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Year 4 - Acute Care > Appraoach To Acutely Unwell > Flashcards

Appraoach To Acutely Unwell Flashcards

1
Q

What does ABCDE stand for?

A

Airway, breathing, circulation, disability & exposure

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2
Q

What are 3 signs of airway issues?

A

See-saw breathing (abdominal breathing)
Using accessory muscles
Central cyanosis

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3
Q

What are signs of Breathing problems? (6)

A
  • sweating
  • redness
  • chest expansion shortens
  • cyanosis
  • accessory muscle use
  • record spO2/auscultation/percussion/tracheal positioning
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4
Q

What signs are for circulatory concern?

A
  • Colour of skin (redness)
  • temperature
  • swelling?
  • veins?
  • pulse, cap. Refill, auscultation, BP
  • look for blood loss
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5
Q

What signs suggest disability problems?

A
  • skewed ABG
  • check for drug toxicity
  • BGM
  • AVPU/GCS
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6
Q

What signs suggest exposure issue?

A

Rashes
External wound
Abdo exam?

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7
Q

Treatment for airway problem?

A
  1. Simple airway manoeuvres
  2. Airway suction
  3. Insert adjunct (oropharyngeal/nasopharyngeal)
  4. Tracheal intubation
  5. Oxygen/ tracheostomy
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8
Q

Treatment for breathing problems?

A

Oxygen if below 94%

Oxygen for COPD aim for 88-92%

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9
Q

What mask would you use for normal patient to get sats above 94%?

A

Usually 15L non-rebreathe

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10
Q

What mask would you use for COPD patient to get sats between 88-92%?

A

Venturi mask 28% for 4L or Venture 24% 4L.

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11
Q

What treatment would you do for cardiovascular problems? (6/7 steps)

A

Insert 1 or more cannula (usually 20g pink or 14/16 orange/grey for more or bigger bolus)
- take blood from cannula

FLUID 500ml Hartmanns OR 0.9% sodium chloride over 15 mins, 250 for those with pre-existing heart problems

Reasses HR and BP every 5 mins.

Repeat fluid challenge if not improved.

ECG recorded
(Aspirin 300mg asap for suspected ACS)

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12
Q

What tx would you give for low glucose?

A

50ml of 10% glucose/dextrose if below 4mmol

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13
Q

what would you give for drug toxicity?

A

Naloxone

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14
Q

What is the goal CRT?

A

<2secs

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15
Q

What can a bounding pulse indicate?

A

Sepsis

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16
Q

What can hypotension suggest?

A

Vasodilation = anaphylaxis, sepsis

SHOCK UNTIL PROVEN OTHERWISE

17
Q

What does hyper-resonance indicate on percussion?

A

Pneumothorax or fluid

18
Q

What type hypersensitivity reaction is an allergic reaction

19
Q

What is sepsis??

A

Where the body launches a large immune response to an infection, causing systemic inflammation and organ dysfunction.

20
Q

What causes sepsis

A

Release of chemicals = endothelial lining of blood vessels = more permeable = oedema = reduced intravascular volume

= decreased oxygen supply = more anaerobic respiration = lactic acid waste product = metabolic acidosis

21
Q

What is septic shock

A

Hypovolemia and therefore hypoperfusion to organs causing organ failure

22
Q

How do we treat spesis?

A

Sepsis six

23
Q

What do you give and take in sepsis six

A

Give: oxygen, antibiotics and fluid
Take: blood culture, urine output and blood gas for lactate

24
Q

What other medication is given alongside iv fluid for sepsis??

A

Vasopressors (noradrenaline)

25
Q

5 rfs for sepsis?

A
  1. Old age
  2. Young age <1
  3. Chronic conditions
  4. Surgery trauma or burns
  5. Pregnancy
  6. In dwelling catheter
  7. Chemo
26
Q

How is sepsis assesssed?

27
Q

What bloods are done for sepsis??

A

Fbc, U&E, LFT, CRP, ABG, clotting, BGM, culture

28
Q

What other tests are done for sepsis?

A

Urine dip and culture
Ct
Chest x ray

29
Q

What is a common antimicrobial to treat sepsis

A

Ceftriaxone - beta lactam

30
Q

What are the 3 signs of an acute/major haemorrhage?

A

Clammy
Pale
Hypotension

31
Q

What is SCALPeR

A

Location of haemorrhage
Scalp and external factors
Chest
Abdomen
Long bones (femurs)
Pelvis
Retroperitoneum

32
Q

Definition of MAJOR haemorrhage?

A

More than 50% blood loss in 3 hours
70ml/kg in 24hrs

33
Q

5 tx for major haemorrhage

A
  1. Call for help
  2. Locate haemorrhage
  3. Pressure with adrenaline soaked gause/splint or tourniquet
  4. Surgical measure
  5. Correct coagulation
34
Q

Describe the stages of haemorrhagic shock

A

LOVE - 15 - 30 - 40 - GAME OVER
15% LOSS = 1
15-30 = 2
30-40 = 3
40 + = 4

35
Q

What type hypersensitivity is anaphylaxis?

36
Q

4 signs of anaphylaxis

A

Urticaria, swelling, redness/itching and abdominal pain

37
Q

ABCDE approach to anaphylaxis

A

A= secure
B = high flow oxygen and/or salbutamol
C = iv fluid bolus 500ml crystalloid
D = lie patient down for cerebral perfusion
E = urticaria + swelling

38
Q

Tx of anaphylaxis?

A

0.5ml adrenaline IM repeated after 5 mins if needed
Antihistamines
Steroids (IV hydrocortisone)

39
Q

What is measured in the hospital to ensure the anaphylaxis is reducing?>

A

Tryptase is release during mast cell degranulation and is taken within 6 hours of event

Year 4 - Acute Care (1 decks)

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