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FFICM PREP > Definitions > Flashcards

Definitions Flashcards

1
Q

Definition of cardiogenic shock

A

Syndrome of life threatening tissue hypoperfusion due to inadequate cardiac output from primary cardiac dysfunction. (Cold and wet vs warm and dry etc)

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2
Q

What is sepsis?

A

Life threatening organ dysfunction caused by dysregulated host response to infection

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3
Q

What is haemolytic uraemic syndrome

A

Triad of
- microangiopathic haemolytic anaemia
- thrombocytopenia
- renal failure

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4
Q

What is thrombotic thrombocytopaenic purpura?

A

5 signs
- thrombocytopenia
- MAHA
- fluctuating neurological signs
- renal impairment
- fever

DIC is late ominous sign

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5
Q

Major incident

A

Any occurrence that presents serious threat to the health of the community or causes such number of casualties that special arrangements will be required

Big bang
Rising tide
Cloud on the horizon
Headline news

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6
Q

Command and control systems in major incident

A

Strategic command - gold (big picture objectives)
Tactical - silver (planning and coordination)
Operational - bronze (management of hands on work )

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7
Q

What is the pulmonary interstitium?

A

Alveolar interstitium
Capillary interstitium
Basement membrane
Perivascular tissue
Perilymphatic tissue

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8
Q

Anaphylaxis

A

World allergy organisation
- Serious systemic hypersensitivity reaction
- usually rapid onset
- can cause death

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9
Q

Severity of COPD

A

GOLD stage (%predicted FEV1)

Mild >80
Moderate 50-80
Severe 30-50
Very severe <30

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10
Q

Portal hypertension

A

Hepatic venous pressure gradient
- mild 5-10
- clinically significant above 10

Causes ascites, varies and decompensated cirrhosis

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11
Q

Hepato-renal syndrome clinical criteria

A
  • Diagnosis of cirrhosis and ascites
  • Diagnosis of AKI
  • No response to 2 consecutive days of diuretic withdrawal and plasma expansion with albumin
  • Absence of shock
  • No current/recent nephrotoxic drugs
  • No macroscopic signs of structural renal injury (proteinuria, microhaematuria, renal US)
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12
Q

DKA criteria

A

BM >11
Ketones >3
pH <7.3 / bicarbonate <15

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13
Q

Severe DKA

A

B: spo2 <92%
C: systolic by <100 / HR >100 or <60
D: GCS <12
F: ketones >6
pH <7.1
Bicarbonate < 5
K< 3.5 on admission
Anion gap. >16

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14
Q

Hyperglycaemic hyperosmolar state

A

Complication of type 2 diabetes

  • Hyperglycaemia >30 (no ketones, no acidosis)
  • hypovolaemia
    Serum osmolality >320 (2x Na + urea + glucose)
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15
Q

Immersion vs submersion

A

Immersion = airway above surface
Submersion = whole body below surface including airway

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16
Q

Drowning

A

Process by which immersion or submersion in a liquid medium results in primary respiratory impairment

17
Q

Stages of cold water shock

A

Cold shock: thermoreceptors sense cooling and act to increase cardiac output
- tachypnoea, inhalational gasp, tachycardia and vasoconstriction
- risk of decompensating existing cardiovascular disease

Short term immersion leading to cooling, poor nerve conduction and swimming failure

Long term immersion causing hypothermia, ataxia, shivering, dysarthria, amnesia

Circumrescue collapse
- cold diuresis and loss of hydrostatic squeeze so should be rescued supine
- sympathetic slump due to reduced catecholamine
- core after drop with cold blood recirculating causing arrhythmias

18
Q

Osmolality

A

Number of moles per kg of solvent

19
Q

Osmolalrity

A

Osmoses per litre of solution

20
Q

Osmotic pressure

A

Pressure required to prevent movement of solvent molecules by osmosis across a semipermeable membrane

21
Q

Cushing’s syndrome

A

High steroid levels causing
- moon face, obesity and hirsutism
- diabetes and hypertension
- osteoporosis and pancreatitis

Can be from exogenous steroid use

22
Q

Conn’s syndrome

A

Primary hyperaldosteronism
- adrenal hyperplasia or aldosterone secreting adenoma

Causing hypokalaemia, hypernatraemia, muscle weakness and hypertension

23
Q

Anaphylaxis

A

Serious allergic reaction that is rapid in action and may cause death.

