Foundations Doctor App Flashcards
Indication for zopiclone
Short term insomnia
Risks of rapid tranquilisation
- Over-sedation causing loss of consciousness
- Loss of airway
- Cardiovascular collapse:
- Arrhythmias / Hypotension / Sudden death
- Respiratory depression
- Acute dystonia
- Neuroleptic Malignant Syndrome
- Interaction with medication (prescribed or illicit including alcohol)
- Damage to the therapeutic relationship
- Underlying coincidental physical disorders
First line for rapid tranquilisation
IM lorazepam
Second line in rapid tranquilisation if no response
IM haloperidol / olanzepine
Second medication in rapid sedation if partial response
Repeat IM lorazepam
Management of Bradypnoea caused by benzodiazepines
IV flumazenil
Pain medications in palliative care
SC morphine first line
SC oxycodone second line
Anxiety medications in palliative care
SC midazolam
Nausea medications in palliative care
SC cyclizine
SC levomepromazide
SC haloperidol
Secretions medications in palliative care
SC glycopyrronium
SC hyoscine butyl bromide
Acute transfusion reaction symptoms
Fever / chills / rigors Tachycardia Respiratory distress Hyper / Hypotension Syncope Nausea / General Malaise Flushing / Urticaria Pain: Chest / Abdominal / Muscles
What does clear / translucent yellow ascetic fluid indicate?
Normal appearance - portal hypertension
What does cloudy ascitic fluid suggest?
Infection (SBP), pancreatitis, perforated bowel
What does bloody ascitic fluid indicate?
Traumatic tap, malignancy, haemorrhagic pancreatitis
What does milky ascitic tap indicate?
Malignancy, lymphoma, TB
Slightly high RBCs on ascitic tap
Malignancy, TB
Very high RBCs on ascitic tap
Haemorrhage (pancreatitis/ trauma)
High neutrophils on ascitic tap
SBP
High lymphocytes on ascitic tap
TB
High serum ascitic albumin gradient (SAAG)
Transudate - systemic disease - liver / heart / renal failure
Low serum albumin ascitic gradient (SAAG)
Exudate - local disease - malignancy / infection
Standard pre-op investigations
ECG, CXR, bloods, pregnancy test if appropriate
Meds to consider stopping before surgery
Anticoagulants Anti-platelet Insulin Hypoglycaemics Diuretics ACEi / ARBs
Management of anticoagulation prior to surgery
Discussion with haematology and consider cover with shorter acting anticoagulants
Management of insulin prior to surgery
Hold on morning of surgery and use sliding scale
Management of anti-platelets prior to surgery
Hold 7 days prior to surgery
Management of diuretics prior to surgery
Hold on day of surgery
Management of ACEi prior to surgery
Hold on day of surgery
Management of ARB prior to surgery
Hold on day of surgery
Protocol for NBM (when they must stop eating)
2 hours prior to surgery no food or drink
6 hours prior to surgery clear fluids only
If time of surgery unknown prep patient ready for 8am
Risks of transfusion
Common: fever, flushing, rash, itching
Rare, haemolytic reaction, anaphylaxis, transfusion associated circulatory overload, transfusion related acute lung injury, post transfusion purpura, very small risk of blood borne infection
