General Assessment and management

Question 1

Apyrexial/afebrile definition

Answer 1

35-37C

Question 2

Hyperthermia/pyrexia/febrile definition

Answer 2

> 37.5C

Question 3

Hypothermia definition

Answer 3

<35C

Question 4

Hyper pyrexia definition

Answer 4

> 41C

Question 5

Temperature is regulated by the …

Answer 5

Autonomic nervous system from the hypothalamus

Question 6

What are the max and min temps and what can each result in

Answer 6

Max >41C result in convulsions

Min <32C result in cardiac arrhythmias

Question 7

What direction does pyrexia shift the oxygen dissociation curve? And why does this occur?

Answer 7

To the right. As increased temperature results in a higher oxygen demand due to the increase in metabolic activity. This causes haemoglobin to have a lower affinity for oxygen meaning more oxygen is unloaded at the tissue cells.

Question 8

What direction does hypothermia cause the oxygen dissociation curve to shift to? And why does this occur?

Answer 8

Shift to the left. Cells are less metabolically active. Haemoglobin has a higher affinity for oxygen.

Question 9

Symptoms of pyrexia. Why they occur.

Answer 9

>37.5C
sweating 
shivering 
feeling cold
high HR 
high RR 
Due to increase cellular metabolism

Question 10

Normal urine output

Answer 10

0.5-1ml/kg/hr.

UO usually = to input with a degree of insensible loss.

Question 11

Oliguria definition

Answer 11

UO <0.5ml/kg/hr = <30ml/hr

Question 12

Positive fluid balance means

Answer 12

Fluid intake > fluid output

Question 13

Negative fluid balance means

Answer 13

Fluid output > fluid input

Question 14

Anuria definition

Answer 14

No urine output or a UO <100ml/24hrs

Question 15

What does NEWS stand for

Answer 15

National Early Warning Score

Question 16

How fast should NaCl 0.9% be administered?

Answer 16

1L/hr

Question 17

What are factors that may lead to the insertion of an NG tube?

Answer 17

Reduced oral intake
Diarrhoea
Vomiting

Question 18

What are risk factors associated with having an NG tube present?

Answer 18

Feed going into lung
Chocking
Perforation of the oesophagus

Question 19

What are the clinical signs and symptoms of a critically ill adult despite the cause

Answer 19

Tachypnoea 
Reduced arterial BP 
Tachycardia 
Hypotension 
Reduced/ fluctuating GCS 
Reduced urine output

Question 20

What are the 5 stages of the ABCDE approach?

Answer 20

1. Initial assessment
2. Treat life threatening problems
3. Regular reassessment
4. Assess the effects of treatments/interventions
5. Escalate/refer if necessary

Question 21

What does diuresis mean?

Answer 21

Increased or excessive urine production

Question 22

What three factors should be taken into account when prescribing opioids such as morphine?

Answer 22

Patients: age, body mass and pain response.

Question 23

Which low values on two blood related tests would indicate blood loss?

Answer 23

Low haemoglobin and haematocrit

Question 24

How many mls per degree of elevated temperature should fluid resuscitation be increased by?

Answer 24

500mls.

Question 25

What percentage of total adult body weight is fluid?

Answer 25

60%

Question 26

What is the ratio of fluid distribution between the ECF and ICF?

Answer 26

ICF 2: ECF 1

Question 27

How frequent should one be with a NEWS of 0-1?

Answer 27

12hrly

Question 28

What are the 11 different types of venous blood test and what can they indicate?

Answer 28

``` Full blood count- anaemia, infection Urea and electrolytes- renal function Thyroid function test Liver function test Cholesterol Glucose Microbial- CRP, cultures, viral titres Clotting factors- on anticoagulants Creatinine CBG ABG ```

Question 29

What are the 3 types of microbial blood test done to detect infection?

Answer 29

CRP Cultures Viral titres

Question 30

Before ABCDE what should always be observed?

Answer 30

Danger and Risks of approaching to you or pt

Question 31

What are the different factors to be assessed to see if Airway is at risk?

Answer 31

``` Consciousness- low GCS unable to maintain airway require mechanical ventilation Vomiting/nausea Talking Choking Seesaw breathing Flail chest Surgical emphysema SOB Noise: wheeze, stridor, croaking Volume of breathing Sputum production Cough Equal lung expansion Chest percussion: ?fluid Central trachea ```

Question 32

What are the different areas of assessment in Breathing?

Answer 32

``` Effort: ?dyspnoea Pyrexial- increased O2 demand Rate, rhythm, depth: bradypnoea, tachypnoea, chyne-stokes respiration Kussmal breathing- metabolic acidosis Low GCS Damage to cervicale spine- C1-2 innerviates lungs, damage=inability to breathe SaO2 Sputum Pain- ineffective breathing= broken rib, pneumothorax, infection, deflated lobe/lung Chest percussion Noisy breathing COPD ```

Question 33

What are the potential causes of breathing compromise?

Answer 33

``` Airway obstruction COPD Asthma Infection Cardiac failure Chest trauma Shock ```

Question 34

What are the different areas of assessment in Circulation?

Answer 34

Skin assessment: warm? colour? dry or moist? CRT BP: normotensive, hypotensive, hypertensive Pulse pressure UO: decreased kindey perfusion- oliguria, anuria Chest pain: decreased cardiac perfusion Consciousness: cerebral perfusion Nausea: GI perfusion Stool output: large bowel perfusion ECG ABG: indicated at <95% sats MAP? Blood tests: FBC, U+E, Cultures, CRP, viral titre, liver/thyroid function test, cholesterol, glucose, clotting factors, creatinine test, cross match. Raised jugular venous pressure Manually palpate pulses for rate, rhythm, strength: bradycardia, tachycardia

Question 35

Potential causes of cardiac compromise?

Answer 35

ACS Heart failure Shock- tachycardia with reduced BP PE

Question 36

What are the different areas of assessment in Disability?

Answer 36

``` CBG: hypo/hyperglycaemia Scans: CT scan, X-Ray Distress AVPU -> GCS Drugs Pain ```

Question 37

What are the potential causes of altered GCS?

Answer 37

``` Hypoxia Reduced CPP Cerebral pathology Hypercapnia Uraemia Hypovolaemia Cardiac arthythmia Pre/post cardiac arrest ```

Question 38

What are the different areas of assessment in Exposure?

Answer 38

Full body exposure: feel for swelling, wetness, injury, pain, heat, coolness Look for rashes, injury, swelling, PMHX: allergies, surgery, drugs, medical conditions, illness PSHX: living circumstance, family, NOK, partner, dependants Case notes Documentation MDT involvement Care level Temperature: pyrexia, hypothermia SBAR: situation, background, assessment, recommendations

Question 39

What does SBAR stand for?

Answer 39

Situation Background Assessments Recommendations

Question 40

What is Base Excess?

Answer 40

The amount of an acid or base required to change 1L of blood to a pH of 7.4