Desirable conditions Flashcards
what are cardinal signs of anaphylaxis
skin rash acute onset wheezing inspiratory stridor hypotension
how to diagnose anaphylaxis
clinical
allergy test to prevent recurrence
what is the key part of treatment of anaphylaxis
adreanline
secure airway
what are risk factors for anaphylaxis
Hx of atopy / asthma
previous anaphylaxis
what IVx for anaphylaxis
Mast cell tryptase
ecg
U+ E
ABG
what is the immediate management for anaphylaxis
- CPR
- position based on situation
- remove trigger if present
- IM adrenaline
- repeat adrenaline
- high flow oxygen –> 94-98%
- IV access –> fluid challenge
- monitor vitals
what is the management for anaphylaxis after initial treatment
- antihistamine
2. corticosteroid
what is a biphasic reaction
return of anaphylaxis symptoms 6-24 hours after initial
tell patients to return if symptoms return
what discharge medications should be given
oral antihistamine + corticosteroid for 3 days
2 adrenaline auto-injectors
what are the two shockable rhythms
pulseless VT
VF
what is the classic presentation of cardiac arrest
sudden LOC
chest pain
what are the 4 cardiac arrest rhythms
VF
pulseless VT
PEA
asystole
what is torsades de pointes
polymorphic VT
prolonged QT
related to hypomagnesaemia
what is the signs on exam of cardiac arrest
unresponsive
absence of normal breathing
absence of circulation
cardiac rhythm disturbance
what are the risk factors for cardiac arrest
CAD LVD HCM ARVD LQTS electrolyte disturbance
what are the key investigations in cardiac arrest
cardiac monitoring - identify if shockable rhythm FBC electrolytes ABG cardiac biomarkers Echo
for which rhythms is adrenaline recommended for?
both
what is the management for shockable rhythms
- CPR
- Defib
- adrenaline 1mg IV every 3-5min
- second shock
- Amiodarone if non-responsive to
what is the management for non-shockable
- CPR
2. Adrenaline
what is post cardiac arrest care
continued monitoring correction of electrolytes correction of acidosis ECG coronary angio temperature control 32-36 rewarming
what does COPD present as
progressive SOB wheeze cough sputum haemoptysis
what are diagnostic tests for COPD
pulmonary function tests CxR CTPA oximetery ABG
what are some advice and vaccines for COPD patients
stop smoking
flu + pneumococcal
what is the vague treatment for COPD
bronchodilators
inhaled corticosteroids
systemic corticosteroids
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
FEV1/FVC IN COPD
<0.7
IRREVERSIBLE
How does COPD exacerbation present
INCREASED
dyspnoea
worsening of cough
increase in sputum
what suggests an exacerbation is bacterial
change in volume and colour of sputum
what is used to grade breathlessness in COPD
eMRCD scale
what does a good COPD exacerbation history do
compare how there is a change from baseline
ABG results in patient with COPD
ABG
acute resp acidosis / compare with previous ABG / document Fi
repeat 30-60 minutes after oxygen + bronchdilator
why is an ECG done in COPD exacerbation
rule out MI / pneumothorax
what would blood results show in COPD exacerbation
WBC raised –> infection
anaemia
CRP –> moderately raised
what would a CxR show in a COPD exacerbation
rule out pneumonia / pneumothorax / CHF / pleural effusion
what is immediate management for COPD
- B2 agonist +/- muscarinic antagonist on air
- stop any long - consider systemic corticosteroid
- prescribe controlled oxygen with target of 88-92 for retainers
- ABG
- monitor NEWS
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
when should NIV be used?
