High Yield Facts Flashcards
Reversible causes of Cardiac Arrest
4Hs and 4Ts
Hypoxia
Hypo-Hyper-kalaemia (metabolic)
Hypovolaemia
Hypothermia
Tamponade
Toxins
Tension pneumothorax
Thromboembolism
Sick sinus syndrome
Dysfunction of the sinoatrial node often precipitated by ischaemia/fibrosis
Results in bradycardia (±arrest), sinoatrial block or SVT with alternating bradycardia/asystole (tachy-brady syndrome)
Needs pacing if symptomatic.
Enoxaparin
LMWH
40mg/24h SC
or
20mg/24h if eGFR <30ml/min
Septic screen
FBC (repeat every 2d)
Inflammatory markers, ESR, CRP (repeat every 2–4d)
Urine culture (separate samples from any nephrostomies/urostomies)
Sputum culture, if indicated
Blood cultures (3 sets at 6–8h intervals from different veins; additional sets from any central lines)
Microbiology swabs of wounds/pressure areas/cannula or central line sites
CXR if productive cough or abnormal clinical signs present.
If infectious source still not identified, consider:
Procalcitonin (will be negative if non-infective cause, Emergency department [link])
Stopping all antibiotics (if stable) and repeating all cultures after 48h
Echocardiogram if new murmur or new stigmata of bacterial endocarditis
Check sickle-cell status
Blood film for parasites (if malaria is suspected)
Lumbar puncture if CNS infection suspected or needs excluding (CT first).
Severe Asthma
Incomplete sentences
PEFR <50 of best
RR >25
Life-threatening Asthma
PEFR <33% of best
Silent chest
Poor respiratory effort, exhaustion, cyanosis
Sats <92%
PaO2 <8kPa
Normal PaCO2
Altered GCS
Arrhythmia
Near-fatal Asthma
CO2 retention – call ICU
Magnesium sulphate
2g over 20 minutes
IV
When to admit asthma attack
PEFR<75% predicted after 1h therapy
Gradually reduce supplemental O2 and step from nebs back to inhalers over several days; always check inhaler technique and ensure follow-up plan in place before discharge.
Antibiotics for COPD exacerbation
Doxycycline 200mg PO loading then 100mg/24h PO
or
Amoxicillin 500mg/8h PO
CURB-65
Confusion
Urea >7.0mmol/L
Respiratory Rate >30
Blood pressure (systolic >90 or diastolic <60 mmHg)
65- age 65 or over
1 point for each feature
Curb Score 0-1
Low risk of mortality ~3%
?Unstable
?Comorbidities
No –> Discharge and amoxicillin 500mg/8h PO at home
Yes –> admit, amoxicillin 500mg/8h PO
Curb score 2
Moderate risk of mortality ~9%
Admit to hospital
Supportive care
500mg Amoxicillin/8h PO
+
500mg Clarithromycin/12h PO
Send blood cultures
Send sputum cultures
Send pleural aspirate for pneumococcal antigen testing and culture
Send urine for pneumococcal, legionella antigen
Curb score 3-5
High risk of mortality ~15-4%
Admit to hospital, critical care unit
Supportive treatment
IV co-amoxiclav 1.2g
+
IV clarithromycin 500mg
Send blood cultures
Send sputum cultures
Send pleural aspirate for pneumococcal antigen testing and culture
Send urine for pneumococcal, legionella antigen
Consider atypicals
Modified Wells Score
> 4 –> CTPA or treat with LMWH
Enoxaparin 1.5mg/kg/24h SC
<4 –> D-dimer
If negative, review diagnosis
If positive –> immediate CTPA or LMWH
