Definitions Flashcards
Definition of cardiogenic shock
Syndrome of life threatening tissue hypoperfusion due to inadequate cardiac output from primary cardiac dysfunction. (Cold and wet vs warm and dry etc)
What is sepsis?
Life threatening organ dysfunction caused by dysregulated host response to infection
What is haemolytic uraemic syndrome
Triad of
- microangiopathic haemolytic anaemia
- thrombocytopenia
- renal failure
What is thrombotic thrombocytopaenic purpura?
5 signs
- thrombocytopenia
- MAHA
- fluctuating neurological signs
- renal impairment
- fever
DIC is late ominous sign
Major incident
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
Command and control systems in major incident
Strategic command - gold (big picture objectives)
Tactical - silver (planning and coordination)
Operational - bronze (management of hands on work )
What is the pulmonary interstitium?
Alveolar interstitium
Capillary interstitium
Basement membrane
Perivascular tissue
Perilymphatic tissue
Anaphylaxis
World allergy organisation
- Serious systemic hypersensitivity reaction
- usually rapid onset
- can cause death
Severity of COPD
GOLD stage (%predicted FEV1)
Mild >80
Moderate 50-80
Severe 30-50
Very severe <30
Portal hypertension
Hepatic venous pressure gradient
- mild 5-10
- clinically significant above 10
Causes ascites, varies and decompensated cirrhosis
Hepato-renal syndrome clinical criteria
- 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)
DKA criteria
BM >11
Ketones >3
pH <7.3 / bicarbonate <15
Severe DKA
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
Hyperglycaemic hyperosmolar state
Complication of type 2 diabetes
- Hyperglycaemia >30 (no ketones, no acidosis)
- hypovolaemia
Serum osmolality >320 (2x Na + urea + glucose)
Immersion vs submersion
Immersion = airway above surface
Submersion = whole body below surface including airway
Drowning
Process by which immersion or submersion in a liquid medium results in primary respiratory impairment
Stages of cold water shock
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
Osmolality
Number of moles per kg of solvent
Osmolalrity
Osmoses per litre of solution
Osmotic pressure
Pressure required to prevent movement of solvent molecules by osmosis across a semipermeable membrane
Cushing’s syndrome
High steroid levels causing
- moon face, obesity and hirsutism
- diabetes and hypertension
- osteoporosis and pancreatitis
Can be from exogenous steroid use
Conn’s syndrome
Primary hyperaldosteronism
- adrenal hyperplasia or aldosterone secreting adenoma
Causing hypokalaemia, hypernatraemia, muscle weakness and hypertension
Anaphylaxis
Serious allergic reaction that is rapid in action and may cause death.
Life threatening airway / breathing / circulatory symptoms
Vitamin K dependent clotting factors
2, 7, 9 & 10
Plus the anticoagulants protein C and protein S
DIC
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
Refeeding syndrome
Potentially life threatening syndrome of metabolic disturbance characterised by electrolyte and fluid shift upon reintroduction of feeding after a period of starvation
Principles of consent
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”
Ventilator associated pneumonia
- 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
Life threatening asthma
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
Never event
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*
Limited cutaneous systemic sclerosis
Previously known as CREST syndrome
- Calcinosis
- Reynaud’s phenomenon
- oEsophageal dysmotility
- Slerodactyly
- Telangectasia
Orthodeoxia
PO2 decreases when standing upright and improves when lying supine.
Typical of hepato pulmonary syndrome
Hepatopulmonary syndrome definition
Diagnostic criteria
chronic liver disease
arterial hypoxaemia (PaO2 < 75mmHg or A-a gradient > 20mmHg)
intrapulmonary vascular dilation
Pyroglutamic acidosis
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
Delirium
Acute change in consciousness and awareness that fluctuates over time
Brain stem death red flags
- 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
