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Medical Finals 2020 > Anaesthetics, Acute Medicine and Critical Care > Flashcards

Anaesthetics, Acute Medicine and Critical Care Flashcards

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USMLE® Step 1 flashcards
1
Q

What does ASA status refer to?

A

The wellness of patients undergoing anaesthetic.

  1. A normal healthy patient
  2. Patient with mild systemic disease
  3. Patient with severe systemic disease
  4. Severe systemic disease, constant threat to life
  5. Morbid patient who is not expected to survive without the operation
  6. A patient who has already been declared brain dead and whose organs are being removed for transplant
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2
Q

Give 5 medications that need to be stopped pre-op?

A
  • ACE-inhibitors
  • ARBs
  • Anti-platelets
  • Warfarin
  • DOAC
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3
Q

What should be enquired about specifically in a family history pre-op?

A

Malignant Hyperpyrexia

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4
Q

What is NCEPOD?

A

National Confidential Enquiry into Patient Outcome and Death

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5
Q

When taking an anaesthetic history what are some specific history questions that should be asked?

A
  • Exercise tolerance
  • Weight
  • Smoking
  • Allergies
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6
Q

What is Mallampati?

A

A measure of how much a person’s mouth opens to visual aspects of the back of the throat

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7
Q

What are the 3 main types of drugs used in anaesthetics?

A
  • Hypnotics
  • Analgesics
  • Muscle Relaxants
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8
Q

What are airway related risk factors?

A
  • Obesity
  • Bad teeth
  • Beard
  • Snoring
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9
Q

What airway manoeuvre should not be done in a c-spine injury?

A

Head tilt-chin lift

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10
Q

What is the thyromental distance?

A

Distance from tip of your chin to the tip of thyroid cartilage. <6cm increases difficulty

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11
Q

Where should the guedel be measured from?

A

Incisors to angle of mandible

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12
Q

What is a definitive airway and give an example?

A

ET Tube

The cuff is inflated below the vocal cords to allow for oxygen enriched ventilation

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13
Q

When should warfarin be stopped prior to surgery?

A

5 days, and bridged with LMWH

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14
Q

What is a complication of ET tube removal?

A

Laryngospasm - a spasming of the vocal cords that stops oxygen entry

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15
Q

What are some risk factors for post-operative nausea and vomiting?

A
  • Female
  • Previous PONV
  • Opiates
  • Gynae/Abdo/Laparotomy
  • Non-smoker
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16
Q

What anti-emetics are used during surgery?

A

Dexamethasone 4-8mg

Ondansetron 4-8mg

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17
Q

What are the three levels of care?

A

1 - Ward
2 - HDU
3 - ITU

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18
Q

How do you know an intubation is successful?

A
  • Misting of O2 mask
  • Rise and fall of chest bilaterally
  • Saw vocal cords on ET insertion
  • Internal CO2
  • SpO2 increase
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19
Q

What is the difference in a RSI from a normal intubation?

A

Cricoid pressure - provided by an assistant, pushes the trachea against the oesophagus to prevent upflow of stomach contents., it is removed once cuff inflated

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20
Q

What are the different levels that a spinal and epidural are done at?

A

Spinal - BELOW the level of the spinal cord L2-S2 (spinal cord ends at L1). Side effects include hypotension, sensory of motor block
Epidural - usually below L1, this is an indwelling catheter that provides a continuous infusion. It does however confine the patient to bed.

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21
Q

What are some contraindications to spinal or an epidural?

A

Anticoagulated states, local sepsis, shock, raised ICP, hypovolaemia

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22
Q

What is the maximum dose of lidocaine 1% that can be given? In a 70kg gentleman what is the max volume?

A

3mg/kg

21ml

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23
Q

What does lidocaine 1% mean?

A

1% means there is 1 gram (1000mg) in 100mL

10mg in 1ml

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24
Q

How do you manage local anaesthetic toxicity?

A

Intralipid

Control seizures with benzos/phenytoin, ABCDE

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25
Q

What are some symptoms of local anaesthetic toxicity?

A

Tongue numbness, lightheadedness, muscular twitching, unconsciousness, cardiac/resp failure

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26
Q

What two drugs are used to increase BP during surgery?

A

Ephedrine - increases HR as well

Metaraminol - vasoconstriction, decreases HR

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27
Q

Give five methods of oxygen delivery.

