Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CP1 revision > Deck 8 > Flashcards

Deck 8 Flashcards

1
Q

Shock definition

A

Life threatening failure of oxygen delivery to tissues (leads to anaerobic respiration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Shock manifestations

A

Skin (

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Brain IC autoregulation

A

MAP 50-150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Kidney pressure autoregulation

A

MAP 70-170

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Hypovolaemic shock

A

Reduced preload, reduced EDV (low SV and CP impacted, so hypotension)
Compensation by tachycardia, vasoconstriction.

See cold peripheries, tachycardia, hypotension, hypovolaemia.

Haemorhagic is special type that needs RBCs an clotting factors as Tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How much blood lost until BP drops

A

Stage 3, 1500-2000mL loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Distributive shock tpyes

A

Sepsis, anaphylaxis, neurogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anaphylactic shock

A 
Distributive, but also hypovolaemic. T1HS. Histamine mediated vasodilation and pooling into interstiium.
Give adrenaline (0.5mg (0.5mL 1:1000), 10mh chlorphenamine and 200mg steroid) plus fluids as adrenaline wont reverse fluid movement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Septic shock

A

distributive and hypovolaemic.

If refractory to fluids then send to ITU for vasopressor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Neurogenic shock

A

Spinal injury above T6, leaving vagus unopposed.
Paradoxical bradycardia.
Needs fluid therapy (even though euvolaemic) and vasopressor + ionotropes and chronotopes (Adrenaline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Distributive shock signs

A

hypotension, shock signs, flushed complexion and warm peripheries. May have tachycardia, but bradycardia in neurogenic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cardiogenic shock

A

Can be post MI, arrythmias, bradycardia or CHF
Compensatory tachycardia and increased heart contraction. Hypotension, reduced urine, altered GCS and peripheral shutdown. May have fluid overload.

Tx with morphine (2.5mg-5mg for pain, anxiety, dyspnoea), assess fluid balance and give furosemide if pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Obstructive shock

A

Can be tension pneumothorax with mediastinal shift, PE, aortic dissection or cardiac tampoade.

SV impaired, hypotension occurs. Tachycardia and vasoconstriction. Fluid status may be normal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

All shock types have

A

hypotension, oliguria/anuria (AKI risk) and altered mental state)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

peripheral temp cool in shock with

A

All types, except distributive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Skin pale in shock?

A

Hypovolaemic and obstructive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Skin pale and clammy in ? shock

A

cardiogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Skin flushed in ? shock

A

distributive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Thready pulse in ? shock

A

hypovolaemia and cardiogenic (due to vasoconstriction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Rapid bounding pulse in ? shock

A

Septic shock (wide due to vasodilation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Urine monitoring in shock

A

hourly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

mast cell tryptase?

A

may test for this in anaphylactic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

sepsis

A

Life threatening response to injury which damages body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

NEWS2 for sepsis

A

5 or more triggers sepsis screen in presence of RF or concern from HCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Sepsis RF

A

Age extremes, impaired immunity, recent invasive procedure, broken skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Common causes of sepsis

A

pneumonia, UTIs, abdominal source, MSK endocarditis, meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Red flag sepsis criteria

A 
Evidence of altered mental state
Sys BP<90 (or 40 below normal)
HR >130
RR>25
Needs oxygen for min sats
Skin stigmata (rash, cyanosis, mottling)
Lactate >2
Recent chemo
Anuria for 8h/<0.5mL/kg/hr

If any ONE of these then sepsis 6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Amber sepsis criteria

A 
Concern over mental status
"off legs"
Immunosuppressed
Recent surgery/trauma
RR 21-24
BP 91-100
Temp <36
Clinical signs of wound infection

Any ONE of these triggers further review

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Septic shock diagnosis

A

Technically sepsis AND persistent hypotension, vasopressor to maintain MAP >65 and lactate >2
But vasopressor not available outside CC, so sepsis AND <90 despite fluid AND lactate >2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Escalation criteria for sepsis

