ED -passmed points Flashcards
describe the ABG of a patient who has taken an aspirin OD
START RESP ALKALOSIS due to hyperventilation then proceed to mixed metabolic ACIDOSIS and resp alkalosis
patient will have tinnitus
which drugs need stopped in an AKI or to prevent lithium toxicity
STOP the DAMN drugs in AKI/lithium toxicity
D- Diuretics (esp thiazide), A- ACEi/ARB,
M- metronidazole, metformin
N- NSAIDS -> not aspirin
in treated DKA, which electrolyte abnormality do we need to monitor for>
hypokalaemia
- insulin causes potassium to move intracellularly
- drops conc in blood
- monitor with bloods and ECG
difference between type1 and type 2 resp failure
Type 1 respiratory failure: Low pO2, no CO2 retention
Type 2 respiratory failure: Low pO2, high pCO2
a stroke in which artery causes C/L homonomymous hemaniopia with macular sparin
posterior cerebral A
when do we give NIV to patients with infective exac of COPD
when they still have resp acidosis despite the full ceiling of care
vomiting causes what changes to an ABG
metabolic alkalosis with normal anion gap
diarrhoea causes what changes to an ABG
metabolic acidosis with normal anion gap
- loss of bicarb
when to have repeat CXR for inpt pneumonia
6 weeks after
what are the different stages of COPD
1 - FEV1 >80%, Mild - symptoms should be present to diagnose COPD in these patients
2 - FEV1 50-79, modeate
3 - FEV1 30-49, severe
4 FEV1<30 very severe
dose of adrenaline for 6-11 years ol
300mcg every 5 mins IM if needed
what is normal QRS interval time
0.8-0.12
this means that a narrow complex tachy falls into this interval time
broad complex will be more than 120ms
what drugs react with SSRI to cause serotonin syndrome
st johns wort
tramadol
what fluid is given in dka
isotonic saline
fever, rash, desquamation of hands and feet, hypotension are characteristic of which syndrome
staph toxic shock syndrome
triad of acute interstitial nephritits
fever
arthralgia
rash
+ AKI, urinary white cell casts and raised eosinophils
causes of increased anion gap
MUDPILES – Methanol, Uraemia, DKA, Propylene glycol, Iron/isoniazid, Lactate, Ethylene glycol, Salicylates
important complication of a subarachnoid haem and how do we monitor this
SIADH
- U+E -> monitor for hyponatriema
Bilateral, mid-to-lower zone patchy consolidation in an older patient -> what organism causes this type of pneumonia
legionella
describe appearance of chronic subdural haem on CT head
hypodense (dark), crescentic collection around the convexity of the brain
not bound by falx cerebri
what pulses to check on baby in BLS
brachial
femoral
dry cough, erythema multiforme (symmetrical target shaped rash with a central blister) with reticulo-nodular shadowing on CXR and red cell agglutination on blood smear suggests what bacterial cause of pneumonia
mycoplasma pneumoniae
- causes haemolytic anaemia
What is the most common cause of viral meningitis in young adults
Enteroviruses like coxsackievirus are the most common cause of viral meningitis
what type of NIV is used in refractive infective exacerbation of COPD
bipap
- need help removing CO2 retention as pt in type 2 resp failure
how to work out urea:creatinine ratio
creatinine/1000 = same units
urea/creatinine
> 100 = pre-renal cause
<100 = intrinsic cause
complication of DKA treatment and why does it occur
cerebral oedema -> rapid fluid resus can cause the blood osmol to drop so fluids move into the brain tissue
glucose high to low = brain will blow
common cause of meningitis in immunocompromised patients
Cryptococcus neoformans is an encapsulated yeast and an obligate aerobe
this stains well with india ink
common in ppl with HIV
if a bradycardic patient is allergic to atropine, what can you give them?
infusion of adrenaline
patient with AKI is on metformin, what do you do
may have to stop metformin as there is an increased risk of toxicity as it is renally cleared but it does not worsen an AKI itself
which drugs may need to be stopped in an AKI due to increased risk of toxicity
*Metformin
* Lithium
* Digoxin
signs and symptoms of a pneumococcal pneumonia
30 y/o
productive cough, fever, chest pain
herpes labalis
consolidation in lower zones
persistent ST elevation following recent MI, no chest pain is a sign of which MI complication
Left ven aneurysm
PICA stroke symptoms
sudden onset vertigo and vomiting
dysphagia
ipsilateral facial pain and temperature loss
contralateral limb pain and temperature loss and ataxia
ipsilateral oculomotor palsy CNIII and contralateral weakness of the upper and lower extremity - signs of whoch type of stroke?
branches of posterior cerebral A that supply midbrain
WEBER’s syndrome
brown granular casts in urine -> which disease
ATN
when do we use PERC test
when there is a low <15% chance pre-test prob of a PE
NICE diagnosis criteria for an AKI
↑ creatinine > 26µmol/L in 48 hours
↑ creatinine > 50% in 7 days
↓ urine output < 0.5ml/kg/hr for more than 6 hours
criteria for surgical mx of an ectopic
> 35mm in size
BHCG of >5000
fetal heart beat
Fever, abdominal pain, hypotension during a blood transfusion -> what type of reaction?
acute haemolytic reaction
- when given red cells vs febrile non-hame which is more common with platelets or WCC
- also no abdo pain in FNHR
contraindication for carboprost
asthma - can exacerbate bronchoconstriction
urea increase proportionally higher than creatinine increase is a sign of what cause of oliguria
dehydration
normal CT in suspected stroke?
