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OSCE Y5 > Common ACUTE presentations treatments (ABCDE) > Flashcards

Common ACUTE presentations treatments (ABCDE) Flashcards

1
Q

PE with haemodynamic instability

A

Thrombolysis

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2
Q

Tension pneumothroax

A

Needle decompression 2nd intercostal space
mid-clavicular line

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3
Q

Pneumonia

A

CURB65 score

CXR - in intermediate or high-risk patients -> blood and sputum cultures, pneumococcal and legionella urinary antigen tests

CRP monitoring is recommend for admitted patients to help determine response to treatment

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4
Q

WHat makes up a CURB65 score

A

Confusion
Urea >7
Respiratory rate >30
Blood pressure <90 systolic
>65 yrs

Intensive care for those w/ score 3 or more

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5
Q

Cushing’s reflex - triad of:

A

Hypertension - widening pulse pressure
Bradycardia
Irregular breathing

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6
Q

Holding measure for increased intracranial pressure

A

Mannitol

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7
Q

Anaphylaxis - dose of adrenaline

A

0.5 ml/mg 1:1000 IM

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8
Q

How often should adrenaline be repeated

A

Every 5 minutes

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9
Q

Adult bradycardia treatment:

A

Atropine 500 mcg
Repeat up to 6 times (3mg total)

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10
Q

Bradycardia if atropine not working:

A

Isoprenaline - 5 mcg IV
Adrenaline IV 2-10 mcg
Transcutaneous pacing

If these don’t work - transvenous pacing

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11
Q

Adult tachycardia w/ pulse:

A

Amiodarone - 300 mg IV over 10-20 mins
900 mg IV over 24 hours

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12
Q

Indications for AMIODARONE in tachycardia

A

Three failed DC shocks in unstable pt.
Regular BROAD COMPLEX TACHYCARDIA

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13
Q

When to use Adenosine in SVT

A

When vagal manoeuvres fail

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14
Q

Adenosine dose

A

6 mg IV
12 mg IV
18 mg IV

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15
Q

4Hs - reversible causes of cardiac arrest

A

Hypovolaemia
Hypo/hyperkalaemia (electrolyte)
Hypothermia
Hypoxia

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16
Q

4Ts - reversible causes of cardiac arrest

A

Tension pneumothorax
Tamponade
Toxins
Thrombosis

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17
Q

Cardiac arrest adrenaline dose

A

10 ml 1:10000 Adrenaline IV every 3-5 minutes

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18
Q

Paediatric BLS algorithm

A

start with 5 rescue breaths
Then 15:2 at a rate of 100-120 BPM

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19
Q

Lactate level in shock

A

> 2.2

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20
Q

Pre-operative period: when to stop ACEi/ARBs

A

1 day before surgery

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21
Q

When to stop Warfarin before surgery:

A

5 days before surgery

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22
Q

When to stop LMWH before surgery

A

24 hours prior

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23
Q

Anti-platets drugs: when to stop before surgery

A

7 days before surgery

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24
Q

What to do for anticoagulation if pt. is high risk after stopping warfarin (5 days)

