falls unconscious. PMH of AF and high BP what should you do first
check the airway and secure it
A-E
airway, breathing, cardiovascular, disability, exposure
when is an airway not patent
secretions, aspirated or if GCS below 8
if patient can speak airway is patent
consider suction , airway opening manoeuvres such as head tilt or naso or oropharyngeal
treat cause if knows such as foreign body or anaphylaxis( if suscpeted treat dont move on to ABCDE)
breathing what would you do to investigate
resp rate
pulse oximetry
calves ( dvt and pe)
tests such as ABG and CXR
mx
15L 02 via non rebreathe mask - less for COPD
treat any evident cause - pneumothorax, asthma, copd, exacerbation, opiate, OD and PE
breathing what would you do to investigate
resp rate
pulse oximetry
calves ( dvt and pe)
tests such as ABG and CXR
mx
15L 02 via non rebreathe mask - less for COPD
treat any evident cause - pneumothorax, asthma, copd, exacerbation, opiate, OD and PE
how to assess circulation
capillary refill time - central
pulse - rate rhythm and volume
BP
temperature
auscultation and JVP
tests
wide bore cannula - take blood and VBG
3 lead cardiac monitoring
ECG
catheter for fluid monitoring
treat cause and reassess after any intervention
disability what do you check
DEFG - dont ever forget glucose
GCS
pupils reactivity and symmetry
pain assessment
tests - CT brain
what comes under e
exposure - exposre the body lookign for rashes and injuries
examine abdomen
focused exam of any relevant systems
40yr old female brought in by ambo with 1.5hr of SOB and dry cough, BMI is 35, calves huge, positive for covid what is this dx
PE
PE is a blockage in pulmonary circulation - can be fat , air amniotic fluid but most commonly VTE
sx
pleuritic chest pain - worse on inspiration
breathlessness
cough hemoptysis etc
wells score for risk
ECG, echo and CXR
score of 4 or less then d dimer psotive what do you give
LMWH - enoxaparin
score 5 or more what do you do
give LMWH and CTPA when psottivle
if CTPA is negative what do you do
stop heaprin
if ctpa is postive
anticogaultion for 3-6 months
INR for someone with PE
2-3
if score of 4 or less and d dimer negative what do you do
seek another diagnosis
massive pe signs and tx for this
SBP under 90 , for over 15mins , pulselessnesss or bradycardia
thrombolysis immediately with alteplase
sub-massive pe causing RV dysfunction , myocardial necrosis or saddle PE - tx for this
give unfractionated heparin over 72hr and reconsider thrombolysis
25yr man 2hr history of SOB , hyperresonnant R chest , L sided tracheal deviation and sats dont improve with O2. His ecg shows arrhythmia. First step management after A-e?
right sided decompression 2nd intercostal space mid clavicular line
pneumothorax is air in the pleural space caused by trauma, iatrogenic such as biopsy, infection asthma or another lung pathology, spontaneous. what are the three types.
closed - air cant move out
open - air can move in and out of pleural space
tension - air keeps coming in pushing mediastinum to the other side
Ix and management of Pneumothoarx
CXR and measure the distance between the lung edge adn the inside of the chest wall at the hilum
if no SOB and under 2cm air what happens
no treatment
if SOB and over 2cm of air what to do
aspriation and reassess
if aspriation fails twice due chest drain
if unstable
if aspiration fails twice and you cannot get rid of cause what to do
chest train in 5th intercostal space , midaxiallary line and anterior axillary line - lat dorsi adn pec major in trangel of safety
72 male follow a fall, confused and tired, trouble urinating GP prescribed abx. 8/15 on NEWS. blood coagulates before you can even take if from his cannula what is dx
sepsis
sepsis is systemic inflammation due to infection. what is septic shock
severe sepsis reuslts in organ hypoperfusion adn failure. systolic BP less than 90 ,
hyperlactatemia over 4
rf for sepsis
old or young, diabetes or chronic c
chemo, immuno, steroids
preg or peri-partum
indwelling devices eg catheters or central lines
signs of sepsis
hypoxia
oliguria
AKI
thrombocytopenia
coagulation dysfucntions
hypotension
hyperlactatemia over 2
montior sepsis throuhg NEWS score , temp, hr , rr, o2, bp, consciousness - immunosuppressed patietns may get normal score despite being v unwelll due to
neutropenic sepsis
sepsis 6
BUFALO
blood cultures
urine output
fluids
antibiotics
lactate
oxygen
CXR if suspect penumonia
what is neutropenic sepsis
sepsis in patients with low neutrophil count
reusult of chemo or TB drugs
treat anyoen on these drugs or weird , temp - treat with borad spec abx immediately usually piperacilin and tazocin but check guidliens
what drugs cause neutropenic sepsis
antipyschotics
immunosuppresant and drugs for rheumatoid arthritis
chemo
15yr old with 15min SOB and stridor. allergic to tomatoes what step first
a- adrenaline 0.5mg IM
B - 15L o2 non rebreather mask with salbutamol 5mg if wheeze
c - Iv access add fluids 500ml - 1L stat may need to titrate up to 4-8L
hydrocortisone 200mg IV
chlorpheniramine 10mg IV
admit for over 6hr monitor
take mast cell tryptase to confrim theyve had an anaphylactic shock
what confrims an anaphylactic shock after attack
mast cell tryptase
how often can you repeat with `IM adrenaline
every 5 min
if not gettign bettwer move to
IV adrenaline
heavy periods at 40 , fatigued, Hb is 40 , onyl eats biscuits and tea. next best step in management. and how many units of blood would she need
blood transfusion - 3 units
when do consider a blood transfusion
acute blood loss, very low HB or coagulapathy
