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! NHS Normal Values > Just memrise > Flashcards

Just memrise Flashcards

1
Q

Naloxone dose

A

IV 0.8-2.0 mg
2-3 minutes interval
Maximum 10 mg

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2
Q

Co-amoxiclav dose

A

IV 1.2 g
6-8 hourly
- For every unexplained cardiorespiratory collapse

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3
Q

NSTEMI tx dose

A

Morphine 2.5-5mg IV + metoclopromide 10mg iV
Aspirin 300mg PO
Fondaparinux 2.5mg OD SC 2-5 days
Clopidogrel 300mg PO, Ticagrelor 180mg PO
(Prasugrel 60mg OD if bridge to PCI)
BB bisoprolol 2.5mg OD

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4
Q

Posterior STEMI characteristics

A

ST-depression in anterior leads
Dominant R-wave in V1 and V2

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5
Q

DKA dx 3 criteria

A
  1. Cap blood glucose > 11mmol/L OR known DM
  2. Cap blood ketons > 3mmol/L
  3. Venous bicarbonate ≤ 15mmol/L OR pH ≤ 7.30
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6
Q

HHS dx 3 criteria

A
  1. Serum blood glucose ≥ 30mmol/L
  2. Se osmolality > 320 mOsm/kg
  3. pH > 7.3 OR bicarbonate > 15mmol/L
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7
Q

Diabetes mellitus (DM) Diagnostic Criteria

A
  1. Fasting blood glucose > 7.0 mmol/L
  2. OGTT 2h > 11.1 mmol/L
  3. HbA1c ≥ 6.5%
  4. Random plasma glucose > 11.1 mmol/L PLUS hyperglycaemic symptoms (polyuria, polydipsia, unexplained weight loss)
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8
Q

STEMI ECG Features

A
  • ST segment elevation (≥ 2mm in men, ≥ 1mm in women) (in 2 or more contiguous limb leads or chest leads)
  • New Q wave formation (patho Q)
  • New conduction deficit- LBBB (anterior MI)
  • +/- T-inversion
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9
Q

Thrombocytopaenia

A
  • < 150 x10^9/L
  • Severe- < 50 x10^9/L
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10
Q

Anaemia

A
  • Hgb male < 130 g/L
  • Hgb female < 120 g/L

< 80 g/L → transfusion

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11
Q

Elevated lactate

A
  • > 4 mmol/L
  • < 2 is normal
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12
Q

Elevated CRP

A
  • > 5 mmol/L
  • < 5 is normal
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13
Q

Elevated ketones

A
  • > 3.0 mmol/L is DKA
  • < 0.6 is normal
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14
Q

Tx of hypocalcaemia

A
  • Ca2+ normal is 2.2-2.7 mmol/L
  • Mild > 1.9 mmol/L and asymptomatic → SANDOCAL 10000 2 tablets BD PO/NG
  • Severe < 1.9 mmol/L or symptomatic → IV caclcium gluconate
  • Monitor with cardiac telemetry
  • Check magnesium levels (regulates PTH function)
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15
Q

Hypoglycaemia values

A
  • Non-diabetic cap BG- < 3.3 mmol/L
  • Diabetic cap BG- < 4.0 mmol/L
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16
Q

Conscious hypoglycemic pt TX

A
  • Oral 10-20g glucose → dextrose tablets, sugar, glucose gel
  • Check after 15 minutes
  • Give long-acting carbs after → sandwich, fruit, milk, biscuits
  • Monitor BM every 15 minutes for the first hour
  • If patient is stable and BM > 4.0 mmol/L decrease frequency
  • Determine cause
  • Review diabetic medication
  • Discuss drug adjustment with senior to avoid hypoglycaemia
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17
Q

Unconscious hypoglycaemic pt TX

A
  • IV glucose 100ml 20%
  • OR 2 tubes of glucogel in gums
  • Glucagon 1mg IM if refractory (use once only; avoid in repeated hypoglycaemia)
  • Check BM and consciousness after 10 minutes → BM > 4 or unconscious give further glucose IV 100ml 20% for 15 minutes
  • Repeat
  • Call senior
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18
Q

Tx of hypokalaemia

A
  • Normal K+ 3.5 - 5.2 mmol/L
  • > 3.0 mmol/L → SANDO K 2 tablets TDS PO/NG (48h is sufficient)
  • < 3.0 mmol/L → KCl 40 mmol/L in NaCl 0.9% IV (over 4 hours, no faster than 10 mmol/h)
  • Cardiac monitor
  • Check magnesium levels
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19
Q