A

Lactate >4, or SBP<90 or lactate/SBP abnormal despite 20mL/kg bolus after 1 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Management of septic shock

A

Broad spec Abx
500mL fluid bolus (up to 20mL/kg)
Take lactate, urine, blood culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Neutropoenic sepsis

A

Diagnosis is <0.5 10x9

Consider atypical infection sites (including perianal area, but do not perform PR )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Adrenaline dose for anaphylaxis

A

0.5mL of 1:1000 adrenaline (IM) - 0.3mL if <10.
10mg chlorphenamine by low IV infusion/IM
200mg hydrocortisone slow IV
Also give 15L oxygen, raise legs and give fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Causes of airway obstruction

A

CNS depression, physical obstruction, infection, inflammation, bronchospasm, laryngospasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Space for needle decompression in pneumothorax

A

4/5th IC space above rib with orange/greay cannula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Immediate acute asthma management

A 
OSHIT
Oxygen (15L)
Salbutamol
Hydrocortisol (IV, or oral pred)
Ipratropium (SAMA if salbutamol not working)
Theophylline (or aminophylline IV)

Can also give magnesium sulphate
Escalate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Medium concentration oxygen mask

A

35-80% at 5-8L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Nasal cannulae

A

24,28,32,36,40,44 at 1.5L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Venturi mask

A

Gives most accurate delivery

24,28,31,35,40,60% - valve dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Higher oxygen venturi

A

Green

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Medium oxygen venturi

A

Yellow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Low oxygen venturi

A

Blue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Circulation A_>E

A

BP, HR, fluid, clotting, ECG, blood test, cap reful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Management of ACS

A 
MONA
Morphine (5-10mg IV)
Oxygen
Aspirin (300mg, chewable)
Nitrate spray

Can also give beta blocker, reassurance,/clopidogrel, enoxaparin, statin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Hypoglycaemia symptoms

A

Pallor, headache, tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

If BM <4 and patient swallow ok

A

15-20g quick carb
60mL glucagon
2x tube of 40% glucose gel
Glucose tablets

Repeat BM after 15 mins, if <4 then repeat up to 3 cycles then escalate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

If >4 BM following hypo and able to swallow

A

20g long acting (2 biscuits or 1 slice bread, or carb meal)
Look for cause
Continue insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

If <4BM and not able to swallow

A

100mL 20% glucose IV over 15 mins
1mg IM glucagon
Repeat BM after 15 mins, if >4 then long acting carb. If not then 100mL 20% glucose 3x

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

DKA diagnosis and management

A

Glucose >11, ketones (blood >3, urine ++), acidotic or low bicarb

get dehydration, hypovolaemia, hyponatraemia, hyper/hypokalaemia

Give fluid (1L at initial, 1L/2h x2, 1L/4hx2, 1L/8h.
If K 3.5-5.5 then 40mmol/L/L
If <3.5 then senior review.

Give insulin infusion based on weight.

Give glucose once <14mmol/L (10%@125mL/h)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Severe DKA

A 
Ketone>6
pH <7.1
HCO3 <6
Anion gap >16
K<2.5
GCS<12
SPO2 <98
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

DKA complications

A

hypokalaemia, hypomagnesaemia, hypophosphataemia, cerebral oedema, cardiac arrythmias, aspiration pneumonia thromboembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Main ketones in DKA

A

acetone and 2 hydroxybutyric acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

HSS

A

BM>30, lack of Ketones, osmolarity 320+ (2Na+ glucose+ urea)

Gives fluid, generally more slowly
Give insulin once glucose reduction <5mmol/L/hour and then give 1/2 strength

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Primary Pneumothorax

A

No underlying lung disease, due to pleural blep rupture (often apical, CT defect at alveolar wall)
Think marfans and young males

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

RF for primary pneumothorax recurrance

A

60+, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Symptoms and signs of primary pneumothorax

A

Symptoms: minimal/absent, but sudden onset pleuritic pain and dyspnoea. If larger the pallor and tachycardia.
Signs are reduced chest expansion, hyperresonance on percussion, dimished breath sounds on auscultation.

