Deck 1 Flashcards
Endocrine function of pancreas
Alpha: glucagon
Beta: insulin
Delta: somatostatin
PP: pancreatic polypeptide
What is trypsin’s function and how is it activated
Produced by pancreas as trypsinogen
Proteolytic enzyme
Activated by enterokinase enzyme in duodenum
How does pancreatitis lead to hyperglycaemia
destruction of beta cells of langerhans
no insulin
Acid-base balance formula
Henderson-Hasselbach equation
pH= pKa + log ([HCO3]/[PCO2*0.03])
pKa = acid dissociation constant
Anion gap
= (Na + K) - (HCO3 +Cl)
Difference between plasma cations and anions
Normal range of anion gap
4 - 12
What does an increased in anion gap mean
External acid:
- ketones
- poisoning (salicylate)
- lactate
- Kidney failure
(Bicarb consumed by unmeasured acid, leaving a big anion gap)
What is a buffer
Weak acid + conjugate base
or
Weak base + conjugate acid
Resists change in pH
What are buffers in blood
Bicarbonate
Haemoglobin
Causes of metabolic acidosis
Normal anion gap (loss of bircarb)
- diarrhoea
- ileostomy
- tubular damage
Increased anion gap (gain of acid)
- ketones (starvation or diabetes)
- lactate (sepsis)
- poisoning (salicylate)
Causes of metabolic alkalosis
- vomiting
- renal loss of H+
- low chloride state
Causes of resp acidosis
- pneumonia
- ARDS
- Neuro: guillian barre
Causes of resp alkalosis
- hyperventilation
- anxiety
- altitude
Mx of high K
- calcium glucanate 10 mls of 10%
- insulin (10u actrapid) + 50mls 50% dextrose
- Salbutamol nebs
- Resonium
Normal urine output for a child and adult
Adult: 0.5 ml/kg/hr
Child: 1ml/kg/hr
Causes of acute limb ischaemia
Atherosclerosis -> thrombosis
Embolic (secondary to AF)
Rutherford classification of acute limb ischaemia
I: not immediately threatened
IIa: salvageable if prompt rx
IIb: salvageable if immediate rx
III: amputation
Definitive mx of acute limb ischaemia
Embolic: embolectomy
Thrombotic: thrombolysis or bypass graft
What makes a pneumonia HAP and not CAP
HAP: develops after 48hrs post admissi
Early onset vs late onset HAP bacterial causes
Early onset (less than 5 days in hospital): Strep pneumonia
Late onset (>5d)
- MRSA
- pseudomonas
Causes of ARDS
Primary lung cause:
- pneumonia/COVID
- contusion
- aspiration
Secondary:
- Pancreatitis
- sepsis
- Polytrauma
Mx of ARDS
- supportive + rx cause
- Mech ventilation
High PEEP to keep alveoli open on expiration - Prone ventilation
Improves V/Q mismatch
Minimises basal atelectasis
Redistributes secretions - Steroids
Mx of ARDS
- supportive + rx cause
- Mech ventilation
High PEEP to keep alveoli open on expiration - Prone ventilation
Improves V/Q mismatch
Minimises basal atelectasis
Redistributes secretions - Steroids
Prognosis of ARDS
30-60 % mortality
90% when associated with sepsis
Indications for surgical airway
- Failed intubation
- Laryngeal trauma: #
- Upper airway obstruction
CIs to patient controlled analgesia
Delirium/cognitive impairment
They need to understand how to use
Indications for patient controlled analgasia
Pancreatitis
Major ops
Non medication examples of anasthesia
Splinting
Hot/cold packs
Acupuncture
TENS (transcutaneous electrical nerve stimulation)
Risk factors for Chronic post-surgical pain
Pre-op pain Intra-op nerve injury Post-op SEVERE pain Long ops Chemo/radiotherapy
Allodynia
Sensation of pain in presence of non-painful stimuli
Neuropathic pain def
Means of achieving rhythm control in AF
Pharmacological
Electrical cardioversion
Ablation
Indications for electrical cardioversion
Acute AF (within 48hrs) and hemodynamic instability
Elective to new-onset AF
Scoring system for bleeding/stroke for AF
CHADSVAsc: risk of ischaemic stroke
ORBIT: risk of bleeding
If chadsvasc 2 or more and orbit ok, give anticoagulation
Dysentery def
Diarrhoea with blood caused by infection
Common cause of dysentery in the UK
Shigella
Abroad could be amoeba
Differentials for bloody diarrhoea in 25yo
IBD Dysentery Gastroenteritis (o157 serotype of Ecoli) Malignancy Haemorrhoids
Pharmacological options for Crohns?UC
Steroids Mesalamine Azathioprine Methotrexate Infliximab
Reversible causes of coma
Hypothermia
Hypoglycaemia
Hypovolaemia
Electrolyte disturbance (Na, Ca, Mg)
Reversible causes of apnoea
C-spine injury
Guillian Barre syndrome
How to do apnoea test
- oxygenate pt
- hypoventilate till PCO2>6.0
- continue oxygenating but not ventilating. if PCO2 rises by 0.5 then confirms that there is loss of respiratory drive
Absolute CIs for organ donation
CJD
HIV associated illness eg AIDS
Superficial epidermal
Red
Pain
Normal texture
Blanching and refilling capillary
Superficial dermal burn fx
Pink skin
Normal texture
Painful
Blanching and slowly refilling capillary
Blisters present
Assessing extent of burn
Wallace’s rule of 9
Lund & Browder charts
Patient’s hand = 1 %
IV fluid regimen in resus in burns
Heat: 2ml * kg * TBA
Electrical: 4ml* kg* TBA
Give first half in 8hrs, rest over 16hrs
Indication for IV resus for burn pts
adults > 15% TBA
children > 10% TBA
Indications for referral to burns unit
Circumferrential Children > 5% adults >10% Under 5yo or over 60 yo Electric/chemical Inhalation
Mount Vernon formula
(TBA % * kg) /2
fluid needed over the first 36 hrs
GIve the above volume at the following intervals
4,4,4,6,6,12
Deep dermal burn fx
mottled/red
Non-blanching capillary
Slightly painful
Normal skin texture
Full thickness burn fx
White
Leathery/waxy
Pale nonblancing
Painless