A 
Room air
Nasal prongs
Hudson's, Venturi, Non-rebreather
NIV (BiPAP, CPAP)
Intrubation
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28
Q

Give 5 signs of hypovolaemia

A

Tachycardia, hypotension, reduced skin turgor and dry mucous membranes, reduced urine output

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29
Q

What is the calculation for Plasma Osmolality?

A

2(Na + K) + Glucose + Urea

Should be around 290mOsM

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30
Q

What are the two types of IV fluids?

A

Crystalloid

Colloid (albumin, blood, clotting factors)

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31
Q

What is your daily requirement for K, Cl, Na?

A

1mmol/kg/day

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32
Q

How do you calculate maintenance fluids?

A 
First 10kg (100mls per kg)
Second 10kg (50mls per kg)
Remaining weight (20mls per kg)
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33
Q

What is involved in fluid resus?

A

500ml crystalloid bolus in under 15 minutes

Repeat up to 2L then seek senior opinion

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34
Q

What is a contraindication for nasopharyngeal airway?

A

Basal skull fracture

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35
Q

What is involved in Airway management in acutely ill patients?

A
  • assess patency of airway - is patient speaking
  • obstructions?
  • listen - wheeze, gurgle, snoring, stridor, silence
  • increased work of breathing?

Act by maintaining a patent airway - head tilt/chin lift or jaw thrust, remove foreign bodies

  • if this fails then consider airway adjuncts such as a guedel, nasopharyngeal tube or I-gel.
  • give O2 15L non-rebreather
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36
Q

What is involved in Breathing management in acutely ill patients?

A
  • if not already, consider O2
  • chect SpO2 and respiration rate
  • is the patient cyanotic
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37
Q

What is involved in Circulation management in acutely ill patients?

A
  • measure BP, HR, pulse strength and rhythm, cap refill, ABG, bloods
  • establish peripheral access 14 or 16G and use this for bloods
  • give fluids 500mls warmed crystalloid over 15 minutes, can give up to 2L
  • ECG
  • urine output
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38
Q

What is involved in Disability management in acutely ill patients?

A
  • AVPU/GCS
  • pupils
  • drugs
  • diabetes
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39
Q

What is involved in Exposure management in acutely ill patients?

A
  • check temperature
  • full examination for trauma, bleeding, head injury, rashes
  • swelling, oedema
  • obs
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40
Q

You are called to view a patient who is scoring a 7 on their observations. They have a fever and recent fall. What is the first thing you do to access them?

A

ABCDE

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41
Q

What is GCS and what makes up the different sections?

A

Glasgow Coma Scale
Motor (6) - Obeying commands, localises, withdraws, flexion, extension, none
Verbal (5) - Spontaneous, Confused, Inappropriate, Noises, None
Eyes (4) - Spontaneous, Verbal, Pain, None

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42
Q

What are the 6 stages of motor assessment in GCS?

A 
6 - Obeying commands
5 - Localises to pain
4 - Withdraws - normal
3 - Flexion - abnormal decorticate
2 - Extension - decerebral
1 - None
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43
Q

What is the lowest you can score on GCS?

A

3

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44
Q

What does AVPU stand for?

A

Alert
Verbal
Pain
Unresponsive

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45
Q

What does AVPU stand for?

A

Alert
Verbal
Pain
Unresponsive

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46
Q

How can you check pain response?

A
  • Jaw thrust
  • Trapezius Squeeze
  • Supraorbital pressure
  • Sternal rub
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47
Q

What is the formula for a choking patient?

A

5 back slaps

5 stomach thrusts

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48
Q

What is the breath/compression ratio in a child?

Adult?

A

Child: 5 rescue breaths, then 2 breaths for 15 chest compressions

2 rescue breaths, 30 chest compressions

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49
Q

What does haemoglobin need to be to indicate a transfusion is needed?

A

Hb <90 and a history of ischaemic heart disease

Hb <70

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50
Q

What are the different fluid compartments in the body?

A

Intracellular Fluid - K+
Extracellular Fluid (1/3 of TBW) - Na+ and Cl-
- Interstitial Fluid - 80% of ECF
- Plasma Volume - 20% of ECF

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51
Q

How does ADH work?

A

Produced in response to high plasma osmolality or low BP.

