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MRCS-Critical care > Deck 4 > Flashcards

Deck 4 Flashcards

1
Q

What counts as fully immunised for tetanus

A

5 doses

3 in the first months
2 boosters

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2
Q

What type bacteria is tetanus

A

Gram postive
Spore forming
Anaerobe

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3
Q

Necrotising fascitis mortality

A

30%

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4
Q

What drug used to support circulation during cardiogenic shock

A

Dobutamine

B1 increase contractility
B2 vasodilates, reducing peripheral resistance

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5
Q

What drug used to support circulation in septic shock

A

Norad

A1 -> vasoconstriction

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6
Q

How to calculate MAP without BP

A

(CO * SVR) + CVP

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7
Q

Hartmanns composition

A

Na 130
Cl 110
K 5
HCO3 29

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8
Q

Saline composition

A

150 Na

150 Cl

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9
Q

How much of a 1 L bag of saline remains intravascular

A

250mls

2/3 intracellular, 20% of extracellular stays intravascular

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10
Q

How much of 5% dextrose remains intravascular

A

85mls

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11
Q

Minute ventilation

A

Tidal volume = 7ml/kg

Minute ventilation = RR * tidal volume

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12
Q

Complications of ventilation

A

Immediate: trauma to airway and teeth
Early: Barotrauma eg pneumothorax
Late: Ventilator associated pneumonia, atrophy

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13
Q

When to wean someone off ventilator

A

Resolution of injury
Adequate oxygenation
Adequate resp drive

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14
Q

Cardiac output formula

A

HR * SV

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15
Q

Def of cardiogenic shock

A

Inadequate tissue perfusion due to cardiac dysfunction

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16
Q

How does Cardioplegic solution work

A

High amount of K
Ice cold solution
Depolarises the myoctes, doesnt allow repolarisation

Stops cardiac activity and metabolism

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17
Q

Effect of massive infusion of normal saline

A

Dilution of serum bicarb -> metabolic acidosis

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18
Q

Pre-op RFs for AF

A

Age
CVS disease
Alcohol

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19
Q

Post op RFs for AF

A

Sepsis
Hyoivolaemia
Hypoxia

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20
Q

Triad of acute mesenteric ischaemia

A

BG of AF
Sudden onset abdo pain
Diarrhoea/vomiting or both

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21
Q

Why femoral vein not used commonly for a central line

A

Increased risk of thrombosis and infection

21
Q

Why femoral vein not used commonly for a central line

A

Increased risk of thrombosis and infection

22
Q

How to remove central line

A
  1. check clotting and platelets
  2. Patient flat or head down (to avoid air embolus)
  3. Removal of suture and pulling.

If tunnelled, may need removal in theatre.
Tip cut off and sent to micro

22
Q

How to remove central line

A
  1. check clotting and platelets
  2. Patient flat or head down (to avoid air embolus)
  3. Removal of suture and pulling.

If tunnelled, may need removal in theatre.
Tip cut off and sent to micro

23
Ischaemia def
Hypoxia or anoxia causing a reduction in oxygenation of tissue
24
Percentage of reinfarction if major op performed within 1 month of MI
30%
25
Percentage of re-infarction if major surgery performed after 6 months post op
5%
26
Clopidogrel mech of action
Antiplatelet | Inhibits ADP receptor on platelet cell membrane reducing platelet aggregation
27
Aspirin mech of action
Inhibits Cox1 | Stops prostoglandin release which otherwise would be converted to thromboxane, causing platelet aggregation
28
COX 2 inhibition effect
Analgesia Anti-inflam Anti-pyretic
29
Blood loss percentage increase in patients with single or dual antiplatelets
15% single agent | 30% dual agent
29
Blood loss percentage increase in patients with single or dual antiplatelets
15% single agent | 30% dual agent
30
Intra-op techniques to minimise blood loss
- cell saver - tourniquets - Physiological hypotension
31
Systemic SEs of NSAIDs
GI: dyspepsia, ulcer Renal: AKI CVS: salt and water retention Coagulopathy
31
Systemic SEs of NSAIDs
GI: dyspepsia, ulcer Renal: AKI CVS: salt and water retention Coagulopathy
32
RFs for nec fascitiis
Age DM Immunocompromised Obesity
33
Causes of necrotising fascitis
T1- polymicrobial including s aureus T2- monomicrobial eg strep pyogenes T3- monomicrobial C perferinges T4- fungal - candida
34
Score for severity of nec fasciitis
LRINEC Lab risk indicator for nec fasciitis
35
Metabolic response to injury
Ebb: everything slows down, hypothermia, low CO, decreased energy expenditure Flow: Catabolic: protein and fat broken down, wt loss Anabolic: increase in protein and fat storage, wt gain
36
Respiratory quotient
Ratio of CO2 produced to O2 consumed. Determines what cells are using during metabolism Carbs 1 Protein 0.9 Fat 0.7
37
NJ compare to NG tube
NJ: +s = Avoids reflux -s = smaller, kinks more easily, needs endoscopic placement (delays feeding)
37
NJ compare to NG tube
NJ: +s = Avoids reflux -s = smaller, kinks more easily, needs endoscopic placement (delays feeding)
38
Typical Patient controlled anaesthetic dose and setting
diamorphine 0.5 mg | Lock out period 5 minutes
39
What dose of nalaxone to give
0.4mg repeat every 2-3 mins | Max dose of 10mg
40
What anaesthetic used in epidural
LA: bupivacaine or lidocaine + Opiate: fentanyl
41
Methods of drainage of pancreatic pseudocyst
Imaging guided percutaneous drainage Endoscopic drainage through posterior wall Open pseudocyst-gastrostomy or jejunostomy
42
How long for pancreatic pseudocysts to develop
at least 4 wks Should wait for 6-12 weeks before drainage in case self resolves (50% of cases)
43
Young and Bergess classification use
Pelvic fractures
44
Young and Bergess classification components
1. Anterior-posterior compression (front to back force ->open book) 2. Lateral compression 3. Vertical shear: fall from height. Hemipelvis displaced superiorly
45
Burgess and Young classification components
1. anterior posterior (open book) 2. Lateral compression 3. vertical shear: fall from height. hemipelvis displacement
46
Where should pelvic binder be applied
at greater trochanter level
47
How to control haemarrhage secondary to pelvic fracture
1. pelvic binder 2. IR 3. preperitoneal packing

MRCS-Critical care (10 decks)

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