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Y4 > Clinical skills > Flashcards

Clinical skills Flashcards

1
Q

Shockable rhythm & interventions

A

Pulseless ventricular tachycardia
Ventricular fibrillation

Interventions:
CPR-rhythm-defibrillation cycles x3 then 1mg IV adrenaline 1:10,000 and 300mg IV amiodarone
Repeat CPR-rhythm-defibrillation cycle with alternating cycle of IV adrenaline administration

Important to secure airway (intubation/SGA), IV/IO access, waveform capnography

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2
Q

Non-shockable rhythm & interventions

A

Pulseless electrical activity
Asystole

Interventions:
CPR 2mins with 1mg IV adrenaline 1:10,000 & rhythm analysis
Then CPR-rhythm cycle repeated, with alternating cycle IV adrenaline administration

Important to secure airway (intubation/SGA), IV/IO access, waveform capnography

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3
Q

4Hs of cardiac arrest

A

Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia

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4
Q

4Ts of cardiac arrest

A

Tension pneumothorax
Cardiac tamponade
Toxins
Thrombosis

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5
Q

DR ABCDE

A

D - danger
R - response –> AVPU assessment

A - airways --> head tilt-chin lift & jaw thrust manoeuvres
B - breathing --> chest rise and fall
C - circulation --> carotid pulse
D - disability
E - exposure/everything else
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6
Q

Post-resuscitation care

A 
A - new ABG
B - repeat bloods
C - request CXR
D - destination e.g. ITU
E - 12-lead ECG
F - inform family
G - gratitude for team
Aim for:
94-98% spO2
32-36 degrees temperature
normal paCO2
mean arterial pressure > 65mmHg
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7
Q

CPR

A

Cardiopulmonary resuscitation used for cardiac arrest
30 chest compressions of 5-6cm depth (1/3 of chest) and at a rate of 100-120 compressions per minute
2 breaths via bag-valve mask or pocket mask with 500-700ml of air given
Asynchronous ventilation requires 10 breaths per min

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8
Q

Devices used for airway obstruction

A

Yankeur suction
Magill’s forceps

Suction catheter = flexible, long tube used to remove respiratory secretions from the airway, typically used in pts on tracheostomy

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9
Q

SBARR

A

Introduce self

  • Situation - pt demographics, and reason for call
  • Background - reason for admission/concern
  • Assessment - what has been done so far e.g. bloods, examinations, etc.
  • Recommendation - further investigations, tx, specialist input
  • Response - confirm how soon pt will be reviewed
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10
Q

Breath sounds associated with partial obstruction

A

Inspiratory stridor - pharynx or above obstructed
Expiratory wheeze - lower airways obstructed
Gurgling - fluid/semi-solid material in main airway
Crowing - laryngeal spasm
Snoring - tongue obstructing pharynx

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11
Q

Complete airway obstruction

A

See-saw/paradoxical movement of chest and abdomen seen

Absence of breath sounds aka silent chest

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12
Q

Battle’s sign

A

Seen with skull base fracture
Bruising of the scalp overlying the mastoid process (mastoid ecchymosis)
Indicates a petrous temporal bone fracture

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13
Q

Airway adjuncts

A 
Pocket mask
Nasopharyngeal airway
Oropharyngeal airway (Guedel)
Bag-valve-mask
Yankeur suction
Magill's forceps
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14
Q

Variable oxygen devices

A

Hudson mask (simple face mask) = FiO2 of 40-60% at 5-10L/min

Nasal cannula = FiO2 of 24-40% at a flow rate of 1-6L/min

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15
Q

Fixed oxygen devices

A

Venturi mask FiO2 of 24-60% depending on colour with flow rates of 2-15L/min
B24, W28, O31, Y35, R40, G60

Non-rebreathe mask (high conc. reservoir mask) = FiO2 of 85% at a flow rate of 12-15L/min
Contraindicated in pt with pre-existing airway disease due to high risk of carbon dioxide retention

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16
Q

NEWS2 score

A

National early warning score used to monitor adult patients in the acute hospital setting
6 physiological parameters used to assess pt: HR, sBP, RR, temp., consciousness, spO2
2 extra points given if pt on supplemental oxygen