Targets V2 renal collecting tubules to incorporate aquaporin channels into the membrane to allow water reabsorption.

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52
Q

What are considered normal levels of K+, Na+ and Cl-?

A
  • K+ = 4.5
  • Na+ = 140
  • Cl- = 105
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53
Q

How much fluid should an adult have per kg per day?

A

25-30ml/kg/day water so on average 2-3L

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54
Q

What are some complications of a spinal anaesthetic?

A
  • Total spinal block
  • Urinary retention
  • Permanent neurological damage
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55
Q

What is the maximum dose of lidocaine with adrenaline that can be given?

A

7mg/kg

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56
Q

What are some crucial pieces of information needed regarding incoming trauma patients?

A 
ATMIST
A: age of patient, gender
T: time: of incident, ETA
M: mechanism of accident
I: injury
S: signs, obs
T: treatment
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57
Q

What are you priorities in a trauma patient?

A

Stop bleeding
C-spine stabilisation
Prevent hypoxia

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58
Q

What is proven to increase survival in major haemorrhage patients?

A

Transexamic Acid 1g IV over 10 minutes

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59
Q

What is a FAST scan?

A

Focussed Assessment with Sonography in Trauma

Series of USS scans to look for acute injuries or bleeds

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60
Q

What are common places for bleeds in major haemorrhage?

A

Pelvis
Pericardium
Peritoneal Cavity - hepatorenal recess (Morrison’s Pouch), paracolic gutter, hepato-diaphragm area, caudal edge of liver

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61
Q

What is your acute management procedure for a tension pneumothorax?

What is a common cause?

A

Needle decompression thoracocentesis
Mid-clavicular line, 2nd intercostal space

A common cause is a mechanical ventilation in a pleural injury

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62
Q

What are three signs you may see on someone with a pneumothorax?

A 
Absent breath sounds
Asymmetrical chest
Tracheal tug
Hyperresonance
Decreased saturations
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63
Q

Where are chest drains inserted?

A

Mid-axillary line, 5th intercostal space

Saldinger - use of a guidewire to insert the drain

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64
Q

What constitutes a major haemorrhage?

A

> 1500ml blood in the pleural cavity

Treat with chest drain and immediate blood transfusion

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65
Q

What are 4 signs of a cardiac tamponade?

A

Tachycardia
Raised JVP
Hypotension (resistant to fluid therapy)
Muffled Heart Sounds

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66
Q

Where should you avoid cannulating in known diabetics?

A

Foot

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67
Q

What is a risk of giving too much fluids post-surgery?

A

Hyperchloraemic acidosis

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68
Q

What is a paralytic ileus?

A

The lack of peristalsis, can occur as a complication of bowel surgery, causes constipation, distended abdomen, vomiting, absent bowel sounds

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69
Q

What are the different type of clotting factors that can be given and what are the main indication to give each?

A

FFP - used to correct clotting deficiencies, DIC
Cryoprecipitate - give in clotting deficiencies (contains factor VIII and fibrinogen)
Platelet concentrate - given in thrombocytopaenia
Platelet rich plasma - given to patients who are actively bleeding, require surgery or are thrombocytopaenic

70
Q

What advice should be given to someone about eating and drinking prior to surgery?

A

No food for 6 hours and no clear fluids for 2 hours prior to operation

71
Q

What is malignant hyperthermia and what drug is it associated with?

A

Suxamethonium (also halothane)
High temperature, muscle rigidity
Caused by excessive release of calcium from the sarcoplasmic reticulum of skeletal muscle

72
Q

How long should patients undergoing orthopaedic surgeries be on prophylactic VTE anticoagulation?

A

Elective Hip - 28 days
Elective Knee - 14 days
Hip # - Until mobile

73
Q

What effect does smoking have on your ASA?

A

Current smoking classes you as grade 2

74
Q

What is your chance of having malignant hyperthermia if a close relative has it to?

A

It’s autosomal dominant, so 50%

75
Q

What is a Jefferson fracture?

A

A cervical spine fracture with increased widening between the odontoid peg of C2 and C1

76
Q

What does SCIWORA stand for?

A

Spinal cord injury without radiological abnormality

77
Q

What are 4 worrying factors in head trauma?

A

GCS <13 initially
GCS <15 after 2 hours
On warfarin
LOC

78
Q

What are risk factors in a SDH?

