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4th year OSCE > 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.
Refular 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
12 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

17
Q

Cardiac arrest adrenaline dose

A

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

18
Q

Paediatric BLS algorithm

A

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

19
Q

Lactate level in shock

A

> 2.2

20
Q

Pre-operative period: when to stop ACEi/ARBs

A

1 day before surgery

21
Q

When to stop Warfarin before surgery:

A

5 days before surgery

22
Q

When to stop LMWH before surgery

A

24 hours prior

23
Q

Anti-platets drugs: when to stop before surgery

A

7 days before surgery

24
Q

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

A

Bridge with LMWH

25
Q

Acute heart failure management

A

Upright position
O2
Loop diuretics
Morphine - do not give routinely but if necessary
nitrates if concomitant cardiac ischaemia (contraindicated in hypotension)

26
Q

Ventricular tachycardia Mx. in pt. stable vs. unstable pt.

A

If stable: Antiarrhythmics may be used
If unstable (hypotensive, chest pain, heart failure, syncope) immediate cardioversion is indicated

27
Q

Pre-eclampsia tx.

A

Referral to secondary care
Oral Labetalol
(Nifedipine if asthmatic)
Delivery is definitive management -> timing is situation dependent

28
Q

Acute asthma - Ix.

A

Clinical diagnosis
CXR to rule out infection and pneumothorax
ABGs - usually normal
Bloods and sputum cultures if evidence of infection

29
Q

ACS investigations:

A

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
Q

Acute LVF investigations:

A

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
Q

Ruptured AAA ix.

A

Bedside US if available
CT angiography

32
Q

Gallstones Ix.

A

LFTs
Abdomonal USS
CT for surgical planning

33
Q

CBD stone Mx.

A

IV hydration (prevent renal injury)
ERCP

34
Q

Acute pancreatitis Mx.

A

Supportive
NBM
IV hydration - 1L/4 hours (Hartmann’s)
IV antibiotics only if infection/free air on AXR
May need ICU

35
Q

Acute pancreatitis Ix.

A

Amylase/lipase
Abdominal USS (exclude other causes/ check for cause stones etc.)
CT if diagnostic uncertainty
LFTs derranged
Apache II/Glasgow scoring

36
Q

Acute mesenteric ischaemia Ix.

A

VBG: Increased Lactate
Abdominal CT
Angiography

4th year OSCE (39 decks)

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