Clinical Cutoffs/parameters Flashcards
Indications LTOT
PaO2< 7.3 or
PaO2 7.3 - 8 with cor pulmonale or polycythaemia
Transudate and exudate
Exudate> 35g/L
Transudate <30g/L
Light’s criteria
If pleural fluid protein level between 30 and 35 g/L (i.e.borderline) use Light’s criteria – exudate if one or more of the following:
Pleural fluid/Serum protein >0.5
Pleural fluid/Serum LDH >0.6
Pleural fluid LDH > 2/3 of the upper limit of normal
Indications for Acute Dialysis
Persistent hyperkalemia >7mM Refractory pulmonary oedema Symptomatic uraemia: encephalopathy, pericarditis Severe metabolic acidosis pH <7.2 Poisoning e.g. Aspirin
Renal failure
Stage 1 >90 (eGFR) Stage 2 60-89 Stage 3a 45-59 Stage 3b 30-44 Stage 4 16-29 Stage 5 <15
Stop metformin when?
Creatinine above 150 µmol/L
Urology referral criteria - urgent and routine
Urgent referral (i.e. within 2 weeks)
Aged >= 45 years AND:
unexplained visible haematuria without urinary tract infection, or
visible haematuria that persists or recurs after successful treatment of urinary tract infection
Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test
Non-urgent referral
Aged 60 >= 60 years with recurrent or persistent unexplained urinary tract infection
Since the investigation (or not) of non-visible haematuria is such as a common dilemma a number of guidelines have been published. They generally agree with NICE guidance, of note:
patients under the age of 40 years with normal renal function, no proteinuria and who are normotensive do not need to be referred and may be managed in primary care
Diabetes cut offs
Plasma glucose
Fasting (8hr) normal <6; impaired 6-7; diabetes >7mmol/l
Post prandial (2hr post 75g glucose load) normal <7.8; impaired 7.8-11; diabetes >11mmol/l
Criteria for safe asthma discharge
PEFR >75%
Stop regular nebulisers for 24 hours prior to
discharge
Inpatient asthma nurse review to reassess inhaler
technique and adherence
Provide PEFR meter and written asthma action plan
At least 5 days oral prednisolone
GP follow up within 2 working days
Respiratory Clinic follow up within 4 weeks
For severe or worse, consider psychosocial factors
Chronic limb ischaemia
Ankle artery pressure <50mmHg
AND either:
Persistent rest pain requiring analgesia for >2 weeks or
Ulceration/ gangrene
Critical limb ischaemia
Rest pain
Ulceration
Gangrene
Buerger’s angle
> 90 normal
20-30 ischaemia
<20 severe ischaemia
ABPI
Calcification >1.4
Normal > 1
Asymptomatic (Fontaine 1) 0.8-0.9
Intermittent claudication (Fontaine 2) 0.6 - 0.8
Rest pain (Fontaine 3) 0.3 - 0.6
Gangrene and ulceration (Fontaine 4) <0.3
Endarterectomy
Symtpomatic (ECST, NASCET):
70-99%
>50% if low risk
perform within 2wks of presentation
Asymptomatic (ACAS, ACST)
>60% benefit if low risk
Aneurysm
Dilation of blood vessel >50% its normal diameter
AAA monitoring
<4cm yearly US
4-5.5: six monthly US
ABPI for 4 layer graded compression bandage
> 0.8
Jaundice visible at what bilirubin concentration
50uM (normal 3-17)
AST:ALT ratios and cause
AST:ALT >2 = EtOH
AST:ALT<1 = Viral
Serum Ascites Albumin Gradient (SAGG)
SAAG >1.1g/dL = portal HTN (cirrhosis in 80%)
SAAG <1.1G/dL = Other causes (neoplasia, inflammation, infection, nephrotic syndrome)
ECG territories and coronary arteries
Anteroseptal = V1-4 (LAD)
Lateral = V5-6 (Cx)
High Lateral = I, aVL (Cx)
Inferior = II, III, aVF (RCA)
How to calculate alcohol units.