A

Alcoholic

Elderly

79
Q

What is the typical presentation of a subdural haemorrhage?

A

Confusion with a history of trauma (but not always)

80
Q

What is the cause of bleeds in…
SAH?
SDH?
EDH?

A

SAH - berry aneurysm
EDH - middle meningeal artery
SDH - bridging veins

81
Q

What is the typical presentation of an extradural haemorrhage?

A

A head injury, patient feels fine and later presents with decreased GCS.
Biconvex in shape on CT

82
Q

Give some causes of raised ALP other than biliary causes?

A 
Pregnancy
Paget's Disease
Hypercalcaemia
Bone mets
Osteomalacia
83
Q

What are causes of respiratory acidosis?

A
  • Primary lung disease resulting in CO2 retention

- breath holding

84
Q

What are causes of metabolic acidosis?

A
  • Diarrhoea
  • DKA
  • Renal or hepatic failure
  • Strenuous exercise
  • Salicylates
85
Q

Cannonball metastases appear as what on XR and what might cause them?

A

Bilateral widespread multiple rounded opacifications

Primary renal cell carcinma

86
Q

What is a common cause of cavitating pneumonia?

A

Staph aureus

IVDU are most at risk

87
Q

How do you determine correct placement of an NG tube?

A

Aspirate pH <5.5 if not CXR, must include area below diaphragm, NG tube should bisect the carina, tip of NG tube should be underneath the level of the diaphragm

88
Q

What is the difference between small and large bowel on XR?

A

Small bowel - central, valvulae conniventes - cross the whole of the bowel

Large bowel - peripheral, haustra

3/6/9 rule
small bowel: <3 cm
large bowel: <6 cm
caecum: <9 cm

89
Q

Give some causes of metabolic acidosis?

A 
Diabetic ketoacidosis
Lactic acidosis
Severe sepsis
Uraemia
Salycilate overdose
Methanol intoxication
Ethyl alcohol intoxication
Renal tubular acidosis
90
Q

What tests do you do post-DKA and how often?

A

Blood glucose – hourly, serum potassium – 2-4hrly, serum bicarbonate 4hrly

91
Q

What is haemolytic uraemic syndrome and in what does it commonly occur?

A

Haemolytic anaemia
Renal failure
Thrombocytopaenia
Commonly occurs in e.coli infections

92
Q

What receptor do opioids act on?

A

Miu receptors

93
Q

What 3 observations are the most useful in assessing opioid overdose?

A

RR, pupil size, GCS

94
Q

What is an immediate serious complication of burns?

A

Hyperkalaemia

95
Q

What is your immediate management in an uncontrolled seizing patient >5 minutes?

A

Diazepam IV or PR or Buccal

96
Q

What are some causes of metabolic alkalosis?

A

Vomiting, alkaline drugs, loss of colonic secretions

97
Q

What would indicate DIC?

A

Bleeding from 3 unrelated sites

98
Q

What are the different types of shock?

A 
Cardiogenic
Neurogenic
Anaphylactic
Septic
Hypovolaemic (Haemorrhagic)
99
Q

What is the definition of shock?

A

A failure in tissue perfusion leading to hypoxia and end organ failure.

100
Q

What are some signs/symptoms of shock?

A 
Tachycardia
Increased RR
Hypotension
Pale, cold clammy
Confusion
Reduced urine output
Coma
Weak pulse, sweating
101
Q

What are the 4 stages of shock and the relavant blood loss in each?

A

Stage 1 - 15% blood loss
Stage 2 - 15-30%
Stage 3- 30-40%
Stage 4 - >40%

102
Q

What is the difference between anaphylaxis and anaphylactoid reactions?

A

Anaphylactoid reactions are not IgE mediated, they do not require prior exposure.

103
Q

A patient has an anaphylactic reaction to antibiotics. What signs and symptoms might you see?

A

Urticarial rash
Swelling (usually throat or tongue), flushing of the skin, angioedema
SOB, bronchospasm
Abdominal pain, nausea
Tachycardia, collapse, hypotension, vasodilation => low systemic vascular resistance => shock

104
Q

What dose of adrenaline is given in anaphylactic reactions?

A

Adrenaline IM 500micrograms or 0.5miligrams (5mls of 1:1000)

Can be given ever 5 minutes as required

105
Q

What is the anaphylaxis protocol?

