Extra Flashcards
Describe what fluids you’d give for maintenance
2 sweet 1 salt
1L NaCl: 2L 5% glucose
+ 20 mmol K+
How to assess hydration?
Hx of D+V CRT Temperature + perfusion Skin turgor JVP Sunken eyes Mucus membranes Behaviour Collapsing pulse Heart sounds Peripheral oedema Obs Urine output
What to give for fluid bolus in kids first line?
50ml/kg ORS over 4 hours
What points to cover in pre-op assessment?
SHAFT JANE Smoking Health - CV, resp Apnoea Fasting Teeth Jaw Airway Neck movements Exercise tolerance
What are the rules pre-op for: Warfarin NOACs LMWH (therapeutic) Aspirin/ clopidogrel Insulin Oral hypoglycaemics Diuretics/ ACEi COCP
Warfarin = 5 days
NOACs = 24hrs for minor, 48hrs for major surgery
LMWH (therapeutic) = 48hrs
Aspirin/ clopidogrel = 7 days
Insulin = avoid morning dose. Insulin sliding scale from midnight night before
Oral hypoglycaemics = avoid morning dose, same as above. Avoid metformin for 2 days after due to lactic acidosis risk
Diuretics/ ACEi = avoid on day of op
COCP = 4 weeks before + 2 weeks after
What is the murmur for aortic stenosis + what other signs do you see?
Ejection systolic at upper right sternal edge - better on expiration
Slow rising pulse + narrow pulse pressure
What is the murmur for mitral regurgitation?
Pan systolic at apex
Heard best on expiration
What is the murmur for VSD?
Lower LSE pan systolic
How does the MCA work?
Does the patient have an impairment of the brain?
If no - always has capacity
If yes - assess capacity
What additions do you do on a diabetic review?
Screen for: neuro, nephro, eyes, stroke, CVD HbA1c <48 BP <140/80 Any hypos? Bloods: U+E, ACR, lipids Foot check + fundoscopy
What is involved in an annual review?
Intro - understanding of condition ICE PMHx + DHx Symptoms - new, existing, screen for complications Hospital admissions? Targets Emotional wellbeing + QoL Medications - SE, compliance Bloods + tests Lifestyle Extra Demographics Management?
What additions do you do on a HTN review?
Screen for: visual problems, headaches, swelling CVD or CKD - CP, SOB, fatigue, appetite Stage 1 = 140/90, stage 2 = 160/100 Bloods: U+E + urine dip Stress?
What additions do you do on an AF review?
Palpitations, syncope Screen for: stroke, HF ECG Target INR 2-3 Rate, rhythm + warfarin Bloods: INR, LFT, TFT, U+E, clotting, FBC Caffeine + stress
What additions do you do on a HF review?
SOB, cough, PND
Screen for: AF, VTE
Bloods: BNP + cholesterol
Cardioprotective diet - oily fish, wholegrains, nuts, fruit + veg
Fluid status - JVP, pitting oedema, auscultate lungs, CXR/ echo, ascites
Flu jab
What additions do you do on an asthma review?
Cough, SOB, wheeze Asthma attacks? Symptoms at night Symptoms during day Symptoms affecting activities Atopy Triggers Mouth care Passive smoking Check peak flow + inhaler technique Flu jab Personal asthma plan