57
Q

Secondary pneumothorax

A

Underlying lung disease (COPD, asthma, abscess, pumonary fibrosis)

More common 40+ and smoking

58
Q

RF for secondary pneumothorax reoccurance

A

age, emphysema , fibrosis

59
Q

Symptoms of secondary pneumothorax

A

Symptoms: more severe than primary, pleuritic, unilateral chest pain, dyspnoea. Pallor and tachycardia

60
Q

Tension pneumothorax symptoms

A

Tacheal deviation, hypomobility on affected side, cyanosis, severe tachyponoea, tachycardia, hypotension

Clinical diagnosis, decompress immediately

61
Q

RF for tension pneumothorax

A

Ventilated patient, truama patient, post CPR, acute asthma/COPD, blocked chest drain, hyperbaric oxygen Tx

62
Q

Pneumothorax size

A

50% volume lung takes 40 days to reabsorb.

2cm interpleural distance at hilum is 50% volume

63
Q

Pneumothorax management

A

If primary and young/fit, <2cm then consider disacharge with outpatient FU
IF >2cm and dyspnoea then aspirate

If secondary, over 50, smoking Gx or lung disease then admit all
If <1cm then oxygen and obs
1-2: aspirate and admit
>2cm and dyspnoea then chest drain

Further Tx with chemical pleurodesis/thoractomoy

64
Q

Safety net for pneumothorax discharge

A

smoking cessation, no air travel for 6 weeks, no scuba ever

65
Q

Upper GI bleed definition

A

Proximal to ligament of treitz (duodenal/jejunal flexure)

66
Q

Upper GI bleed Ddx

A

peptic ulcer, varicoel bleed, oesophagitis (GERD or candida), Mallory Weiss tear (epithelial tear), Boerhaave’s syndrome (transmural), upper GI malignancy, aortoenteric fistula, AV malformation, Dieulafoy’s lesions (abnormally large blood vessel)

67
Q

Key questions in upper GI bleed

A

blood colour, bolume, clots, retching syncope, pain, bowel symptoms, B lymphomts, surgical Hx, ulcer risk, liver damage drugs, smoking, alcohol, tattoos, liver disease

68
Q

Melaena

A

Black tarry stools. acute upper GI bleed or sometimes small bowel/right colon

69
Q

Coffee groundvomit

A

Digested, so ceased or mild bleed

70
Q

Imaging for ulcers

A

CXR if ? perforation
FBC, u&E, LFT, clotting screen, G&S, VBG
OGD within 24h of acute haematemesis +CT abdo with contrast if active beel in unstable patient

71
Q

Glasgow Blachtford bleeding score

A

Hb, urea, systolic BP, clinical features (HR, melaena, syncope), clinical features (HF, liver disease)
6+ needs intervention
1+ needs encoscopy

72
Q

Rockall score

A

rebleed risk post endoscopy

Looks at age, shock, comorbidities,, endoscopic findings and predicts risk

73
Q

Most common peptic ulcer

A

Duodenum

74
Q

Peptic ulcer that bleeds more

A

gastric

75
Q

Which ulcer worse after earing

A

gastric, duodenal tend to be less painful after eating, moreso 2-4 h later

76
Q

Oesophageal varices management

A

Endoscopy
If unstable then theatre
Give prophylactic Abx due to sepsis risk
Give terlipressin to reduce poortal HTN

77
Q

Lower GI bleed definition

A

distal to ligament of treitz

78
Q

Types of bleed

A

Occult (FIT screen, IDA)
Mod rectal bleed (PR bleed/melaena in haemodynamically stable)
Severe bleed (hypotension and hct drop)

79
Q

Common lower GI bleed in <30

A

haemorrhoids, anal fissure, IBD

80
Q

> 50 lower GI bleed common causes

A

? colorectal cancer, divetircular disease

81
Q

> 65 lower GI bleed

A

Angiodyplasia, diverticular disease

82
Q

Angiodysplasia

A

Acquired
Submucosal AV malformations
Aortic stenosis association (and other valve disease