A 
Adrenaline 500micrograms
Hydrocortisone 100-200mg IV
Oxygen
Chlorphenamine IV 10mg
Fluids IV Saline
106
Q

What bloods tests are sent off in anaphylactic reactions?

A

Tryptases

107
Q

What is the difference between sepsis, severe sepsis and septic shock?

A

Sepsis - severe infection with systemic manifestations
Severe sepsis - organ dysfunction
Septic shock - persistent hypoperfusion, hypotension

108
Q

What is the Sepsis 6 protocol?

A

Give Fluids, Antibiotics, Oxygen

Take urine volume, blood cultures, lactate

109
Q

What is neutropenic sepsis and in what speciality is it an emergency?

A

Oncology emergency due to the immunosuppression of their patients
It is sepsis occurring with a dangerously low WCC (neutrophil <1.0)

110
Q

What is your management of acute asthma?

A 
Oxygen
Salbutamol Nebs, if not working consider IV
Hydrocortisone IV 50-100mg
Ipratropium Bromide
Theophylline
Mg
111
Q

What is the acute management protocol of hypoglycaemia?

A

If unconscious: IV 20% dextrose 5ml/kg (so around 100ml)

If conscious: glucose gel

112
Q

Give 7 differentials for the unconscious patient.

A 
Hypoglycaemia
Wernicke's Encephalopathy
Opiate Toxicity
Benzo Toxicity
Syncope
DKA
Alcohol
113
Q

A patient comes in with acute paracetamol overdose. When should bloods be taken?

A

Paracetamol levels are only accurate over 4 hours after ingestion, the levels should be looked up in relativity to time of ingestion

If unknown ingestion time or staggered overdose start NAC with U&E, LFT and INR on arrival

INR is usually abnormal after 6-12 hours

Treat >150mg/kg

114
Q

What are common symptoms of paracetamol overdose?

A

Nausea, vomiting, metabolic acidosis, coma, hepatic failure (coagulopathy, deranged LFT, hypoglycaemia, RUQ pain, jaundice)

115
Q

What is your treatment for paracetamol overdose?

A

N-acetylcysteine

116
Q

What is the reversal agent for an overdose of…
Opiates
Alcohol
Aspirin

A

Opiates - Naloxone
Alcohol - Pabrinex (thiamine replacement)
Aspirin - Activated charcoal

117
Q

What might you see in the blood results of a patient who is dehydrated?

A

Raised urea

Raised Hb, haematocrit, sodium, albumin

118
Q

What would you see in a hyperinflated lung?

A

Inspiration >6 ribs present, flattened diaphragm

119
Q

Where should a chest drain be inserted?

A

Mid-axillary line, triangle of ??, lateral edge of latissimus dorsi, 5th ICS, lateral edge of pectoralis major, base of axilla, usually left to avoid splenic puncture

120
Q

How do you manage someone with heart failure and oedema presenting acutely?

A 
Oxygen
Morphine
Furosemide
GTN
Sit the patient upright
121
Q

What are some potential complications of surgery?

A
  • Wrong patient
  • Wrong site
  • Lack of notification of allergy status
  • Anaesthetic complications
  • Circulatory complications
  • Wrong operation
122
Q

What are the main three types of anaesthetic?

A
  • Local
  • General
  • Spinal
123
Q

What is the mechanism of action for local anaesthetic?

A

It prevents the uptake of sodium ions into the nerve, inhibiting the action potential from taking place.

124
Q

Where should local anaesthetic not be injected? What are risks of venous injection?

A

Do not inject in fingers

Injecting into the bloodstream risks muscle and heart paralysis and death

125
Q

What are some potential complications of general anaesthetic?

A
  • incorrect dose
  • unknown allergy
  • co-morbidities
126
Q

What are some complications of spinal anaesthetic?

A
  • infection
  • wrong site administration (it should be L3/4
  • low pressure headaches
  • administration in wrong space
127
Q

What is cardiogenic shock and what are some causes of it?

A

A dysfunctional heart that results in a failure to pump blood effectively around the body. Causes include MI, cardiac arrest, cardiomyopathy, arrythmia

128
Q

What are signs of septic shock?

A
  • temperature
  • tachycardia
  • increased respiratory rate
129
Q

What is the ideal analgesic used in diabetic neuropathic pain?

