Critical care Flashcards
GCS score
GCS score
Eye response
4: Spontaneously
3: to speech
2: to pain
1: none
Verbal response
5: oriented
4: confused
3: inappropriate
2: unintelligible
1: none
Motor response
6: obeys command
5: localizes to pain
4: withdraws from pain
3: flexion to pain
2: extension to pain
1: none
GCS 8 or lower
next step?
Admit to ICU for intubation
Electrolyte abnormality after massive blood transfusion? (massive =10 units of packed rbcs in 24 hrs/ one half of persons blood volume in 24 hrs)
- hypocalcemia (citrate toxicity)
- hypomagnesemia
- hyper/hypokalemia
Electrolyte abnormality after starting feed on a starved patient?
REFEEDING SYNDROME
- hypomagnesemia
- hypokalemia
- hypophosphatemia
MACHINE GUN KELLY PO
- worst headache of life/First time headache this severe
- acute
- occipital
- nausea/vomiting
- neck stiffness
- photophobia
Diagnosis and investigations?
SUBARACHNOID HEMORRHAGE
SOURCE: Berry aneurysm rupture
RISK FACTORS
- hypertension
- Ehler Danlos syndrome
- smoking
- AD polycystic kidney disease (increased chance of berry aneurysm)
1st step: CT head
2nd step: if CT inconclusive> Lumbar puncture after 12 hrs for xanthochromia
gold standard: cerebral angiography
MX
- Nimodipine to prevent cerebral vasospasm
- Platinum coiling to stop bleeding
- RTA
- seatbelt
- chest and abdominal pain
- gas bubbles in pleural cavity
- NG tube curled above hemidiaphragm
DIAPHRAGMATIC RUPTURE
Raised pulmonary capillary wedge pressure (normal: 6-12)
What type of shock?
CARDIOGENIC SHOCK
Swan Ganz catheter
- MDMA overdose
- muscle rigidity
- dilated pupils
- Hyperthermia (>40 degrees)
Management?
MX
- IV Dantrolene if >40 degrees
- IV diazepam or lorazepam for agitation
- Correct Metabolic acidosis.
- sickle cell disease
- hx of crises
- hx of pneumonia
- chest pain
- SOB
Diagnosis?
ACUTE CHEST SYNDROME
INVESTIGAYION
- CXR
- Oxygen levels
MX
- oxygen
- analgesia (morphine)
- IV fluids
- treat pneumonia (antibiotics)
- transfusion (hypoxic > simple, hgb more than 90/not improving > exchange transfusion)
crush injury > compartment syndrome
Mangement?
Fasciotomy
circumferential burn injury > compartment syndrome
Escharotomy
- radio radial delay
- stable
- hx of hypertension
- severe acute interscapular pain or chest pain that radiates to back
Diagnosis and Investigation?
THORACIC AORTIC DISSECTION
associated with Marfan’s and Ehler Danlos syndrome.
If stable > CT angiography (definitive)
If unstable > transesophageal echocardiogram
MX
IV labetalol
morphine
asthmatic patient with silent chest
Management?
Intubation and ventilation.
- DKA patient
- started on Iv fluids and insulin
- showing papilledema on fundoscopy
- and headache onset
Diagnosis and Management?
showing signs of cerebral edema
MX
mannitol infusion
- post lap surgery
- in recovery room
- fever
- hypotension
Diagnosis? what type of shock?
SEPTIC SHOCK
TCA overdose (amitriptyline)
Management?
MX
IV 50ml of 8.4% sodium bicarbonate
