General Flashcards
SBAR
Situation - who you are, where you are, who the patient is, how they are
Background - patients reason for admission, brief medical hx
Assessment - vitals and clinical impressions
Recommendations - what you need and when you need it
Anaphylaxis:
Management
Airway - 100% O2/intubate Adrenaline IM 0.5mg 1.1000 (1:10,000 IV) IV access Antihistamine (Chloramphenamine 10mg IV) Steroid (Hydrocortisone 200mg IV) Fluids Treat wheeze of present e.g salbutamol
GCS
M1 no response to pain M2 extensor to pain M3 flexor to pain M4 withdraw to pain M5 localizing response to pain M6 obeying commands
V1 none V2 incomprehensible V3 inappropriate V4 conversational V5 oriented
E1 none
E2 to pain
E3 to speech
E4 eyes open
Sepsis Six
Lactate and Hb Fluid resus IV ABx O2 Cultures Urine output
SIRS criteria
Any two of:
Temp >38 or 20
HR >90
WCC >12 or
Alcohol withdrawal:
management
Chlordiazepoxide 10-50mg QDS 5-10 days (depending on severity) gradually reducing dose, to ease symptoms
If CI can give carbamazepine 800mg
For hallucinations haloperidol or olanzapine.
If seizures give diazepam 4mg IV/rectal
Alcohol dependency:
Management
Pabrinex vitamin supplement to avoid Wernickes
Acamprosate/ naltrexone/disulfram to prevent relapse
Reye’s syndrome
Rare complication of viral infection eg influenza, gastroenteritis, varicella or aspirin use
Mitochondrial dysfunction leads to cerebral edema, ⬆️ICP, fatty degeneration with little clinical signs
Vomiting, lethargy, drowsy, tachypnoea, diarrhoea, raised ICP Sx, neuro Sx
Tx - supportive
Fluids:
Liver failure
Too much Na+ causes ascites
Only use 5% dextrose
Fluids:
Chronic renal failure
Avoid excess fluid, sodium and potassium. Avoid hartmanns as contains lactate.
Fluids:
Sepsis
Needs fluids to treat intravascular depletion, but avoid too much Nacl i.e don’t wap up loads of saline, because of renal strain and acidosis risk.
Go for hartmanns
Fluids:
Alcoholic
Must give pabrinex before any 5% dextrose as can precipitate korsakoffs
Fluids:
Brain haemorrhage
NO DEXTROSE
Causes osmotic haematoma swelling
Fluids:
Heart failure
Don’t exceed more than 2l/24 hours
Fluid Challenge for hypotension patients
250-500ml crystalloid over 5 minutes Monitor BP, UO, JVP Respond fully ➡️ just maintenance Responds then falls ➡️ more fluids No response ➡️ either fluid overloaded or really depleted. Assess
Fluids:
Acute haemorrhage
2l hartmanns STAT
Fluid overload:
Signs
Fluid intake> output Raised CVO Pulmonary edema Weight above pre op weight CVP rises and plateaus with fluid challenge
Churg-Strauss Syndrome:
Features, blood test, Tx
Triad of:
Late onset asthma+esinophilia+small vessel vasculitis (e.g vassopasm, MI, DVT)
pANCA +ve
Sepsis/SIRS type picture
Tx steroids, INF
Wegeners granulomatosis:
Features, blood test, Tx
Vasculitis affecting particularly kidneys, and resp.
Saddle nose, obstruction, epistaxis
Progressive glomerulonephritis - proteinuria, haematuria
Skin purpura, nodules
cANCA
TX: steroids and cyclophosphamide
Hypovolaemia Sx
S sinus tachycardia H hypotension O oliguria C cold K Klammy S slow cap refill
Metabolic effect of Diarrhoea
Hypokalaemic alkalosis
Metabolic effect of vomiting
Hypochloraemic alkalosis
Shock symptoms
Sinus tachycardia Hypotension Oliguria Cold Klammy Slow cap refill
Stages of clubbing
- Increased fluctuancy of nail bed
- Loss of angle
- Increased curvature of nail
- Expansion terminal phalanx
JVP:
General features
Neck relaxed as behind sternocleidomastoid
Pulsation but not visible vein
Double pulsation
Type I Hypersensitivity
Analphylaxis
Atopy
IgE
Type II hypersensitivy
Autoimmune haemolytic anaemia
IgG or IgM
Type III hypersensitivity
IgG IgA
SLE
Type IV delayed hypersensitivity
Delayed hypersensitivity
T cell mediated
TB, graft vs host
Target cells
Sickle cell
Sarcoidosis
Non caseating granulomas Young adults/African BHL, swinging fever, polyarthalgia Cough, fever, malaise, dyspnoea, weight loss Hypercalcaemia