A

Duloxetine

130
Q

What is the difference between a group and save and a crossmatch?

A

G&S - when you envision future surgery, taken in advance to determine patient’s blood type and save some blood for transfusion

Crossmatch - urgent red cell products required, checks there is no reaction and transfusion product is then sent

131
Q

What are the different types of acute reactions to a blood transfusion?

A
  • haemolytic transfusion reaction
  • non-haemolytic febrile transfusion reaction
  • urticaria and anaphylaxis
  • transfusion related lung injury
132
Q

What are the symptoms and immediate management of an acute haemolytic reaction to a blood transfusion?

A
  • Hypotention
  • Rigors
  • Lumbar pain
  • Dyspnoea
  • Haemoglobinuria
  • Abdominal Pain
  • Agitation
  • Renal Failure

Treatment: terminate the transfusion and fluid resuscitation

133
Q

What is the maximum dose of potassium that can be prescribed?

A

40mmol potassium in 1L over 4hrs (or 20mmol/hour) is the most you can give on the ward

134
Q

What are your daily fluid requirements?

A

Na/K/Cl - about 1mmol/kg/day
Glucose - 50-100g/day
25-30ml/kg/day (usually total of 2-2.5L per day)

135
Q

What is the assumed urine output in a patient?

A

Normal loss is 1ml/kg/hour

Assume around 0.5ml/kg/hour when replacing fluids

136
Q

How do you manage post-operative nausea and vomiting (PONV)?

A

Cyclizine 50mg TDS

Intra-op, patients are usually given ondansetron 4-8mg and dexamethasone 4-8mg

137
Q

When do you not treat a spontaneous pneumothorax?

A

If it is under 2cm and patient is haemodynamically stabel?

138
Q

When do you proceed straight to a chest drain as your definitive management for a spontaneous pneumothorax?

A

Haemodynamically unstable
Bilateral
>2cm, breathless and underlying history of lung disease
If aspirating with cannula is unsuccessful

139
Q

What is a possible sign of a basal skull fracture?

A
  • Battle’s sign - bruising and swelling behind the ear

- Bleeding or CSF from the ear

140
Q

How do you test is a clear fluid is cerebral spinal fluid?

A

Test for glucose - positive in CSF

141
Q

What are some complications of a SAH?

A
  • rebleeding
  • vasospasm
  • hyponatraemia (secondary to SIADH)
  • seizures)
  • hydrocephalus
  • death
142
Q

What are the classic three symptoms of raised ICP?

A

Urinary incontinence
Confusion (dementia and bradyphenia)
Ataxia (gait abnormality)

143
Q

What is Cushing’s Reflex?

A

Bradycardia and Hypertension caused by raised ICP

144
Q

What drug do you use to treat vasospasms in SAH?

A

Nimodipine (CCB)

145
Q

What are some indications for an urgent CT head?

A
  • Vomiting more than once with no other cause.
  • New neurological deficit (motor or sensory).
  • Reduction in conscious level (as measured by the Glasgow coma score).
  • Valsalva (associated with coughing or sneezing) or positional headaches.
  • Progressive headache with a fever.
146
Q

What are some potential causes of a high anion gap?

A

MUDPILES

  • methanol
  • uraemia
  • DKA
  • paraldehyde
  • infection
  • lactic acidosis (paracetamol overdose)
  • ethanol
  • salicylates
147
Q

What are you immediate doses of drugs to give in an anaphylactic reaction?

A

Adrenaline IM 500micrograms
Chlorhenamine 10mg IV
100-200 hydrocortisone IV

148
Q

When can a patient be discharged post-anaphylactic reaction?

A

9-12 hours

149
Q

When should tryptase levels be done in anaphylaxis?

A

Immediately, 1-2hrs, 24hrs

150
Q

In a patient presenting with a 5-day history of vomiting, look clinically dry, slightly confused and an ABG showing metabolic acidosis with respiratory compensation - what bedside tests would be useful in diagnosis?

A

Urine dipstick - +++glucose +++ketones
Capillary blood glucose - high

DKA presentation

151
Q

How does DKA lead to metabolic acidosis?