COPD Exacerbation Tx

A
  • Low SpO2 → O2 therapy (see ABG to see if they are CO2 retainers)
  • Wheeze → Salbutamol nebuliser, ipratropium bromide nebuliser, prednisolone PO or hydrocortisone IV
  • No response → call senior +/- aminophylline
  • Antibiotics with sputum sample
  • Mucus → expectorants → Saline neb, carbocisteine PO, chest physiotherapy
  • ABG shows acidosis → BiPAP
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20
Q

Status epilepticus tx

A
  • Any seizure > 5 mins
  • Buccal midazolam or rectal diazepam or IV lorazepam
  • If seizure persists > 10 mins → IV lorazepam 4mg
  • If seizure > 20 mins → Phenytoin IV (alternative agent), Levetircetam, Valproate
  • If seizure > 20 mins → escalate to critical care
  • Suspected alcohol abuse → Pabrinex IV
  • Suspected cerebral edema → Dexamethasone IV
  • Monitor patient vitals; consider LP, CT head, EEG
  • Review medication- may reduce seizure threshold (see BNF)
  • Seizure PRN prophylaxis prescription adviced- e.g. Levetiracetam
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21
Q

DVT Tx

A
  • DOACs- Apixaban, Rivaroxaban
  • Warfarin with LMWH bridging for 5 days
  • Compression stockings

Provoked DVT- 3 months tx
Unprovoked DVT- 6 months tx
Lifetime maybe

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22
Q

Signs of cerebral edema/ increased ICP

A

Early signs:
* Headache
* Nausea, vomiting
* Altered consciousness
* Papilledema
* Pupil changes

Late signs:
* Cushing’s triad- hypertension (widening pulse pressure), bradycardia, irregular respirations (Cheyne-Stokes/ apnoea)
* ‘Blown pupil’- fixed, dilated pupils
* Posturing- decorticate, decerebrate
* Seizures
* Decreased GCS
* Focal neurological deficits

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23
Q

Beck’s triad

A
  1. Distended neck veins (JVD)
  2. Hypotension
  3. Muffled heart sounds
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24
Q

Thromboprophylaxis tx

A

For hospitalized, immbobile, VTE risks, pregnant, post-partum pts
* LMWH- enoxaprain 40mg SC OD
* Compression stockings
* If renal impairment present (eGFR < 30 ml/min) give reduced dose of LMWH

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25
Q

Pulmonary embolism (PE) tx

A
  • DOACs- Apixaban, Rivaroxaban
  • Massive PE- thrombolysis with alteplase, surgical or catheter-directed thrombectomy

Unprovoked- 3 months tx
Provoked- 6 months tx
Lifetime maybe

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26
Q

Heart failure tx

A
  • Fluid restriction
  • Diuretics- Furosemide 40mg IV
  • GTN infusion
  • NIV
  • BNP measurement
  • Daily weight measurements, urine output measurement- aim negative fluid balance
  • Monitor renal function and electrolytes
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27
Q

Pneumonia tx

A
  • Oxygen
  • Early antibiotics
  • IV fluids as required

Productive?- do a sputum culture
CXR- if normal, think atypical pneumonia -> atypical screening (urine screen) for mycoplasma, legionella
Viral?- COVID, influenza, RSV
CRP, WCC, Neutrophil- see improvements?
Fever?- take blood culture- think sepsis or bacteremia

28
Q

First-line hypertension tx

A
  1. ACE/ARB
  2. CCB
  3. Thiazide

Hypertensive emergency:
* BB- labetalol
* CCB- nifedipine, nicardipine, nimodipine
* Only in aortic dissection- nitroprusside, GTN

29
Q

Frailty assessment

A
30
Q

Head injury assessment

A
31
Q

Cerebral edema/ ICP tx

A
  • Elevate head of bed 30°
  • Hyperosmolar therapy- mannitol, hypertonic saline
  • Intubation and ventilation- induce mild hyperventilation
  • Neurosurgical consult- decompressive craniectomy, external ventricular drain
32
Q

DKA tx

A

Follow protocol
* Fluid replacement
* Fixed rate insulin infusion (FRII) regardless of patient BM
* Replace potassium and glucose
* VBG shows normal pH- switch to variable rate (VRII) after checking patient BM hourly
* Patient recovers and can eat and drink- return to basal bolus regime (normal tx)

33
Q

HHS tx

A
  • FLUIDS!!!
  • Correct K+
  • If needed, use insulin (not always needed)
34
Q

