General Points 12 Flashcards
ECG changes in PE
S1, Q3, T3 Tall R waves in V1 P Pulmonale in inferior leads RAD/RBBB Atrial arrhythmias T wave inversion in V1/2/3 Right heart strain
ECG changes in hypothermia
J waves
Goodsals rule
Anterior fistulae will tend to have an internal opening opposite the external opening.
Posterior fistulae will tend to have a curved track that passes towards the midline.
Stages of hypothermia
1 (mild) - awake and shivering (32 - 35C)
2 (moderate) - drowsy and not shivering (28 - 32C)
3 (severe) - unconscious and not shivering (20 - 28C)
4 (profound) - no vital signs (<20C)
Pancreatic pseudocyst
In acute pancreatitis result from organisation of peripancreatic fluid collection. May or may not communicate with the ductal system.
Collection is walled by fibrous or granulation tissue and typically occurs 4 weeks or more after an attack of acute pancreatitis
Most are retrogastric
75% are associated with persistent mild elevation of amylase
Ix - CT, ERCP and MRI or Endoscopic USS
Symptomatic cases may be observed for 12 weeks as up to 50% resolve
Treatment is either with endoscopic or surgical cystogastrostomy or aspiration
Pancreatic necrosis
Pancreatic necrosis may involve both the pancreatic parenchyma and surrounding fat
Complications are directly linked to extent of parenchymal necrosis and extent of necrosis overall
Early necrosectomy is associated with a high mortality rate (and should be avoided unless compelling indications for surgery exist)
Sterile necrosis should be managed conservatively (at least initially)
Some centres will perform fine needle aspiration sampling of necrotic tissue if infection is suspected. False negatives may occur. The extent of sepsis and organ dysfunction may be a better guide to surgery
Pancreatic abscess
Intra abdominal collection of pus associated with pancreas but in the absence of necrosis
Typically occur as a result of infected pseudocyst
They are usually managed by placement of percutaneous drains