doesnt rule out ischaemic stroke, only rules out if haemorrhage
liver transplant criteria for paracetamol OD
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
when should you not use steroids in meningitis
Do not use corticosteroids in children younger than 3 months with suspected or confirmed bacterial meningitis
most common type of pneumonia in alcoholics
klebsiella
- gelatinous sputum
- consolidation higher in lungs
what is refractory anaphylaxis
defined as respiratory and/or cardiovascular problems persisting despite 2 doses of IM adrenaline
give IV adrenaline infusion
CT signs of an acute ischaemic stroke
hyperdense artery
areas of low density in grey and white matter of the territory in question
definitive tx for a persisitent leak in a pneumothorax or recurrent eps
video assisted thoracoscopic surgery procedure
- allows for pleurodesis by olbiterating the pleural space and allows for bullecotmy
tx of legionella
clarithromycin / any macrolide
which artery is likely to be blocked if patient has complete heart block post mi?
RCA -> supplies the AVN
absolute contraindications to thrombolysis
- Previous intracranial haemorrhage
- Seizure at onset of stroke
- Intracranial neoplasm
- Suspected subarachnoid haemorrhage
- Stroke or traumatic brain injury in preceding 3 months
- Lumbar puncture in preceding 7 days
- Gastrointestinal haemorrhage in preceding 3 weeks
- Active bleeding
- Oesophageal varices
- Uncontrolled hypertension >200/120mmHg
relative CI to thrombolysis
Pregnancy
- Concurrent anticoagulation (INR >1.7)
- Haemorrhagic diathesis
- Active diabetic haemorrhagic retinopathy
- Suspected intracardiac thrombus
- Major surgery / trauma in the preceding 2 weeks
definitive tx of SAH
arterial coiling
when are nitrates contraI in ACS
when pt has hypotension <90mmhg
4 H and 4T
hypoxia
hyperkalaemia
hypothermia
hypovolemia
thrombus
tamponade
toxins
tension pneumothorax
important step to do in an obstetric cardiac arrest
if >20 weeks, left lateral tilt to the table
what is a jacksonian march and what area of the brain is it associated with in a seizure?
type of focal aware seizure where jerking starts distally in limb and moves proximally up the limb
associated with seizure in frontal lobe
3 ways you can test to determine if a COPD patient is steroid sensitive
asthma prev
eosinophilia
dinural variation in symptoms
when do you seek a surgical opinion when treating a pneumothorax
if after 3-5 days there is persistent air leak (e.g. bubbling chest drain) or failure of the lung to re-expand, a thoracic surgical opinion should be sought
electrolyte imbalance in legionella pneumonia
hyponatriema
which antiplatelet do you give if pt has high bleeding risk in NSTEMI
clopidogrel
normally give ticagrelor
blood vessels disturbed in a subdural haemorrhage?
Subdural haemorrhage is caused by damage to bridging veins between cortex and venous sinuses
how to manage a post-ischaemic stroke in pt with AF
- exclude haemorrhagic cause
- aspirin for 2 weeks
- then lifelong anticoag -> either DOAC or warfarin
how to manage a post-ischaemic TIA in pt with AF
exclude haemorrhagic cause
anticoag can start straight away
urine osmol in ATN?
<350 low
what investigation needs to be performed if someone has a TCA OD
ECG -> risk of widening of QRS causes increased risk of seizures and arrhythmias
which patients can have fast track discharge after anaphylaxis
following needs to be met -> can leave 2 hours after discharge
- good response to a single dose of adrenaline
- complete resolution of symptoms
- has been given an adrenaline auto-injector and trained how to use it
- adequate supervision following discharge
which patients need to have a minimum 6 hour resolution of symptoms before discharge after anaphylaxis
2 doses of IM adrenaline needed, or
previous biphasic reaction
which patients need to have a minimum 12hour resolution of symptoms before discharge after anaphylaxis
- severe reaction requiring > 2 doses of IM adrenaline
- patient has severe asthma
possibility of an ongoing reaction (e.g. slow-release medication) - patient presents late at night
patient in areas where access to emergency access care may be difficult - observation for at 12 hours following symptom resolution
best test for legionella pneumonia?
urinary antigen
what is the window for thrombectomy in an acute ischaemic stroke
6 hours
what abx cover to give if meningitis is suspected to be listeria?
IV amoxicillin -> suspect this in adults >50y/o
indications for dialysis in an AKI pt
AEIOU:
A—acidosis;
E—electrolytes/hyperkalemia;
I— overdose of medications/drugs;
O—overload of fluid ;
U—uremia leading to encephalitis/pericarditis.
when should beta blockers be stopped in acute heart failure
patient has heart rate < 50/min
second or third degree AV block
shock
complication of rapid draining of pneumothorax
re-expansion pulmonary oedema
which artery is affected in amaurosis fugax
retinal/ opthalmic artery
first line anti-epileptic in atonic seizures for women
lamotrigine
ECG change with TCA OD?
QRS widening
what is the risk in use of large volumes of NACL for fluid resus
risk of hyperchloraemic metabolic acidosis
- normal anion gap
what are the preferred type of stent in a PCI
drug-eluting -> coated in an antiproliferative agent
vs bare-metal stent
what is a marker for poor prognosis in a paracetamol OD
prothrombin time elevated as it suggests liver failure
when do you start a dextrose infusion in a DKA pt
once BG <14mmol/L
start 10% dextrose as an addition to the saline ay 125mls/hr