Hypernatraemia tx

A
35
Q

Hyperkalaemia tx

A
  • Stabilise heart membrane potential- sodium zirconium cyclocilicate, IV calcium gluconate
  • Shift K+ into cells and remove from body- Insulin-Glucose IV infusion, salbutamol nebulised

Regularly monitor K+ and glucose levels

36
Q

Hypermagnesaemia tx

A
37
Q

Asthma exacerbation tx

A
  • Oxygen (target 94-98%)
  • Salbutamol and ipratropium bromide nebulised
  • Predinosolone PO or hydrocortisone IV
  • Magnesium sulphate IV
  • Consider aminophylline IV (after senior consultation)
38
Q

Haemorrhage tx (major haemorrhage protocol)

A
39
Q

Constipation tx

A
40
Q

3 signs of anaphylaxis

A
  1. Acute airway compromise- stridor, tachypnoea, wheeze
  2. Skin reactions- rashes, urticaria
  3. Circulatory compromise- hypotension/ shock, tachycarida
41
Q

Delirium assessment (CAM- confusion assessment method)

A
  1. Acute onset and fluctuating course.
  2. Inattention.
  3. Disorganized thinking or altered level of consciousness.
42
Q

Dementia tx

A
43
Q

AAA tx

A

*

44
Q

Thoracic aortic aneurysm rupture

A

CXR- wide mediastinum
Pulse and BP- different between arms
CTA!! with contrast

  • Vascular referral if dissected
  • Large dilation/ symptomatic/ clot formation- vascular referral
  • Asymptomatic- conservative treatment- keep systolic < 110bpm using BB (labetalol) or CCB

Presentation:
* Unequal arm pulses and BP
* Acute limb ischemia
* Hemiplegia (carotid artery)
* Paraplegia (anterior spinal artery)
* Anuria (renal arteries)
* Aortic valve incompetence, inferior MI, cardiac arrest (more proximal dissection)

45
Q

Esophageal varices tx

A
46
Q

Esophageal rupture tx

A
47
Q

PTX tx

A
  • Needle thoracocentesis
  • Chest tube insertion
  • CXR after
48
Q

Alcohol withdrawal tx

A
  • Chlordiazepoxide
  • Pabrinex (thiamine) IV
  • Oral thiamine
  • Oral multivitamin
  • Hydration and electrolytes (magnesium and phosphates)

Do hematinics (iron studies)

49
Q

Non-emergency hyperglycaemia tx
(no elevated ketones, no severe hyperglycaemia i.e. < 30 mmol/L)

A
  • Corrective insulin- 2-5 units of short/rapid insulin
  • Review ketones and BM after 4 hours
  • Repeat correction as needed
50
Q

Hypoglycaemia tx

A

Patient conscious (non-emergency):
* Oral 10-20g glucose
* Long acting oral carbs
* Review patient diabetic medication- insulin, sulfonylureas

Patient unconscious
* IV glucose 100ml 20% +/- glucagon 1mg IM (if refractory; use only once)
* Repeat every 10-15 minutes depending on BM

51
Q

MCA (mental capacity assessment)

A
  1. Can pt understand what i’m saying
  2. Can they retain information
  3. Can they weigh the info
  4. Can they communicate it back or repeat it to you

Even if 1 is iffy- NO CAPACITY
Treat with best interest

52
Q

Bradyarrhythmia tx

A
  • Atropine
  • Adrenaline
  • Transcutaneous pacing
  • Glucagon (if caused by BB or CCB)
  • Aminophylline
53
Q

Tachyarrhythmia tx

A
  • Immediate synchronised cardioversion
  • Pharmacological cardioversion- Adeonosine
  • Rate control- BB, CCB

In regular, narrow tachyarrhythmia try vagal maneuvers first

54
Q

Atrial fibrillation

A
  • Determine cause- cardiac, endocrine, electrolyte, infection, etc.
  • CHA2DS2-Vasc score to assess stroke risk
  • HAS-BLED score to assess bleeding risk if treated with anticoagulants
  • First-line tx- NOACs
  • NO ASPIRIN to prevent stroke
  • Rate control- beta blocker, CCB, digoxin (heart failure)
  • Cardioversion- sotalol, flecainaide, amiodarone, DC cardioversion (if haemodynamically unstable)
55
Q

Cellulitis

A

Presentation- erythema, edema, warmth, tenderness
Ddx. erisypelas- unlike erisypelas, cellulitis has poorly defined lesion with induration

