ASSCC 2 Flashcards
Define DIC:
Pathological consumptive coagulopathy, due to activation of both the coagulation and fibrinolytic systems, leading to formation of micro thrombi in many organs and consumption of clotting factors and platelets
Treatment of DIC:
FFP
Platelets
Cryprecipitate
Shelf life of platelets:
5 days
Indication for platelet infusion:
- Platelet loss/consumption/dysfunction
- Thrombocytopenia <50 x 10^9
3 stages of haemostasis:
1) Vasoconstriction
- SMC contraction via local reflex, thromboxane A2 and serotonin released from activated plts
2) Platelet activation
- Adherence, aggregation and thrombin plug
3) Coagulation
- Intrinsic + extrinsic pathway: fibrinogen –> fibrin
Definition of massive blood transfusion:
1) Replacement of >1 blood volume in <24hrs
2) >50% of blood volume in 4 hrs
3) In children: Transfusion of >40ml/kg
6 Complications of massive blood transfusion:
1) Hypothermia
2) Fluid overload
3) ARDS / TRALI
4) Electrolyte disturbance - hyperkalaemia + hypocalcaemia
5) Thrombocytopenia
6) Coagulopathy
3 Intraoperative measures to reduce blood loss:
1) Cell saver machine
2) Hypotensive technique
3) Good haemostasis
4 early post-op complications of AAA repair:
1) Colonic ischaemia
2) Renal failure
3) Sexual dysfuction
4) Spinal cord ischaemia
1st degree burn:
Epidermis
Red, painful, mild swelling
2nd degree burn:
Papillary region of dermis
White/red, intense pain, severe swelling, blisters, spares hair follicles/sweat glands
3rd degree burn:
Reticular region of dermis
White, relatively painless, leathery
Define ARDS:
Acute Respiratory Distress Syndrome
Diffuse alveolar damage + lung capillary endothelial injury
Diagnosis of ARDS:
1) CXR: Diffuse bilateral pulmonary infiltrates, not fully explained by effusion/fluid overload/lung collapse
2) Pulmonary artery capillary wedge pressure < 18mmHg
3) PaO2 / FiO2 < 26.6 kPa
Resp support for ARDS:
- Low tidal volume
- Moderate PEEP
- Prone position
- High frequency oscillation
- ECMO for refractory hypoxaemia
Pharmacological support for ARDS:
- Low dose steroids
- Inhaled nitric oxide/prostacyclin
- Antibiotics
Difference between tension and simple pneumothorax:
In tension:
1) Trachea and mediastinum shifted to opposite side
2) Tachycardia and hypoxia
3) Emergency requiring urgent needle thoracostomy then tube thoracostomy
4) Continuous entry of air through one way valve
Borders of safe triangle for chest drain insertion:
1) Lat border of pec major
2) Lat border of lat dorsi
3) Line drawn from nipple backwards
6 indications of central line insertion:
1) Monitoring of fluid balance and fluid resuscitation
2) TPN
3) Certain fluids and medications ie chemo
4) Failed peripheral venous access
5) Haemodialysis
6) Transvenous cardiac pacing
Complications of CVL insertion:
1) Infection
2) Thrombosis
3) Arterial puncture: haemorrhage, pseudoaneursym, haemothorax
4) Pneumothorax
5) Left IJV: chylothorax
6) Perforation of RA -> cardiac tamponade
7) Arrhythmias
Post CVL insertion CXR for:
1) Tip in SVC just superior to RA
2) Pneumothorax
Anatomical landmarks for CVL in IJV:
1) Mastoid process
2) Carotid pulse
3) 2x heads of sternocleidomastoid
How to remove CVL in IJV?
Head down
- Prevent air embolism
Sites for inserting CVL:
1) IJV
2) Subclavian
3) Femoral
4) PICC
Most likely organisms to cause line infection in CVL:
1) Staph epidermidis
2) Staph aureus
3) MRSA
5 sterile barrier precautions while inserting CVL:
1) Sterile gloves
2) Sterile gown
3) Hat
4) Drape
5) Mask
3 layers of adrenal cortex + hormones produced:
1) Zona glomerulosa: mineralocorticoids, aldosterone
2) Zona fasciculata: glucocorticoids, cortisol
3) Zona reticularis: androgens
Actions of cortisol on carbs, proteins and fats:
Carbs: - Antagonises insulin = hyperglycaemia - Stimulates gluconeogenesis Proteins: - Stimulates AA uptake and protein synthesis in liver - Inhibits AA uptake in peripheral tissues Fats: - Stimulates lipolysis
How do corticosteroids affect bone?
1) Directly inhibit osteoblast activity
2) Direct stimulation of bone resorption
3) Inhibit calcium absorption in GIT
4) Stimulates calcium loss in kidneys
5) Inhibits sex steroids
4 General actions of cortisol:
1) Anti-inflammatory
2) Mineralocorticoid actions
3) Metabolic effects
4) Control of stress response
Side effects of long term corticosteroids:
1) Cushingoid features
2) CVS: HTN, fluid retention
3) MSK: proximal myopathy, AVN, osteoporosis
4) Endocrine: Diabetes
5) Opportunistic infections
6 steps in hypo-pit-adrenal axis:
1) Hypothalamus releases
2) CRH
3) Anterior pituitary releases
4) ACTH
5) Adrenal cortex releases
6) ) Cortisol
9 Advice to patients starting steroid:
1) Don’t stop them suddenly
2) Tell Dr that you take steroids - consider med-alert bracelet/card
3) May weaken bones ^risk fractures
4) May ^blood glucose and cause diabetes
5) May ^ weight
6) May ^ risk infections, delayed wound healing
7) ^ risk of peptic ulcers: do not take NSAIDs
8) May cause mood changes
9) May cause muscle weakness
Causes Addisonian crisis:
1) Addison’s disease
2) Trauma
3) Surgery
4) Sudden stopping of steroid medication
5) Infection
5 cardinal features of addisonian crisis:
1) Abdominal pain
2) Nausea/vomiting
3) HypOnatraemia, hypERkalaemia
4) Unexplained shock
