Bowel obstruction Flashcards
What ways does a volvulus run on an x-ray
Sigmoid: bottom left to top right
Caecal: bottom right to top left
Where are yellow cards sent to
The medicine and healthcare regulatory agency (MHRA)
Treatment for anaphylaxis
100% O2, intubate if obstruction is imminent, 500 micrograms adrenaline IM (repeat every 5 mins), 10 mg chlorphenamine IV and 200 mg hydrocortisone IV, 0.9% NaCl STAT (may need up to 2L) and if there is wheeze treat for asthma
Measure serum tryptase 1-6 hrs after suspected anaphylaxis
How do you insert an oropharyngeal airway
Insert curved side uppermost, twisting it through 180° once inserted halfway
When would a nasopharyngeal airway be used instead of an oropharyngeal one
If the mouth is difficult to open eg. seizures or in lighter patients as it’s better tolerated
Contraindicated: possible base of skull fracture
How do you wean patients off respiratory support in ICU
Tracheostomy
What does the apache II score measure
Objectively how sick a patient is, taking into account both acute and chronic issues
What should you suggest if a COPD patient with fully compensated type 2 respiratory failure is given venturi O2 but then they have increase CO2 and acidosis?
BiPAP
Monitoring of different NEWS scores
> 7= continuous, <15 mins
1-4= hourly monitoring and inform a registered nurse
High risk drugs in terms of prescribing errors
Opiates
Anticoagulants
Insulin
Antibiotics
Infusion fluids
What is your individual duty of candour if an adverse event occurs
- Act immediately to put it right, and to prevent further harm.
- Notify the patient as soon as possible, providing a factual explanation.
- Give a verbal apology.
- Explain the short and long term affects.
- Offer support to put matters right (where possible).
- Explain what steps will be taken to prevent such an incident happening again.
- Record details of the discussion in the patient’s record.
- Report the incident through their hospitals process.
When is a written apology to a patient needed when as adverse event occurs
It is a notifiable safety incident
Notifiable safety incidents
An unintended or unexpected incident that occurred in respect to a patient’s care that, in the reasonable opinion of a healthcare professional, could result in or appears to have resulted in: the patient’s death, severe harm, moderate harm or prolonged psychological harm (>28 days).
A near miss cant be a notifiable safety incident
Severe harm
A permanent lessening of bodily, sensory, motor, physiologic or intellectual functions, including removal of the wrong limb or organ or brain damage.
Moderate and significant harm
Moderate harm: significant harm and moderate increase in treatment
Significant harm: the temporary lessening of bodily, sensory, motor, physiological or intellectual function
What is a low harm incident
Any incident that required extra observation or minor treatment and caused potential harm to the patient
Near miss incident
Any incident that has the potential to cause harm but was prevented and therefore no harm occurred to the patient
What is the disclosure process for a notifiable safety incident
Incident detection and initial response, team discussion, notification and open disclosure, and follow up and process completion
The patient shoiuld be notified as soon as possible
What does a patient need to be doing to be discharged from a major bowel surgery
Look well, be up and about, blood test be back to their baseline, be eating and drinking well and have some evidence of bowel functioning (eg. flatus as a minimum)
Suspected meningitis treatment
Suspected meningococcal disease- empirical treatment based on superstition:
- Admit the person to hospital as an emergency by telephoning 999
- Parenteral benzylpenicillin at the earliest opportunity, provided that treatment does not delay urgent transfer to hospital
Meningitis treatment in hospital
- For Meningococcal meningitis- Benzylpenicillin, Cefotaxime
- For Invasive Pneumococcal disease- Cefotaxime
- For Haemophilus meningitis- Cefotaxime
Criteria for a lacuanar stroke
One of the following:
- pure sensory stroke
- pure motor stroke
- sensori-motor stroke
- ataxic hemiparesis
Criteria for a posterior circulation stroke (POCS)
One of the following:
- CN palsy and a contralateral motor/sensory deficit
- bilateral motor/sensory deficit
- conjugate eye movement disorder
- cerebellar dysfunction
- isolated homonymous hemianopia or cortical blindness
First line investigation for asthma exacerbation
Arterial blood gas
First line diagnostic test for heart failure
Echocardiogram
First line therapy for acute severe asthma
Inhaled bronchodilators- salbutamol nebulisers
Initial management for intermittent claudication
Supervised exercise and cardiovascular risk management
Elderly patient presenting with large amounts of blood PR
Diverticulosus
Initial management for PE
Acute phase- low molecular weight heparin
Long term- warfarin (vitamin K antagonist) and Rivaroxaban (factor Xa inhibitor)
What is used to grade the severity of airflow obstruction in COPD
Forced expiratory volume
Positive predictive value
The probability that a patient with a positive test result will have the disease
UTI differentils
Prostatitis- painful with severe urinary problems
Bladder calculis- pain or difficult micturition
Benign prostatic hypertrophy- urinary symptoms and occasional microscopic haematuria
Bladder cancer- painless haematuria
UTI- painful with positive leukocytes and nitrites
How to diagnose coeliac disease
- Positive tissue transglutaminase
- Refer to gatroenterologist for an intestinal biopsy
Different causes of anaemia
- Anaemia of chronic disease: normocytic and normochromic
- Gatro intestinal bleeding: microcytic and hypochromic with raised platelets
- Methotrexate toxicity: causes bone marrow suppression so is normocytic and platelets are low
- Vitamin B12 deficiency: macrocytic anaemia
Arterial blood gas for meningitis
Metabolic acidosis
When do you see an extensor plantar response
UMN lesion
Treatment for rheumatoid arthritis
DMARD- methotrexate, sulfasaline and leflunomide
Methotrexate- teratogenic
Red flags in back pain
Age >50, thoracic pain, unexplained weight loss, neurological symptoms, atypical pattern (night pain or sudden onset), fever, IV drug use, steroid use, history of cancer (mnemonic = A TUNA FISH).
Using warfarin
Use LMWH as a cover as warfarin takes time to work
Warfarin can be used when there is a metallic heart valve
What anticoagulant do you give in A fib
A DOAC
WRISKE- NG insertion
Is it central?
Does it bisect the carina in the middle?
Is the tip visible below the diaphragm?
Is the tip visible at least 10cm below the gastro-oesophageal junction (where the stomach starts)?