For example, to work out the number of units in a pint (568ml) of strong lager (ABV 5.2%):
strength (ABV) x volume (ml) ÷ 1,000 = units
e.g. 5.2 (%) x 568 (ml) ÷ 1,000 = 2.95 units
MMSE scores and dementia severity
25-30 Normal
21-24 Mild
10-20 Moderate
<10 Severe
Asthma exacerbation levels
Near fatal
Life threatening
Severe
Moderate
MMSE scores
Normal 25-30 Mild 21-24 Moderate 10-20 Moderate severe 10-14 Severe <10
Lithium therapeutic index and toxicity levels
Normal 0.6-1.0 (aim for 0.8)
Toxicity - anything over 1.2
Normal protein excretion
<150mg/day
Although urine dipstick unreliable as are 24hr collections - use protein or albumin:creatinine ratios on early morning MSU
Impaired glucose tolerance
Impaired glucose tolerance (IGT) is defined as fasting plasma glucose less than 7.0 mmol/l and OGTT 2-hour value greater than or equal to 7.8 mmol/l but less than 11.1 mmol/l
Impaired fasting glucose
A fasting glucose greater than or equal to 6.1 but less than 7.0 mmol/l implies impaired fasting glucose (IFG)
Primary pneumothorax - cut off for aspiration and chest drain
if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
otherwise aspiration should be attempted
if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted
Secondary pneumothorax - cut off for aspiration/ drain/ observation
if the patient is > 50 years old and the rim of air is > 2cm and/or the patient is short of breath then a chest drain should be inserted.
otherwise aspiration should be attempted if the rim of air is between 1-2cm. If aspiration fails (i.e. pneumothorax is still greater then 1cm) a chest drain should be inserted. All patients should be admitted for at least 24 hours
if the pneumothorax is less the 1cm then the BTS guidelines suggest giving oxygen and admitting for 24 hours
How long before can drive post MI?
4 weeks
SIADH
Hyponatraemia associated with elevated urine osmolality with urine sodium above 20 mmol/l and a low plasma osmolality.
(Aassociated with diseases such as pneumonia, bronchial small cell cancer, subarachnoid haemorrhage , pulmonary TB, meningitis, head injury, intermittent porphyria)
Pre-diabetes HbA1c
Prediabetes is defined by a HbA1c of 42-47 mmol/mol (6.0-6.4%)
COPD severity FEV1 % predicted
Mild FEV1> 80% predicted
Moderate 50-80%
Severe 30-50%
Very severe <30%
Aortic valve replacement at what pressure gradient?
> 50mmHg
Ejection fraction ratios?
Normal = 50-70%
Borderline = 41-49%
Heart failure or cardiomyopathy <40
Hypertrophic cardiomyopathy >75%
Degree of aortic stenosis
Mild <25mmHg
Mod 25-40 mmHg
Sev >40 mmHg
Critical >50mmHg
DEXA scoring
T score - comparison to young referenced mean.
+1 to -1 = Normal
-1 to - 2.5 = osteopenia
<2.5 = osteoporosis
(Z score - comparison to people of same age)
DKA criteria
Glucose >11mmol/L
blood pH <7.3 or HCO3 <15
capillary ketones >3mmol or urinary ketones ++
INR therapeutic targets
INR 2-3: DVT/PE, hypercoagulable states, AF
INR 2.5-3.5: aortic metallic heart valves
INR 3-4: mitral metallic heart valves
Normal maintenance requirements if NBM
H20+ 1.5ml/kg/h
Na +1-2mmol/kg/24h
K+ 0.5-1mmol/kg/24
urine output should be >0.5ml/kg/24h
Treatment dose LMWH for PE
1.5mg/kg
Concentrated and dilute urine
Concentrated urine osmolality >300mosm/kg
Dilute urine osmolality <250mosm/kg
Metformin prescribing and kidney problems
In adults with type 2 diabetes, review the dose of metformin if the estimated glomerular filtration rate (eGFR) is below 45 ml/minute/1.73m2:
Stop metformin if the eGFR is below 30 ml/minute/1.73m2
Prescribe metformin with caution for those at risk of a sudden deterioration in kidney function and those at risk of eGFR falling below 45ml/minute/1.73m2