Life threatening airway / breathing / circulatory symptoms

24
Q

Vitamin K dependent clotting factors

A

2, 7, 9 & 10

Plus the anticoagulants protein C and protein S

25
Q

DIC

A

Clinical features and supportive lab tests

PT >15s
APTT raised
Fibrinogen level low
Low platelet count
High D-Dimer

Blood film may show red cell fragments in microangiopathic haemolytic anaemias

26
Q

Refeeding syndrome

A

Potentially life threatening syndrome of metabolic disturbance characterised by electrolyte and fluid shift upon reintroduction of feeding after a period of starvation

27
Q

Principles of consent

A

1) It is entirely voluntary
2) All relevant information has been provided to facilitate the decision
3) the patient has capacity

  • Patients over 16 presumed to have consent (but can be challenged until over 18 if deemed in their best interests)
  • Below this may need demonstration of “Gillick competence”
28
Q

Ventilator associated pneumonia

A
  • Onset 48-72 hours after intubation
  • Occurs in 9-27% of all mechanically ventilated patients

New or progressive infiltrates on CXR
Systemic signs of infection
Changed in sputum

Within 4 days = early VAP
- strep pneumoniae
- h influenza
- MSSA
- antibiotic resistant gram negative (E. Coli, klebsiella, enterobacter, proteus)

After 4 days = late VAP
- MRSA
- acinetobacter
- pseudomonas
- ESBL producing bacteria

29
Q

Life threatening asthma

A

Clinical signs
- exhaustion or reduced GCS
- arrhythmia
- Hypotension
- cyanosis
- Silent chest/poor resp effort

Investigations
- PEFR <33% best or predicted
- SpO2 <92%
- PaO2 <8kPa
- “normal” PCO2

30
Q

Never event

A

Patient safety incidents that are preventable but are so serious they should never happen E.g.
- wrong site surgery
- wrong implant
- wrong route of medication
- wrong strength of midazolam
- misplaced NG tubes
- transfusion reactions
- * undetected oesophageal intubation removed in 2018*

31
Q

Limited cutaneous systemic sclerosis

A

Previously known as CREST syndrome

  • Calcinosis
  • Reynaud’s phenomenon
  • oEsophageal dysmotility
  • Slerodactyly
  • Telangectasia
32
Q

Orthodeoxia

A

PO2 decreases when standing upright and improves when lying supine.

Typical of hepato pulmonary syndrome

33
Q

Hepatopulmonary syndrome definition

A

Diagnostic criteria

chronic liver disease
arterial hypoxaemia (PaO2 < 75mmHg or A-a gradient > 20mmHg)
intrapulmonary vascular dilation

34
Q

Pyroglutamic acidosis

A

Glutathione depletion (long term paracetamol)

Dysfunction of 5 oxoprolinsse (typically from flucloxacillin)

Causes severe raised anion gap metabolic acidosis
- treat with bicarbonate and NAC infusion.
- stop paracetamol and flucloxacillin

35
Q

Delirium

A

Acute change in consciousness and awareness that fluctuates over time

36
Q

Brain stem death red flags

A
  • Testing < 6 hours of the loss of the last brain-stem reflex
  • Testing <24 hours of the loss of the last brain-stem reflex, where aetiology primarily anoxic damage
  • Hypothermia (24 hour observation period following re-warming to normothermia recommended)
    -Patients with any neuromuscular disorders
  • Steroids given for space occupying lesions such as abscesses
    -Prolonged fentanyl infusions
  • Aetiology primarily located to the brain-stem or posterior fossa
  • Therapeutic decompressive craniectomy

FFICM PREP (10 decks)

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