Clinical Scenarios Flashcards
Chest pain (MI)
Immediate management
Administer sublingual GTN (monitor BP for hypotension)
IV morphine with antiemetics if pain persists
300mg Aspirin and Clopidogrel 300mg
Anticoagulation - loading dose of enoxaparin or fondaparinux if NSTEMI
STEMO - Primary PCI with 120 minutes or thrombolysis if PCI unavailable
Chest pain - tension pneumothorax management?
Tension pneumothorax, if the person’s condition is life threatening:
Consider inserting a large-bore cannula through the second intercostal space in the mid-clavicular line, on the side of the pneumothorax.
Chest pain - acute pulmonary oedema management?
Give an intravenous diuretic (for example furosemide 40 mg to 80 mg, given slowly).
Give an intravenous opioid (for example diamorphine 2.5 mg to 5.0 mg, given slowly over 5 minutes).
Give an intravenous anti-emetic (for example metoclopramide 10 mg). This can be mixed with diamorphine.
Give a nitrate, either sublingually or buccally (for example GTN spray, two puffs).
How quickly should someone be seen with chest pain?
Same day assessment if pain in the last 12 hours
within 2 weeks if the person is pain free with chest pain more that 72 hours ago
Long term management of ACS?
Address complications such as arrhythmias, heart failure, or shock.
Dual antiplatelet therapy (e.g., aspirin + ticagrelor).
Statin (e.g., atorvastatin 80 mg), beta-blocker, and ACE inhibitor.
Lifestyle advice: smoking cessation, exercise, dietary modification.
Sepsis Initial approach?
ABCDE assessment
Bloods - FBC, U&Es, lactate, CRP, cultures
Sepsis initial management?
Follow the Sepsis Six:
Administer oxygen if required.
Take blood cultures.
Give IV antibiotics (broad-spectrum, e.g., piperacillin-tazobactam).
Administer IV fluids.
Measure lactate.
Monitor urine output (insert catheter if needed).
Escalate care early if signs of septic shock persist (e.g., ICU).
What is sepsis?
Sepsis, a life-threatening medical emergency, results from a dysregulated host response to infection, leading to systemic inflammation and organ dysfunction.
The latest consensus definitions, known as Sepsis-3, identify sepsis as an infection with a concurrent increase in the Sequential Organ Failure Assessment (SOFA) score by ≥2 points, while septic shock is defined by persisting hypotension despite fluid resuscitation, necessitating vasopressors to maintain a mean arterial pressure of ≥65 mmHg, and a serum lactate level >2 mmol/L.
The new guidelines recognise the following terms:
sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection
septic shock: a more severe form sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’*
AKI initial assessment
ABCDE assessment
Assess for ureic complications (pericarditis, pulmonary oedema)
assess volume status in C
Monitor potassium levels - ECG to look for signs of hyperkalaemia
Initial management of AKI?
Hyperkalaemia - stabilize the myocardium with IV calcium gluconate
Shift potassium intracellularly with IV insulin and dextrose
Dialysis if required
Volume status
If hypovolaemic - IV fluids
If overloaded - consider diuretics
Stop nephrotoxic drugs
Investigations for AKI?
Urinalysis - check for blood, protein or casts
ECG monitoring
U&E’s bicarbonate and phosphate
Assess for causes - FBC (anaemia/infecion), CK (rhabdo) or immunological markers (ANA, ANCA)
anti GBM
complement levels
Immunoglobulin levels
A
Renal USS
causes for AKI?
Pre-renal - reduction in renal perfusion - Prolonged prerenal states, if not rectified, can progress to ATN, causing intrinsic renal damage.
Intrinsic
- Acute tubular necrosis
- Glomerulopathies
Interstitial disease
Vascular causes
Post renal
- obstruction
- back flow of urine
What are notifiable diseases?
Hep A/B/C
Acute meningitis
Acute Poliomyelitis
Anthrax
Botulism
Brucellosis
Cholera
Diphtheria
Enteric fever (typhoid/paratyphoid)
Haemolytic uraemia syndrome
Infectious bloody diarrhoea
Ivasive Group A strep
Legionnaires disease
Leprosy
Malaria
measles
Monkey pox
Plague
Mumps
Rabies
Rubella
Severe acute respiratory distress syndrome
Scarlet fever
Smallpox
Tetanus
Tuberculosis
Thymus
Viral hemorrhagic fever
whopping cough
yellow fever
Do not wait for laboratory confirmation of the disease. By law, you must report any suspicion of a notifiable disease
clinical signs of DVT?
Tenderness and firmness of the calf on palpation
Calf pain on dorsiflexion – known as Homans sign
Discolouration of the peripheral foot
Swelling of the affected leg which I would measure against the contralateral leg