A

Bridge with LMWH

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25
Acute heart failure management
Upright position O2 Loop diuretics Morphine - do not give routinely but if necessary nitrates if concomitant cardiac ischaemia (contraindicated in hypotension)
26
Ventricular tachycardia Mx. in pt. stable vs. unstable pt.
If stable: Antiarrhythmics may be used If unstable (hypotensive, chest pain, heart failure, syncope) immediate cardioversion is indicated
27
Pre-eclampsia tx.
Referral to secondary care Oral Labetalol (Nifedipine if asthmatic) Delivery is definitive management -> timing is situation dependent
28
Acute asthma - Ix.
Clinical diagnosis CXR to rule out infection and pneumothorax ABGs - usually normal Bloods and sputum cultures if evidence of infection
29
ACS investigations:
Bloods - FBC, UEs, LFTs, Mg, Ca, TROPONINS, Glucose, Coagulation profile, cross-match O- X - CXR (signs of heart failure) E - ECG S - specials = Coronary angiography
30
Acute LVF investigations:
Bloods - FBC, UEs, LFTs, Mg, Ca, TROPONINS, Glucose, Coagulation profile, cross-match, phosphate, lipids, BNP O - X- CXR (ABCDE) kerley b-lines, alveolar shadowing etc. E - ECG Special tests: Echocardiography, BNP
31
Ruptured AAA ix.
Bedside US if available CT angiography
32
Gallstones Ix.
LFTs Abdomonal USS CT for surgical planning
33
CBD stone Mx.
IV hydration (prevent renal injury) ERCP
34
Acute pancreatitis Mx.
Supportive NBM IV hydration - 1L/4 hours (Hartmann's) IV antibiotics only if infection/free air on AXR May need ICU
35
Acute pancreatitis Ix.
Amylase/lipase Abdominal USS (exclude other causes/ check for cause stones etc.) CT if diagnostic uncertainty LFTs derranged Apache II/Glasgow scoring
36
Acute mesenteric ischaemia Ix.
VBG: Increased Lactate Abdominal CT Angiography
37
Renal colic Ix.
Urine dipstick CT KUB X-ray KUB
38
Renal colic Mx
Analgesia (IM Diclofenac) <1 cm muscle relaxants > 1 cm uteroscopy/ESWL > 2 cm - in renal pelvis percutaneous nephrolithomtomy
39
Ectopic pregnancy Ix.
bHCG urine bHCG serum Transvaginal US
40
Ectopic pregnancy Mx.
Methotrexate if uncomplicated Laparoscopic salpingectomy Laparotomy Anti-D prophylaxis
41
Ovarian cyst rupture/torsion Ix.
Transvaginal or trans abdominal USS
42
Pelvic inflammatory disease Ix.
Inflammatory markers raised Gynaecological swabs
43
Pre-eclampsia Ix.
BP Urine dipstick: Proteinuria, HELLP Cardiotocography Fetal USS
44
Pre-eclampsia Mx.
Delivery is only definitive mx. Labetalol for BP Magnesium sulphate will prevent fits Aspirin may be used for prevention
45
Suspected TIA/stroke Ix.
CT head ECG Carotid artery dopplers Coagulation profile
46
CVA Mx.
Acute: Aspirin or thrombolysis/thrombectomy Long term: clopidogrel + statin BP control Carotid endarterctomy if >50-70% stenosis (depending on criteria used)
47
Definitive investigation Aortic stenosis
Echocardiograph
48
Torsades de pointes Mx.
ABCD - Magnesium sulphate
49
Ventricular tachycardia mx.
Amiodarone if haemodynamically stable DC cardioversion if not
50
Atrial fibrillation mx. When to use rate
Rate control if >65 years w/ IHD and no Sx/not suitable for cardioversion
51
Rhythm control - AF. When can this be used
Acute setting if clear onset <48 hours ago Otherwise, pt. must undergo 4 weeks of therapeutic anticoagulation and rate control
52
Blood to consider in acute GI bleed
G&S crossmatch FBC (Blood loss) UEs (Increased urea in GI bleeds) LFTs (varices risk) Clotting (coagulopathy common in liver disease) Glucose
53
Acute variceal bleed mx.
Terlipressin Prophylactic IV antibiotics Endoscopic intervention (variceal band ligation)
54
Non-variceal bleed mx.
IV PPI Endoscopic intervention
55
Hypoglycaemia blood glucose level
<4
56
Hyperglycaemia blood glucose level
>11
57
Normal capillary ketones
<0.6
58
Means of confirming diagnosis in suspected DKA
VBG Capillary/URINE ketones (>3 mmol/L) Glucose
59
Insulin infusion rate and type for DKA
IV FIXED RATE 0.1 unit/kg/hour insulin from 50 units human soluble rapid-acting in 50 ml saline
60
DKA - when capillary glucose is <14 mmol Mx.
Give 10% IV glucose at 125 ml/hour in addition to 0.9% saline
61
When should insulin be given in HHS
IF glucose is not falling with fluids alone or there is ketosis
62
HHS Insulin rate
0.05 units/kg/hour
63
Hypoglycaemia Mx. unconscious
200 ml 10% glucose or 100 ml 20% glucose IV 1mg IM GLUCAGON if no IV access
64
Hypoglycaemia Mx. conscious Cannot swallow: Can swallow:
Cannot swallow: 2 tubes 40% glucose gel around teeth Can swallow: 15-20g fast acting carbohydrate plus long acting carbohydrate
65
Stroke scoring system
ROSIER score
66
Classifying life-threatening asthma severity mnemonic
33, 92 CHEST
67
33, 92 CHEST Mnemonic components
33 = PEFR <33% predicted 92 = Sats <92% Cyanosis Hypotension Exhaustion Silent chest Tachycardia
68
Acute pulmonary oedema Mx.
POND Position (sit up) Oxygen (high-flow initially aim for 92-96%) Nitrates (in SEVERE pulmonary oedema) Diuretic if fluid overloaded (furosemide 40 mg IV)
69
Further interventions if POND unsuccessful for pulmonary oedema:
CPAP - if hypoxaemic despite above interventions Inotropes +/- intra-aortic balloon pump in ICU if in cardiogenic shock (hypotension + overload)
70
Pulmonary oedema Ix.
B - baseline blood plus B-type Natriuretic peptide and Troponin PLUS ABG O - X- CXR E - ECG and echocardiography S - special tests = BNP, catheterise and implement strict fluid balance charting
71
Anaphylaxis: specific component to ask for in blood test
Mast cell tryptase
72
Pharmacological seizure management: If seizure on going w/in 10 mins: 20 mins: 30 mins: 60 mins
10 mins: 4mg lorazepam IV or 10 mg DIAZEPAM PR 20 mins: repeat as above 30 mins: Phenytoin 20 mg/kg IV or Levetiracetam 40 mg/kg IV 60 mins: General anaesthesia in intensive care

OSCE Y5 (7 decks)

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