clasp Ixs and txs Flashcards
Subdural haemorraghe ixs
CT scan mainstay of investigation
Subarachnoid haemorraghe ixs
CT cerebral angiogram - (to identify an anyeursm)
Spinal cord compression ix
immediate MRI
what are the reversible causes of cardiac arrest
4 H’s and 4 T’s
Hypoxia, Hypovalemia, Hypo/hyperkalemia/metabolic, Hypothermia
Thrombosis, Tamponade (cardiac), Toxins, Tension pneumothorax
hypovalaemic shock tx
fluids and electrolytes
cardiogenic shock tx
inotropics by beta or dopaminergic stimulation- dobutamine, adrenaline, dopamine, dopexamine
intra-aortic baloon pump if pharmacological tx not working
what is obstructive shock and causes
physical obstruction to filling of the heart → reduced preload and cardiac output
tamponade, PE, tension penumothorax
obstructive shock tx
PE - DOAC + thrombolysis (thrombolysis used in pe when there is haemodynamic instability)
Cardiac tamponade - pericardial drainage
Tension pneumothorax - decompression and chest drainage
distributive shock, what is it and subtypes
- significant reduction in SVR beyond the compensatory limits of increased cardiac output
- Generally initial high cardiac output but insufficient to maintain forward perfusion
- main subtypes:
- Septic - bacterial endotoxin mediated capillary dysfunction
- Anaphylactic - mast cell release of histamnergic vasodilators- (tx adrenaline as vasoconstricts and stabilises mast cell)
- Neurogenic - loss of thoracic sympathetic outflow following spinal injury (= loss of sympathetic tone= bradychardia due to unopposed vagal tone)
neurogenic shock tx
- Dopamine alongside vasopressors are the mainstays of treatment
what are shockable and non shockable cardiac arrest rythms
shockable:
vfib
pulseless ventricular tachycardia
non shockable
pulseless electrical activity
asystole
sepsis vs septic shock
(define septic shock)
septic shock is sepsis but assoc with cellular/metabolic dysfunction.
septic shock = sepsis + persistant hypotension lactate>/= 2
SIRS defined
sirs is >/=2 of the following
- Heart rate >90 bmp
- Respiratory rate >20/min
- Temperature >38℃ or <36℃
- WCC >12 000/mm3 or <4 000/mm3 or >10% immature neutrophils
what antibiotics inc risk of c.difficile
the 4 cs
co-amoxiclav, cephlasporins (eg. ceftriaxone), clindamycin, ciprofloxacin (quinolones)
where are anaerobes found
mouth, teeth throat, sinuses and lower bowel
Gram positive found where in the body
skin and mucous membranes
Gram negative found
GI tract
(types of allergy) which occurs sooner- immediate onset reaction (type 1) or accelerated/immediate reaction
accelerated occurs later- within 1-6 hours of last dose.
immediate (type 1) within 1 hour
both IgE mediated
what in penillicin is responsible for allergic reaction
B-lactam ring
How is sepsis monitored/defined
Early news warning score
Score of 5 or more with known/suspected infection= sepsis till proven otherwise
Or can be less than 5 but concerning features eg. Non blanching rash
Adjust news score up if
Clinical/carer concern
Deterioration,surgically remidiable sepsis
Neutropenia
Blood gas/ lab evidence organ dysfunction/lactate
Staph a test
First gram stain
Then rapid PCR- also tells u if its mrsa
When does PCR not work
On dirty samples eg urine, stool
Gram pos cocci in pairs or chains ix
Agglutination aasay (serological test antibodies antigens)
How to testbfor weird bacteria species
MALDI-TOF
Bacteria testing order
Bloods>(1-5days)> positive alert + gram stain> culture results and maldi tof> discs etc
Important causes if gram negative sepsis
E. Coli, neiserria meningitis, psuedomonas aerginusa
Mechanisms of abx resistance (5)
-change target cell
-reduced uptake
- pump which spits bacteria back out
- inactivating enzymes
-decrease cell membrane permeability
Malaria ix
Thick and thin smear
c.difficile tx
ORAL vancomycin
if cant take orally then NG tube etc- has to go into stomach
if life threatening add IV metronidazole
if recurrs within 12 weeks- oral fidaxomin
what additional test must be carried out for c.difficile
abdo x-ray- check for toxic megacolon
what does coagulese negative staph usually indicate in a culture
usually a contaminant
suspect pathogenic if presence of ICED (implantable Cardiac electronic Device) or prosthetics etc.
symptom of anaerobic pneumonia
pleural infection
pneumonia treatment
amoxicillin——IV co-amoxiclav + doxy depending on severity
(<2 CURB65= mild, >3=severe)
all get pneumococcal and influenza vaccine
additional tests for pneumonia
HIV test
Chest x-ray at 6 weeks
ICED infection tx
1st line: IV vancomycin
staph A bacteraemia ixs
48 hourly blood culture until negative
transthoracic echo
staph A tx
flucox
if allergic: vancomycin
(IV is septic etc)
Which drugs have a b lactam ring
Penicillins
Cephalosporins
Carbapenams
Aztreonam
Sepsis 6 o
Oxygen- when given and targets
Start is sats <92- take this with a pinch of salt, if unwell just give as unlikely to do harm
Aim: 94-98
Sepsis 6 targets in hypercapniac patients
Who is at risk for this
Target 88-92
ABG- pco high indicates hypercapnic pt.
Ppm at risk: COPD, end stage lung disease etc
What are you testing for when taking blood cultures for sepsis 6
Check for infection + fbc u&es, LFTs, CRP, clotting, lactate
How are fluids given in sepsis 6.and what type of fluid
20mls/kg in divided doses, crystalloid
Consider pt history eg. Hf
Can use lactate to guide response
Do not give dextrose- does not restore circulating volume
What is pharmacokinetics
What the body does to the drug
- absorption & bioavailability
-distribution
-excretion
-
new score of 1-4 when should initial treatment be started by
<6h (6h cut off for max time)
news of 5-6 when is max time for starting initial tx
<3hrs
news score of >/=7 what is the max time for starting initial treatment
<1hr
What mutation causes marfans
Fibrillin
What mutation causes marfans
Fibrillin
What is a mendelian disorder
Disease predominantly caused by a change in a single gene
(High penetrance)
What mutation causes loeys dietz syndrome
Mutation in TBR1 or TBR2
animal bites antbiotic tx
co-amoxiclav
what contraindicates trimethoprim
methotrexate
bacteriuria tx in asymptomatic Catheterised patients:
no treatment! the longer catheter is in situ the greater the likliehood of developing bacteriuria.
only treat if symptomatic
if symptomatic 7 day course of abx not 3
cavitating lesion pneumonia- what organism
staph a
hameophillus type A
Lyme disease tx
Doxcy- 3 weeks
jirovecci pneumonia tx
co - trimaxazole
