critical illness Flashcards
how long should patients fast for elective surgery?
non clear liquids/ food 6 hours
clear liquids 2 hours
when do patients require laxatives before colonoscopy?
day before colonoscopy
how should TPN be administered?
central vein (eg subclavian) as strongly phlebitic
what change may be seen on the full blood count as a long-term result of COPD?
polycythaemia- increased haematocrit
what are signs of moderate acute asthma
PEFR 50-75% best or predicted
Speech normal
RR < 25 / min
Pulse < 110 bpm
what are signs of severe acute asthma
PEFR 33 - 50% best or predicted
Can’t complete sentences
RR > 25/min
Pulse > 110 bpm
what are signs of life threatening acute asthma
PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma
what is the management of acute asthma
A - air, 02
S - sabutamol
T = ipaTropium bromide (severe or life threatening)
H = hydrocortisone
M = magnesium sulphate
A - Aminophylline
causes of upper zone pul fibrosis
C- Coal worker’s pneumoconiosis
H - Histiocytosis/ hypersensitivity pneumonitis
A - Ankylosing spondylitis
R - Radiation
T - Tuberculosis
S - Silicosis/sarcoidosis
causes of lower zone pul fibrosis
idiopathic pulmonary fibrosis
most connective tissue disorders (except ankylosing spondylitis) e.g. SLE, RA
drug-induced: amiodarone, bleomycin, methotrexate
asbestosis
criteria for discharge following acute asthma
been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12-24 hours
inhaler technique checked and recorded
PEF >75% of best or predicted
The Resus Council UK define anaphylaxis as:
the sudden onset and rapid progression of symptoms
Airway and/or Breathing and/or Circulation problems- requires adrenaline
site of injection IM adrenaline?
anterolateral aspect of middle thigh
when is insertion of chest drain contraindicated?
INR > 1.3
Platelet count < 75
Pulmonary bullae
Pleural adhesions
what ph are NG tubes safe to use?
<5.5
what are shockable rhythms?
ventricular fibrillation/pulseless ventricular tachycardia (VF/pulseless VT)
what are non shockable rhythms?
asystole/pulseless-electrical activity (asystole/PEA)
when should nitrates be used with caution in ACS?
hypotension
what metabolic picture does OD in aspirin cause?
resp alkalosis (hyperventilation) then met acidosis ( metabolite salicylic acid)
2 side effects of gentamicin
nephrotoxic, ototoxic
when do you give IV magnesium?
<0.4, tetany, arrhythmias or seizures
what can lithium toxicity be precipitated by?
dehydration
renal failure
drugs: diuretics (especially thiazides), ACE i/ARB, NSAIDs and metronidazole.
criteria for liver transplant following paracetamol OD
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
