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MRCS-Critical care > Deck 5 > Flashcards

Deck 5 Flashcards

1
Q

Lethal triad of trauma

A

Coagulopathy
Acidosis
Hypothermia

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2
Q

Flail chest def

A

Fractures of 2 ribs in 2 or more places creates free section of thoracic wall

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3
Q

Causes of T2 resp failure

A

Untreated T1 resp failure eg pneumothorax/contusion

Central cause: head injury

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4
Q

Where does furosemide work

A

Ascending loop of Henle

Blocks Na/K channel

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5
Q

How does hyponatraemia cause confusion

A

Low Na leads to cerebral oedema

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6
Q

SIRS criteria

A

RR>20
HR>90
WCC 4> or >12
Temp 36> or >38

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6
Q

SIRS criteria

A

RR>20
HR>90
WCC 4> or >12
Temp 36> or >38

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7
Q

Causes of post temp

A

Water Wind Walk Wound Weird drugs

UTI
Atelectasis or pneumonia
DVT or PE
Wound or deeper infection (leak)
Drugs: haloperidol and
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8
Q

Voltgage criteria for left ventricular hypertrophy on ECG

A

R > = 7 small squares (35mm) in V5/6

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9
Q

Where do thiazides work

A

Proximal part of distal convoluted tubule

Blocks Na/Cl symporter

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10
Q

Where does spironolactone work

A

Distal part of distal convoluted tubule
Blocks Na/K exchange pump

Leads to Hyperkalaemia

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11
Q

What is sedation

A

Altered conciousness +/- analgesia +/- decreased anxiety

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12
Q

Difference between Light, deep sedation and GA

A

Light:

  • maintains airway
  • responds to stimuli
  • anxyiolytic

Deep:

  • airway not necessarily patent
  • responds on repeated painful stimuli

GA:

  • not rousable
  • airway not protected
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13
Q

What sedation used for joint reduction

A

Light sedation

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14
Q

Indications for sedation

A
  • Reduction of fractures
  • nervous patient undergoing imaging
  • endoscopy
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14
Q

Indications for sedation

A
  • Reduction of fractures
  • nervous patient undergoing imaging
  • endoscopy
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15
Q

CIs to sedation

A
  • Unstable pt
  • refusal
  • long procedure
  • not appropriately starved (NBM 2/6)
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16
Q

Complications of sedation

A

Early:

  • respiratory depression
  • anaphylaxis to meds
  • hypotension

Later:
- aspiration pneumonia

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16
Q

Complications of sedation

A

Early:

  • respiratory depression
  • anaphylaxis to meds
  • hypotension

Later:
- aspiration pneumonia

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17
Q

Drugs used in sedation

A

Benzo: midazolam
Opiate: morphine
Gas: NO

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18
Q

Reversal of benzos

A

Flumezanil

Often not given as precipitates seizures (instead supportive measure waiting for it to wear off)

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19
Q

When safe to discharge home post sedation

A
  1. obs back to baseline
  2. motor and mental function back to baseline
  3. E+D ok
  4. Collected by responsible adult
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20
Q

Septic shock anaesthetic definition with numbers

A

Sepsis and BOTH

  • persistant hypotension requiring vassopressor to maintain MAP>65mmHg
  • Lactate >2 despite volume resus
21
Q

Difference in presentation of septic shock and hypovolaemic shock

A

Septic:
- warm red peripheries (vasodilation_

Hypovolaemic
- cool clammy peripheries

22
Q

Shock definition

A

Inadequate tissue perfusion to meet metabolic requirements

23
Q

Potential blood loss in tibia, humerus, femur, pelvis

A

Tibia/humerus: 750ml

Femur: 1.5

Pelvis: all circulating volume

24
Q

Stages of haemorrhagic shock (obs)

25
Q

Transfusion protocol in haemorrhagic trauma case

A
  1. Pack A (volume replacement) and Pack B (RBC, FFP, Platelets)
  2. Other trusts:
    RBC:FFP:Platelets 1:1:1 ratio
25
Q