Antibiotics- flucloxacillin, doxycycline, erythromycin
Necrotising infection- debridement, C&S, IV antibiotics

Wound swab
DVT assessment
Fever- blood culture

56
Q

Back pain

A

Primary pathology:
* **Muscle strain due to overuse ** (most common)
* Spondylosis (degenerative arthritis of the spine)
* Intervertebral disc herniation
* Compression fracture
* Anatomical abnormalities- scoliosis, spondylolisthesis

Systemic:
* Infection- epidural abscess, vertebral osteomyelitis, discitis
* Metastasis- lung, breast, prostate, renal, thyroid, myeloma
* Inflammatory back pain- ankylosing spondylitis, psoriatic/ reactive/ enteropathic arthritis

Referred:
* Aortic dissection, aneurysm
* Pacnreatitis
* Kidney- pyelonephritis, nephrolithiasis, perinephric abscess
* Retroperitoneal haemorrhage

57
Q

What is cauda equina syndrome

A
  • Leg weakness
  • Urinary retention
  • Decreased anal sphincter tone
  • ‘Saddle anaesthesia’

Massive midline disc herniation- immediate neurosurgical consult

58
Q

Red flags in back pain

A

Cancer:
* Age > 60
* History of cancer
* Unexplained weight loss
* Failure to improve with conservative therapy

Infection:
* Fever
* Immunosuppression
* Focal midline tenderness
* Known or suspected bacteremia
* Indwelling venous catheter
* IVDU

Cauda equina syndrome:
* Urinary retention
* Fecal incontinence

MRI > XR in back pain

59
Q

Cocaine tx

A
  • Hypertension and tachycardia- BZD, nitroglycerin, phentolamine (alpha-blocker)
  • Chest pain/ MI- MONA
  • Anxiety, agitation, psychosis, seizures- BZD
  • Hyperthermia- aggressively cool patient, IV fluids to prevent rhabdomyolysis (monitor for AKI), BZD to reduce metabolic activity

AVOID BB- can cause unopposed alpha-adrenergic activity that can worsen hypertension

60
Q

Paracetamol poisoning

A

Fatal- 12g or 150mg/kg in adults
Presentation- Vomiting, RUQ pain, jaundice, hepatic encephalopathy, AKI

Investigation
* blood paracetamol > 4h post-ingestion, plotted against paracetamol normogram
* Glucose, U+E, LFT, INR, FBC, HCO3-, lactate

Management:
* Activated charcoal 1g/1kg if < 4h after ingestion
* N-acetylcysteine (NAC) if paracetamol conc. over treatment line, or unknown timing, or staggered dose

Monitor:
* LFT, INR, VBG, paracetamol conc.
* If INR < 1.3 and ALT normal, tx may stop

61
Q

Salicylate poisoning

A

Mild toxicity- 150mg/kg = > 2.5 mmol/L blood salicylate conc.
Presentation- tinnitus, nausea, vomiting, headache, abdominal pain, tachypnea, tachycardia , confusion, slurred speech, hypoglycaemia, hallucinations, cerebral and pulmonary edema, hypotension, arrhythmia, hypoventilation

Management:
* Activated charcoal 1g/kg (max 50g) if within 1h of ingestion, consider repeat doses
* Correct volume and K+ depletion
* Alkalinize urine- 1L 1.2-1.4% IV sodium bicarbonate over 3-4h; aim for urine pH 7.5-8.0
* Haemodialysis
* Supportive care- correct hypoglycaemia, treat seizures

Investigate and monitor:
* Paracetamol and salicylate conc.
* U+E, bicarbonate, lactate, ABG (monitor pH- metabolic acidosis), glucose
* FBC, clotting studies, calcium, magnesium, LFT
* Monitor serum K+ as hypokalaemia can occur- caution AKI
* ECG and cardiac monitor
* Repeat salicylate conc. every 2h
* Psychiatric assessment before sending home

62
Q

Fall

A
  • Rule out bleeding- are they on anticogulants?
  • Focal neurological deficit?
  • Did they hit their head?
  • Confusion?
  • History- TIA, MI
  • CT Head, XR for fractures (symptom dependent)
63
Q

Neutropenic sepsis

A
  • ISOLATE in side room
  • Antibiotics
64
Q

Important cellulitis ddx

A

DVT

65
Q

Sudden spike in oxygen demand

A

Pulmonary embolism

66
Q

AAA presentation

A

65yo male with abdominal pain radiating to groin
Unexplained back/ loin pain
Syncope, shock

Hypertension, smoker, male

! NHS Normal Values (6 decks)

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