Commonly presents as IDA (occult loss). Often painless, bried, brisk loss

83
Q

Blood mixed with stool

A

suggests proximal to sigmoid to allow mixing time

84
Q

Blood on stool surface

A

Suggests sigmoid or rectal source

85
Q

Blood after stool

A

Suggests anal cause

86
Q

Blood only on paper

A

suggests fissure

87
Q

Blood lone, no stool

A

Large bleed that’s stimulated bowel

88
Q

paracetamol OD presentation

A

N&V, RUQ pain, jaundice

89
Q

Benzo OD presentation

A

CNS depression, ataxia, slurred speech, resp depression

90
Q

opioid OD presentation

A

resp depression, pin point pupil, coma

91
Q

Alcohol intoxication presentation

A

slurred speech, ataxia, vomiting

92
Q

Investigations in OD/tox

A

physical obs and exam (esp neuro), ABG/VBG, ECG, baseline bloods (renal and hepatic), serum level

93
Q

Alcohol effects due to

A

GABA and 5HT actions

94
Q

Alcohol withdrawal

A

Seen in people >20 units/ day

Chlordiazepoxide plus vit D and thiamine

95
Q

Wernicke’s

A

B1 (thiamine) deficiency. Ataxia, ophthalmoplegia, new onset confusion

96
Q

Korsakoff’s

A

Irreversible brain damage on background of Wernicke’s. Anterograde amnesia, confabulation, personality change

97
Q

paracetamol toxicity mechanism

A

saturated glucuraonide conjugation (N acetyl p benziquinoneimine builds up)
N&V initially.
Then loin pain, vomiting, jaundice, abod pain, hypotension, hypoglycaemia, pancreatitis arrythmias

Tx with acetylcysteine (or activated charcoal if recent ingestion)
Use paracetamol level (post 4h - Note LFT wont show damage until 18h) for dose.
Psychiatric assessment once stable

98
Q

acetycysteine side effects

A

rash, oedema, hypotension, bronchospasm - manage with IV chlorphenamine

99
Q

OD assess,emt

A

current state, events prior to OD, planning, concealment, substance abuse at time, access to means for repeat

100
Q

Self harm RF

A

Men at 25-34, women at 15-24, personality disorder, drug/alcohol abuse

101
Q

Suicide RF

A

psychiatric illness, statement of intent, access to means, Hx of self harm/violence, FHx self harm/suicide, significant life events, painful physical illness, impulsive personality, male, older age, post partum psychosis

102
Q

High risk/low risk suicide

A

low risk is first attempt, impulsive, non violent, relieved at rescue, unsure of outcome
High risk is concealment, notes, violent means, previous attempts

103
Q

% of body weight that’s water

A

60 (55 in women)

104
Q

Proportion of body water intra/extracellular

A

2/3s intracellular, 1/3 extracellular

105
Q

% of extracellular water that’s intravascular/interstitial

A

25% intravascular, 75% interstitial

106
Q

Hydrostatic pressure gradient causes

A

circulatory pressure, oedema, mechanical restrictions (plaster cast, infection, bandaging)

107
Q

Neonate/children water %

A

70-80%

108
Q

Metabolic fluid

A

400mL/day (often not counter for fluid balance)

109
Q

Average adult fluid needs

A

2-2.5L

110
Q

Adult daily insensible loss

A

500-800mL

111
Q

Guideline for IV fluid (NICE)

A

25-30mL/kg/day (around 2L)

112
Q

Electrolyte need/day (NICE)

A

1mmol/kg/day Na/Cl/K (~70mmol)

113
Q

Glucose need per day in fluid (NICE)

A

50-100g/day glucose (limits ketosis)

114
Q

GI losses /day

A

100mL/day (more in GI upset)

115
Q

Minimum obligatory urine production

A

0.5mL/kg/hr (~840mL/day)