respiratory acidosis
severe dysponoea
persistent hypoxaemia
when should NIV treatment start
60 minutes after ABG
120 minutes after hospital arrival
when should ABx be given for patients with COPD
patients that need ventilation
increase in sputum / colour/ breathlessness
5-7 therapy
how long should oral corticosteroids be prescribed for after exacerbation
5 days
what are the benfits of NIV
improves surivial / gas exchange
reduces breathing workload
tell me about tension headaches
Hx - emotional stress / depression / insomnia
tight band
non-pulsatile / aching / constricting
Ex - pericranial tenderness / trapezius / temporalis tenderness
clinical diagnosis
how to treat tension headaches
simple analgesia
how does a migraine present
unilateral pulsing / throbbing pain migraine with aura N+V visual phenomenon photophobia symptoms last < 60 min
what is the classic presentation of SAH
thunderclap sudden onset headache vomitting photophobia non-focal neuro signs
what is the exam findings in SAH
nuchal rigidity
what investigations to do in patients with SAH
U=E - hyponatraemia
CT head - blood in cirlce of willis
LP - xanthochromia
what do give patients with confirmed SAH
nimodipine to prevent cerebral ischaemia
what are the two ways of managing SAH
- surgical –> endovascular coil / surgical clipping
2. unable to surgery –> conversative management
what are the risk factors for SAH
HTN smoking FHx AKPKD alcohol / cocaine
when should SAH be managed by
secure aneurysm by 48h
what monitoring should be done for patients with SAH
- Neuro status + exam every hour
consult with neurosurgeon if any deterioration
2.BP via arterial line - continous ECG
what is the management for SAH GCS < 8
- CPR
- supportive care + monitoring
- fever
- hyponatraemia
- hyperglycaemia
- VTE prevenetion - Nimodipine
- anticonvulsant
- stop + reverse anticoagulation
- Endovascular coiling / surgical coiling
what is SAH management for SAH GCS > 8
- Supportive care + monitoring
- Nimodipine
- anticonvulsants / analgesia / stool softner
- endovascular coiling + surgical clipping
what are the neurological causes of collapse
generalized seizure parkinson's disease TIA/stroke vasovagal situational syncope
what is the classical history of collapse from seizures
sudden LOC
limb stiff + jerk
incontinence / tongue biting / myalgia
post-ictal
what investigations + management for seizures
EEG / CT head / electrolytes / glucose / drug levels
management
anti-epileptics if > 2 episodes
what is the classical history for TIA/stroke
hemiplegia
homonymous hemianopia
dysphasia
sensory loss
what investigations to do for TIA/stroke
CT head
ECG for AF
coagulation screen
carotid doppler
history of vasovagal
occurs in response to stimuli
preceding pallor / sweating
LOC for 2 min
causes of cardiac collapse
postural hypotension
aortic stenosis - collapse on exertion
arrhythmia
history of collapse due to postural hypotension
dizziness + LOC when standing
recent change in medications
history of collapse due to aortic stenosis
collpase on exertion
history of collapse due to arrhythmia
palpitations
strange feeling before LOC
cardiac history + FHx
what are non- cardiac/ neuro causes of falls
drugs
alcohol
mechanical fall
what is hyponatraemia defined as
Na+ < 135
causes of hyponatraemia
volume depletion
volume overload
euvolaemia
DM / cirrhosis / CHF
what is the common complication of hyponatraemia
cerebral oedema
treat with hypertonic 3% saline
how to treat hyponatraemia
hypertonic 3% saline fluid restriction stop causative medications DONT TREAT TOO QUICKLY myelinolysis
symtpoms of hypnatraemia
N+V
altered mental status
seizures + coma
low urine output
what investigations to do in hyponatraemia
serum sodium
U+E
serum osmolality
urine sodium
when does cerebral oedema occur more often
acute < 48hrs hyponatraemia
at what rate to give sodium in hyponatraemia
100-300ml in 100mLincrements over 10 minutes
what is hyperkalaemia defined as
K+ > 5.5mmol
what is the cause hyperkalaemia
high potassium intake
decreased renal excretion
how does hyperkalaemia present
muscle weakness + ECG change
what are the ECG changes in hyperkalaemia
tall tented T waves
loss of p wave
what is the main complication of hyperkalaemia
life-threatening arrhythmia
VF
what medications increase risk of hyperkalaemia
chemo drugs ACEi/ARB Spirnolactone / amiloride NSAIDs digoxin trimethoprim beta blockers
how can renal impairment cause hyperkalaemia
kidneys excrete potassium
what symptoms of hyperkalaemia
usually asymptomatic
weakness + fatique
palpitations + chest pain
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
what is the management of hyperkalaemia
- cardiac proteection
- calcium gluconate - Insulin + glucose infusion
- monitor glucose closely - salbutamol
- check potassium 1/2/6/12 hours after treatment
how does aortic dissection present
sudden onset ripping / tearing pain
intrascapular pain
syncope