Transfusion protocol in haemorrhagic trauma case

A
  1. Pack A (volume replacement) and Pack B (RBC, FFP, Platelets)
  2. Other trusts:
    RBC:FFP:Platelets 1:1:1 ratio
26
Q

Different types of shock

A
  1. Hypovolaemic
  2. Obstructive
  3. Cardiogenic
  4. Distributive
27
Q

Examples of obstructive shock

A

PE
Tamponade
Tension pneumothorax

28
Q

Examples of cardiogenic shock

A

MI

Arrhythmia

29
Q

Examples of distributive shock

A

Neurogenic
Anaphylaxis
Septic

29
Q

Examples of distributive shock

A

Neurogenic
Anaphylaxis
Septic

30
Q

Triggers for release of aldosterone

A

Angiotensin II
Low sodium
High K

31
Q

Sx of Addisonian crisis

A

Abdo pain
N+V
Shock
Hyper/hypothermia

32
Q

Primary causes of addisonian crisis

A

Addisons disease (low cortisol supply cannot meet body requirements) can lead to acute crisis

33
Q

Secondary cause of addisonian crisis

A

Sudden stopping of steroids tablets
Not doubling the dose in stress (trauma, operation, infection)

Both caused by body not being able to suddenly increase its production of cortisol

34
Q

Mx addisonian crisis

A

IV steroids
IV fluids
Replacement of electrolytes

35
Q

Prevention of addisonian crisis in pt undergoing operation

A

Bolus IV hydrocortisone 100mg on induction
Infusion of IV hydrocortisone 200mg/24hr until patient can eat and take tablets
Double the routine dose of oral

Tapper down to normal dose at later date

36
Q

Day case criteria

A

Social:

  • live within reasonable distance
  • responsible adult

Medical:

  • good pre-op performance status
  • no unstable medical conditions

Surgical:

  • short op
  • no serious complication requiring immediate attention
  • post op mobilisation
36
Q

Day case criteria

A

Social:

  • live within reasonable distance
  • responsible adult

Medical:

  • good pre-op performance status
  • no unstable medical conditions

Surgical:

  • short op
  • no serious complication requiring immediate attention
  • post op mobilisation
37
Q

LEMON assessment of difficult intubation

A

Look: short neck, facial trauma
Evaluate 3-3-2 rule
Mallampati score
Obstruction: epiglotitis, tonsillar oabscess, trauma
Neck mobility: c-spine injury, rheumatoid

38
Q

3-3-2 rule for intubation

A

Incisors: 3 fingers fit between
Hyoid and chin: 3 fingers
Thyroid notch and floor of mouth: 2 fingers

39
Q

Referral to coroner criteria

A
  1. death within 24hrs of admission
  2. suspicious accidental death
  3. after an operation or procedure
  4. unknown cause
40
Q

Content of emergency tracheostomy box

A
  • Tracheostomy tube of same size and one size smaller
  • spare inner tubes
  • resus bag and mask
  • suction
  • 0.9% saline + syringe
  • scissors, tape
41
Q

System to manage desaturating pt with Tracheostomy

A
  1. call anaesthetist
  2. remove vocal cap/valve
  3. remove inner tube
  4. apply intratracheal suction
  5. deflate cuff
  6. remove tracheostomy and oxygenate
42
Q

What does FFP include

A

Albumin
All clotting factors
Fibrinogen
vWF

43
Q

What does cryoprecipitate include

A

Factor 8 and 13

vWF

43
Q

What does cryoprecipitate include

A

Factor 8 and 13

vWF

44
Q

Causes of gastric outlet obstruction

A

Benign: pyloric stenosis due to stricture, ulcer, foreign body

Malignant:

  • gastric ca
  • pancreatic, duodenal Ca
45
Q

Electrolyte abnormalities seen due to vomiting

A

Metabolic alkalosis (loss of H+ and Cl)

Low K (increased aldosterone to restore volume leads to low K)

46
Q

Sx of low K

A

myalgia
Weakness
Cramps

47
Q

ECG changes in low K

A

Prolonged PR
U wave
Flattened T wave

48
Q

ECG changes in low K

A

Prolonged PR
U wave
Flattened T wave

MRCS-Critical care (10 decks)

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