17
Q

Indication for nasopharyngeal airway

A

Reducing Glasgow Coma Score

Patients who cannot tolerate an oropharyngeal airway e.g., during a seizure

18
Q

Contraindication for nasopharyngeal airway

A

Skull base fracture signs/suspicion

19
Q

Calculating alcohol units

A

Alcohol units = volume (ml) * ABV / 1,000

1 unit = 10ml of pure ethanol

20
Q

Erb’s point (cardiology)

A

3rd intercostal space L sternal edge

S2 heard best

21
Q

Mental state examination

A

ABSMAT PCI
Appearance, Attitude, Behaviour - fidgety, agitated, avoiding eye contact
Speech (rate/tone/volume) - pressured speech, monotonous, low volume, fast rate
Mood (pt description) & Affect (examiner’s observation)
Thoughts (form, content, possession) - speed, flow and coherence, delusions, obsessions, compulsions, suicidal thoughts, homicidal/violent thoughts, thought insertion/withdrawal/broadcasting
Perception - derealisation, depersonalisation, hallucinations, illusions, pseudo-hallucinations
Cognition - concentration, attention, memory, orientation
Insight - illness, interventions, impact
Judgement - considered decision

22
Q

Glasgow Coma Score

A

3-15 points

Motor response - out of 6 (highest score for any limb)

  1. Obeys commands
  2. Localises to pain
  3. Withdraws from pain
  4. Abnormal flexion to pain (decorticate posture = severe CNS damage)
  5. Extending to pain
  6. None

Verbal response - out of 5

  1. Orientated
  2. Confused
  3. Words
  4. Sounds
  5. None

Eye opening - out of 4

  1. Spontaneous
  2. To speech
  3. To pain
  4. None
23
Q

AMTS

A

Abbreviated mental state test
Used to determine any mental/cognitive impairment in elderly patients, max score is 10, score <8 indicates impairment

Questions asked:
age
time
--> ask pt to repeat "42 west register street" then keep in mind
year
location
identify 2 people nearby
DOB
year of 1st/2nd world war
name of current monarch
count back from 20
recall address given earlier

Limitations: language barrier, pt may not normally be able to recall dates of world wars/current monarch

24
Q

Motivational interviewing

A

Definition: patient-centred interpersonal discussion to address pt uncertainty and increase motivation to change problematic behaviours

  1. agenda setting - prioritise pt’s needs/concerns
  2. demonstrate empathy - OARS (open-ended qs; affirmation of strength, efforts, past success; reflect by repeating/rephrasing what pt has told you to draw more info; summarise to check understanding)
  3. importance and confidence scale 0-10 to evoke motivation for change
  4. value and goals - what pt wants to achieve in life
  5. action plan
  6. support services available
25
Q

Purple blood tube

A

Used for haematology: FBC and HbA1c

26
Q

Yellow/Gold blood tube

A 
Used for biochemistry
U&Es
LFTs
CRP
TFTs
Bone profile
Cardiac enzymes
Iron studies
Magnesium
Lipid profile
Endocrinology
Tumour markers
Toxicology
Drug level tests
Microbiology
Virology
Immunology
27
Q

Blue blood tube

A

Coagulation screen
D-dimer
INR

28
Q

Grey blood tube

A

Glucose & lactate

29
Q

Pink blood tube

A

Group & save
Crossmatch
Labelled by hand

30
Q

Blood culture bottles

A

Aerobic (blue) and anaerobic bottles (red)

Aerobic blood culture collected first as air in needle can be pushed into the aerobic bottle

31
Q

Auscultatory gap

A

Transient disappearance of the Korotkoff sounds between systolic and diastolic pressures during cuff deflation
Causes underestimation of sBP or overestimation of dBP

32
Q

Korotkoff sounds

A 
K1 = systolic pressure
K4 = 1st diastolic pressure (only used for pregnant women or pt with increased circulation when measuring manual BP)
K5 = 2nd diastolic pressure

Y4 (7 decks)

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