A
  • DKA occurs due to lack of insulin in the body - there is and increase in glucagon leading to increased glucose release from the liver with an inability to process this.
  • High serum glucose results in increased urinary secretion (osmotic diuresis) leading to polyuria, dehydration and polydipsia
  • the absense of insulin causes lipolysis (conversion of fatty acids into energy) resulting in ketone increase, causing acidosis)
  • hyperventilation occurs (Kussmaul) as an attempt to blow off excess CO2 to reduce the pH of the blood
152
Q

What is your management of acute severe asthma?

A 
Oxygen
Salbutamol - watch HR with salbutamol (BB increase HR), give back-to-back nebs with O2
Hydrocortisone IV 50-100mg
Ipratropium Bromide
Theophylline or Aminophylline
Mg - give magnesium
153
Q

A patient presents with chest pain and their ECG shows ST-elevation. What is your acute management?

A

Aspirin 300mg
Morphine 5-10mg IV + antiemetic metoclopramide
Oxygen
Primary PCI

154
Q

An NSTEMI is treated with what medications?

A

Aspirin 300mg
Clopidogrel 300mg and then 50mg
Fondaparinux 2.5mg OD SC (or another LMWH)
Nitrates - GTN spray

155
Q

A patient with acute heart failure is managed?

A
  • oxygen
  • diamorphine 1.25-5mg slowly
  • furosemide 40-80mg and sit the patient up
  • if worsening consider CPAP
156
Q

What are some symptoms of carbon monoxide poisoning?

A
  • headache
  • subjective weakness
  • nausea and vomiting
  • vertigo
  • confusion
  • pale skin and mucosa
157
Q

What investigation is diagnostic of carbon monoxide poisoning and what else might affect this?

A

Carboxyhaemoglobin levels
<3% in non-smokers
<10% in smokers
10-30% will be symptomatic and >30% is severe

158
Q

A patient presents with CO poisoning, how do you manage this?

A
  • 100% O2 target saturations 100%

- hyperbaric oxygen

159
Q

Give 3 signs of opioid overdose?

A
  • pinprick pupils
  • decreased consciousness
  • respiratory depression (RR<12)
160
Q

A 52-year old gentleman is admitted at 9pm for an endoscopy at 9am the next morning. The nurse asks for some maintenance fluids - how much do you give. He is 73kg.

A

Probably doesn’t need IV fluids - encourage oral intake

161
Q

What, in general, are the maintenance fluids you prescribe someone of 50kg?

A

Maintenance approximately 1500ml/24hrs

  • 500ml 0.9% NaCl 8hrs
  • 500ml 5% glucose 8hrs + 20mmol K+ (this is 25g glucose)
  • 500ml 5% glucose 8hrs + 20mmol K+
162
Q

What is Beck’s triad?

A

Raised JVP
Decreased arterial pressure
Muffled HS

163
Q

What is consider 1% SA when talking about burns?

A

A palm-size

164
Q

What is the 9% rule in regards to burns?

A
  • head
  • L arm
  • R arm
  • chest front
  • abdomen front
  • chest back
  • abdomen back
  • thigh front
  • thigh back
  • leg front
  • leg back
165
Q

What is Parklands formula and what is it used for?

A

For how much fluids to give in a burn victim
Fluid = 4 x weight x burn %
Give half in 8 hours, half in 16 hours
Give 100% O2, 15L, mechanical intubation

166
Q

What are some signs of smoke inhalation?

A 
tachycardia
tachypnoea
cough
stridor
respiratory distress
hoarse voice
singed nasal hairs
167
Q

What is the grading used for burns?

A

1st degree - red and painful, no blisters, superficial epidermis, increased CRT
2nd degree - superficial dermal, painful, blistering, swelling
- deep dermal, white, absent sensation, blisters
3rd degree - no blisters, full thickness, dry

168
Q

When do you give a tetanus vaccine in A&E?

A

To those at risk of tetanus who last recieved a form of the vaccine >10 years ago, or those non-vaccinated are given immunoglobulins

169
Q

How might someone with hypothermia present?

A

CNS depression, LOC, slurred speech, bradycardia, AF

170
Q

In general, what antibiotics are used in…?

  • sepsis
  • GI infection
  • complicated UTI
A

sepsis - coamoxiclav + metronidazole (if penicillin allergic give gentamicin and clindamycin)
GI infections - coamox or metronidazole
UTI complication - ciprofloxacin and gentamicin

Medical Finals 2020 (25 decks)

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