Enhanced learning conditions Flashcards
how does aortic dissection present
severe ripping / tearing pain
intrascapular pain
syncope
what is the management principles for aortic dissection
oxygen
ALS
haemodynamic support
what investigations are diagnostic
CT
MRI
TOE
how is aortic dissection managed
1. ascending aorta urgent surgical repair 2. descending aorta beta blockade / medical management life long surveillance with regular imaging
what investigations are useful for management
ECG CxR cardiac enzymes CTPA U+E / LFT lactate FBC
what is medical management for aortic dissection
beta blockade
opioid analgesia
vasodilators
what are the symptoms of pericarditis
severe retrosternal chest pain
worse with inspiration + supine position
examination findings in pericarditis
pericardial friction rub
low grade fever
what are diagnostic signs for pericarditis
diffuse ST elevations
small pericardial effusions on echo
what is the treatment for pericarditis
treat underlying systemtic disorder
NSAIDs + colchicine
pericardiocentesis
what investigations for pericarditis
ECG
troponin
pericardial fluid culture
symptoms of pneumothorax
dyspnoea
chest pain
symptoms of tension pneumothorax
rapid laboured respirations
cyanosis
profuse diaphoresis
tachycardia
what is first line treatment for pneumothorax
observation with supplemental oxygen therapy
what is the next step in treatment for pneumothorax
percutaneous aspiration
chest drain
suction
examination findings in pneumothorax
hyperexpand ipsilateral hemithorax
hyper-reasonant
absent / diminsihed breath sounds
investigations for pneumothorax
CxR
what is the management for tension pneumothorax
immediate needle decompression
- 14G IV cathether mid calvicular line 2/3rd intercostal space
oxygen therapy
tube thoracostomy
what are 3 key symptoms + signs of opiate overdose
respiratory depression
miosis
apnoea
what is initial treatment for opiate overdose
adequate ventilation
naxloxone
monitor for re-sedation and repear antidote dose
investigations for opioid overdose
trial of naloxone - reverse of symptoms
ECG
opioid urine screen
what are markers for suspected TCA overdose
hx of sucidide
sudden deterioration in mental status + vital signs
hypotension
tachycardia
how is TCA overdose diagnosis made
clinical history
ECG changes - sinus tachy moving to wide complex tachycardia
what are the symptoms of TCA overdose
tachycardia hypotension mydriasis warm + flsuhed urinary retention decreased bowel sounds
what invesitgations for TCA overdose
ECG
sodium bicarbonate trial- narrows QRS
ABG-metabolic acidosis
what is the management for TCA overdose
supporttive care
GI decontamination
sodium bicarbonate bolus
signs + symptoms of TIA
focal neurological deficit
sudden onset + brief symptoms
resolve < 48hrs
risk factors for TIA/stroke
AF / valvular disease / carotid stenosis / CHF / HTN
what are the investigations for TIA
Blood glucose FBC prothrombin time / INR / PTT ECG brain MRI with diffussion CT head
what is the management for TIA
antiplatelet therapy
statin
life style modifications
carotid endarterectomy
what the the class 4 symptoms of stroke
visual field deficit
weakness
aphasia
impaired co-ordination
what are the main investigations for stroke
CT head glucose electrolytes U+E cardiac enzymes ECG FBC
what is treatment of stroke <4.5 hours of onset
altephase aspirin endovascular intervention supportive care swallowing asssessment VTE prophylaxis + ealry mobilisation
what is the management of stroke > 4.5 hrs
aspirin 300mg
supportive care
swallowing asssessment
VTE prophylaxis
what are the features of moderate acute asthma
increasing symptoms
PEF - 50-75% best
no features of acute severe
what are features of acute severe asthma
PEF 33-50%
RR > 25
HR > 110
inability to complete sentences in one breath
what are features of life-threatening asthma
PEF < 33 Sp02 < 92 Pa02 < 8kPa normal PaC02 silient chest cyanosis poor resp effort arrhythmia exhaustion hypotension
what is the management of an acute asthma attack
Oxygen - keep sats 94-98 nebulised B2 agonist driven by oxygen add ipratropium bromide Steroids -continue pred 40 for atleast 5 days after nebulised magnesium sulphate refferal to ITU
when should patients be referred to intensive care
require ventilatory support
deteriorating PEF
worsening hypoxia
hypercapnia