116
Q

Typical ward fluid regime

A

1L saline with 20mmol KCl/8h

1L 5% dextrose with 20mmolKCl/8h x 2

117
Q

Sweating electrolyte

A

sodium

118
Q

Diarrhoea electrolyte loss

A

sodium, potassium, bicarb

119
Q

vomiting electrolyte loss

A

potassium, chloride, hydrogen

120
Q

Urine output suggestive of dehydration

A

<1mL/kg/hour

121
Q

Hypervolaemia symptoms

A

cough, frothy sputum, fluid in serous cavities, HTN, peripheral oedema, pulmonary oedema, dyspnoea, raised JVP, S3/S4 , tachycardia

122
Q

Hypovolaemia symptoms

A

headache, absent/low JVP, decreased skin turgor, dry mucous membrane, low BP, oliguria/anuria, orthostatic hypotension, peripheral shutdown, prolonged cap refil, shock.
Urine output below 1mL/kg/hour suggests dehydration.

123
Q

Isotonic fluid (crystalloid) properties

A

0.9%NaCl stays in EC space

124
Q

Hypertonic fluid

A

e.g. 3% NaCl/mannitol draws fliud out

125
Q

Hypotonic fluid

A

e.g. 0.45% NaCl lowers serum osmolarity

126
Q

Properties of 0.9%NaCl

A

154mmol Na and 154 mmol Cl

25% ditributes intravascular, 75% interstitial. so in 1L, 250mL intravascular

127
Q

Glucose solution properties

A

Generally 5% (50g/L). ISomolar with plasma. 2/3s intracellular, 1/3 extracellular. Only 8% stays IV

128
Q

Colloids

A

Blood, dextrans, gelatin, human albumin HES.

Draws fluid into IV compartment. Higher cost, anaphylaxis risk

129
Q

NICE colloid recommendation

A

4-5% human albumin only in severe sepsis. 20% should not be used as too rapid.

130
Q

4Ds of fluid therapy

A

drug, dose, duration, de-escalation

131
Q

Fluid therapy initiating

A 
Sys<100
HR>90
CAP>2s/cold peripheries
RR>20
NEWs5+
Passive leg raise suggests fluid responsiveness

Giv e 500mL 0.9%NaCl in 15 mins.

132
Q

Tx in fluid overload

A

Stop fluids
furosemide
sublingual nitrate (reduce preload)
IV nitrates (reduces pre and afterload but needs BP monitoring)
CPAP (improves gas exchange and recruits collapsed alveoli - needs critical care)

133
Q

Blood transfusion

A

ID checks crucial
Verbal consent
Administer 1.5-2h/unit
FFP at 30mins/unit

134
Q

Hypertensive emergency

Signs

A

Papilloedema on fundoscopy
May show enlarged blind spot in visual field test
May see retinal haemorrhage

135
Q

Hypertensive emergency investigation

A 
FBC
U&E (renal function)
Glucose level
Cholesterol profile
LFT
Calcium (?PTH)
cortisol +/- dex suppression
Renin/aldosterone
urine protein:creatinine ratio
Urine metanpehrrines (?phaeochromocytoma)
imaging (ecg, echo, USS, CT, MRI, MRA)
136
Q

Malignant HTN pathology

A
  • Cerebral infarction, IC haemorrhage, subarachnoid haemorrhage
    • MI, HF, AAA
    • Acute renal failure
      Retinopathy
137
Q

Cardiac arrest protocol:: shockable

A

VF/VT
1 shock, CPR for 2 mins
After 3 shocks, 10mL 1:10000 IV adrenaline, 300mg amiodarone
Repeat adrenaline 3-5 mins

138
Q

Non shockable Cardiac arrest

A

10mL 1:10000IV adrenaline

30:2 CPR

139
Q

Reversible causes of cardiac arrest

A

Toxins
Tamponade
Tension pneumothorax
Thombosis (coronary or pulmonary)

Hypoxia
Hypovolaemia
Hypothermia (note that hypothermia inhibits clotting factors)
Hyperkalaemia/hypokalaemia

CP1 revision (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions