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Desirable conditions Flashcards

1
Q

what are cardinal signs of anaphylaxis

A 
skin rash
acute onset 
wheezing
inspiratory stridor
hypotension
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2
Q

how to diagnose anaphylaxis

A

clinical

allergy test to prevent recurrence

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3
Q

what is the key part of treatment of anaphylaxis

A

adreanline

secure airway

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4
Q

what are risk factors for anaphylaxis

A

Hx of atopy / asthma

previous anaphylaxis

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5
Q

what IVx for anaphylaxis

A

Mast cell tryptase
ecg
U+ E
ABG

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6
Q

what is the immediate management for anaphylaxis

A
  1. CPR
  2. position based on situation
  3. remove trigger if present
  4. IM adrenaline
  5. repeat adrenaline
  6. high flow oxygen –> 94-98%
  7. IV access –> fluid challenge
  8. monitor vitals
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7
Q

what is the management for anaphylaxis after initial treatment

A
  1. antihistamine

2. corticosteroid

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8
Q

what is a biphasic reaction

A

return of anaphylaxis symptoms 6-24 hours after initial

tell patients to return if symptoms return

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9
Q

what discharge medications should be given

A

oral antihistamine + corticosteroid for 3 days

2 adrenaline auto-injectors

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10
Q

what are the two shockable rhythms

A

pulseless VT

VF

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11
Q

what is the classic presentation of cardiac arrest

A

sudden LOC

chest pain

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12
Q

what are the 4 cardiac arrest rhythms

A

VF
pulseless VT
PEA
asystole

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13
Q

what is torsades de pointes

A

polymorphic VT
prolonged QT
related to hypomagnesaemia

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14
Q

what is the signs on exam of cardiac arrest

A

unresponsive
absence of normal breathing
absence of circulation
cardiac rhythm disturbance

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15
Q

what are the risk factors for cardiac arrest

A 
CAD
LVD
HCM
ARVD
LQTS
electrolyte disturbance
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16
Q

what are the key investigations in cardiac arrest

A 
cardiac monitoring - identify if shockable rhythm 
FBC
electrolytes
ABG
cardiac biomarkers
Echo
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17
Q

for which rhythms is adrenaline recommended for?

A

both

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18
Q

what is the management for shockable rhythms

A
  1. CPR
  2. Defib
  3. adrenaline 1mg IV every 3-5min
  4. second shock
  5. Amiodarone if non-responsive to
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19
Q

what is the management for non-shockable

A
  1. CPR

2. Adrenaline

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20
Q

what is post cardiac arrest care

A 
continued monitoring
correction of electrolytes
correction of acidosis 
ECG 
coronary angio
temperature control 32-36
rewarming
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21
Q

what does COPD present as

A 
progressive SOB
wheeze
cough
sputum 
haemoptysis
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22
Q

what are diagnostic tests for COPD

A 
pulmonary function tests
CxR
CTPA
oximetery 
ABG
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23
Q

what are some advice and vaccines for COPD patients

A

stop smoking

flu + pneumococcal

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24
Q

what is the vague treatment for COPD

A

bronchodilators
inhaled corticosteroids
systemic corticosteroids

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25
what are features of COPD on examination
``` barrel chest hyperreasonant percussion distant breath sounds poor air entry coarse crackles distended neck veins cyanosis clubbing tripod ```
26
FEV1/FVC IN COPD
<0.7 | IRREVERSIBLE
27
How does COPD exacerbation present
INCREASED dyspnoea worsening of cough increase in sputum
28
what suggests an exacerbation is bacterial
change in volume and colour of sputum
29
what is used to grade breathlessness in COPD
eMRCD scale
30
what does a good COPD exacerbation history do
compare how there is a change from baseline
31
ABG results in patient with COPD
ABG acute resp acidosis / compare with previous ABG / document Fi repeat 30-60 minutes after oxygen + bronchdilator
32
why is an ECG done in COPD exacerbation
rule out MI / pneumothorax
33
what would blood results show in COPD exacerbation
WBC raised --> infection anaemia CRP --> moderately raised
34
what would a CxR show in a COPD exacerbation
rule out pneumonia / pneumothorax / CHF / pleural effusion
35
what is immediate management for COPD
1. B2 agonist +/- muscarinic antagonist on air - stop any long 2. consider systemic corticosteroid 3. prescribe controlled oxygen with target of 88-92 for retainers 4. ABG 5. monitor NEWS
36
what are symptoms of acute respiratory failure
RR > 30 accessory muscle usage acute change in mental status hypoaxaemia that does not improve with supplemental oxygen
37
when should NIV be used?
respiratory acidosis severe dysponoea persistent hypoxaemia
38
when should NIV treatment start
60 minutes after ABG | 120 minutes after hospital arrival
39
when should ABx be given for patients with COPD
patients that need ventilation increase in sputum / colour/ breathlessness 5-7 therapy
40
how long should oral corticosteroids be prescribed for after exacerbation
5 days
41
what are the benfits of NIV
improves surivial / gas exchange | reduces breathing workload
42
tell me about tension headaches
Hx - emotional stress / depression / insomnia tight band non-pulsatile / aching / constricting Ex - pericranial tenderness / trapezius / temporalis tenderness clinical diagnosis
43
how to treat tension headaches
simple analgesia
44
how does a migraine present
``` unilateral pulsing / throbbing pain migraine with aura N+V visual phenomenon photophobia symptoms last < 60 min ```
45
what is the classic presentation of SAH
``` thunderclap sudden onset headache vomitting photophobia non-focal neuro signs ```
46
what is the exam findings in SAH
nuchal rigidity
47
what investigations to do in patients with SAH
U=E - hyponatraemia CT head - blood in cirlce of willis LP - xanthochromia
48
what do give patients with confirmed SAH
nimodipine to prevent cerebral ischaemia
49
what are the two ways of managing SAH
1. surgical --> endovascular coil / surgical clipping | 2. unable to surgery --> conversative management
50
what are the risk factors for SAH
``` HTN smoking FHx AKPKD alcohol / cocaine ```
51
when should SAH be managed by
secure aneurysm by 48h
52
what monitoring should be done for patients with SAH
1. Neuro status + exam every hour consult with neurosurgeon if any deterioration 2.BP via arterial line 3. continous ECG
53
what is the management for SAH GCS < 8
1. CPR 2. supportive care + monitoring - fever - hyponatraemia - hyperglycaemia - VTE prevenetion 3. Nimodipine 4. anticonvulsant 5. stop + reverse anticoagulation 6. Endovascular coiling / surgical coiling
54
what is SAH management for SAH GCS > 8
1. Supportive care + monitoring 2. Nimodipine 3. anticonvulsants / analgesia / stool softner 4. endovascular coiling + surgical clipping
55
what are the neurological causes of collapse
``` generalized seizure parkinson's disease TIA/stroke vasovagal situational syncope ```
56
what is the classical history of collapse from seizures
sudden LOC limb stiff + jerk incontinence / tongue biting / myalgia post-ictal
57
what investigations + management for seizures
EEG / CT head / electrolytes / glucose / drug levels management anti-epileptics if > 2 episodes
58
what is the classical history for TIA/stroke
hemiplegia homonymous hemianopia dysphasia sensory loss
59
what investigations to do for TIA/stroke
CT head ECG for AF coagulation screen carotid doppler
60
history of vasovagal
occurs in response to stimuli preceding pallor / sweating LOC for 2 min
61
causes of cardiac collapse
postural hypotension aortic stenosis - collapse on exertion arrhythmia
62
history of collapse due to postural hypotension
dizziness + LOC when standing | recent change in medications
63
history of collapse due to aortic stenosis
collpase on exertion
64
history of collapse due to arrhythmia
palpitations strange feeling before LOC cardiac history + FHx
65
what are non- cardiac/ neuro causes of falls
drugs alcohol mechanical fall
66
what is hyponatraemia defined as
Na+ < 135
67
causes of hyponatraemia
volume depletion volume overload euvolaemia DM / cirrhosis / CHF
68
what is the common complication of hyponatraemia
cerebral oedema | treat with hypertonic 3% saline
69
how to treat hyponatraemia
``` hypertonic 3% saline fluid restriction stop causative medications DONT TREAT TOO QUICKLY myelinolysis ```
70
symtpoms of hypnatraemia
N+V altered mental status seizures + coma low urine output
71
what investigations to do in hyponatraemia
serum sodium U+E serum osmolality urine sodium
72
when does cerebral oedema occur more often
acute < 48hrs hyponatraemia
73
at what rate to give sodium in hyponatraemia
100-300ml in 100mLincrements over 10 minutes
74
what is hyperkalaemia defined as
K+ > 5.5mmol
75
what is the cause hyperkalaemia
high potassium intake | decreased renal excretion
76
how does hyperkalaemia present
muscle weakness + ECG change
77
what are the ECG changes in hyperkalaemia
tall tented T waves | loss of p wave
78
what is the main complication of hyperkalaemia
life-threatening arrhythmia | VF
79
what medications increase risk of hyperkalaemia
``` chemo drugs ACEi/ARB Spirnolactone / amiloride NSAIDs digoxin trimethoprim beta blockers ```
80
how can renal impairment cause hyperkalaemia
kidneys excrete potassium
81
what symptoms of hyperkalaemia
usually asymptomatic weakness + fatique palpitations + chest pain
82
what investigations to do for Hyperkalaemia
U+E --> raised creatinine would suggest AKI ECG --> tall tented T waves / flattening p-waves / broad QRS serum cortisol --> low in addisons
83
what is the management of hyperkalaemia
1. cardiac proteection - calcium gluconate 2. Insulin + glucose infusion - monitor glucose closely 3. salbutamol 4. check potassium 1/2/6/12 hours after treatment
84
how does aortic dissection present
sudden onset ripping / tearing pain intrascapular pain syncope

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