Clinical Debrief General Flashcards
Which class of drugs can be prescribed in order to increase protein filtration in the kidneys?
ACE Inhibitors
What is Naloxone used for?
It is a powerful antagonist for opioid receptors, and used in those who have overdosed.
What is pancytopenia?
It is when all 3 of the following are reduced
- Haemoglobin
- White cell count
- Platlets
Which class of drugs should you stop if someone has dehydration / Diarrhoea and Vomiting (D+V)
Use the Mnemonic DAMN (ie. Stop the DAMN drugs) D - Diuretics A - ACE Inhibitors M - Metformin N - NSAIDS
How can you detect hyperkalemia on an ECG?
- Flattened P waves
- Widening QRS complex
- Tall tented T waves
What is aspiration pneumonia?
It occurs most commonly in those with altered mental status who have an affected gag-reflex, and they end up inhaled oropharyngeal contents into the airways. These contents then end up in the lungs, where it is followed by a subsequent infection.
What are the risk factors for aspiration pneumonia?
- Altered mental status (from drugs, alcohol, anaesthesia etc.)
- swallowing dysfunction
- gastrointestinal disease (increases the risk of regurgitation)
- intubation or tracheostomy tube
- older age
- feeding tube
- recumbent position
What investigations would you order on someone with suspected aspiration pneumonia?
- CXR (new infiltrate in dependent lung fields)
- O2 Sats (will be decreased)
- FBC (will be leukocytosis)
- Sputum culture (looking for type of infection so can tailor treatment to it)
How do you treat aspiration pneumonia?
- Antibiotics (can be IV or oral depending on patient status, and the specific antibiotic is dependent on the pathogen detected
- Supportive care (ie. Empyema, if present, may need drainage. Or if part of the lung is now nectrotic, it may need to be surgically removed)
What is empyema?
It is when pus gathers in the pleural space
What is rhabdomyolysis?
It is a serious syndrome due to a direct or indirect muscle injury. It results from the death of muscle fibers and release of their contents into the bloodstream. This can lead to serious complications such as renal failure
How does someone with rhabdomyolysis present?
Classic Triad is
- Muscle pain in the shoulders, thighs, or lower back
- Muscle weakness or trouble moving arms and legs
- Dark red or brown urine or decreased urination
Keep in mind that half of people with the condition may have no muscle-related symptoms.
Other symptoms include
- Abdominal pain
- Nausea or vomiting
- Fever, rapid heart rate
- Confusion, dehydration, fever, or lack of consciousness
How is rhabdomyolysis diagnosed?
Serum creatinine kinase (CK) levels at more than 5 times the upper limit of normal
How is rhabdomyolysis treated?
Patients are given enough fluid via infusion in order to maintain a urine output of 200-300 mL/hour.
If unresponsive to fluids (ie. anuria), then they are put on haemodialysis, which corrects metabolic acidosis and electrolyte disturbances. It is indicated if there is renal failure as well.
What is hyperkalaemia?
A high serum potassium
What is the main complication that you are worried about in someone with hyperkalaemia? How serious is it?
Main complication is cardiac arrhythmias such as ventricular fibrillation, which can be fatal.
Which conditions can cause hyperkalaemia?
Hint. split into conditions and medications
- Acute kidney injury
- Chronic kidney disease
- Rhabdomyolysis
- Adrenal insufficiency
- Tumour lysis syndrome
- Diabetic ketoacidosis / hyperosmolar hyperglycaemic state
Which test is used to diagnose hyperkalaemia?
- U&E’s on a blood test
Other than serum potassium levels, what else do you need to look for in the bloods for someone with hyperkalaemia? Why?
Creatine, urea and eGFR.
This is because you are checking whether there is acute or chronic kidney failure.If there is, it may be necessary to send them for haemodialysis.
On an ECG, what conditions shows up with
- Tall peaked T waves
- Flattened or absent P waves
- Broad QRS complex
Hyperkalaemia
At what concentration of serum potassium do you need to perform an ECG?
6 mmol/L
How do you conservatively manage hyperkalaemia?
Can alter diet and medications