Just memrise Flashcards
1
Q
Naloxone dose
A
IV 0.8-2.0 mg
2-3 minutes interval
Maximum 10 mg
2
Q
Co-amoxiclav dose
A
IV 1.2 g
6-8 hourly
- For every unexplained cardiorespiratory collapse
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
4
Q
Posterior STEMI characteristics
A
ST-depression in anterior leads
Dominant R-wave in V1 and V2
5
Q
DKA dx 3 criteria
A
- Cap blood glucose > 11mmol/L OR known DM
- Cap blood ketons > 3mmol/L
- Venous bicarbonate ≤ 15mmol/L OR pH ≤ 7.30
6
Q
HHS dx 3 criteria
A
- Serum blood glucose ≥ 30mmol/L
- Se osmolality > 320 mOsm/kg
- pH > 7.3 OR bicarbonate > 15mmol/L
7
Q
Diabetes mellitus (DM) Diagnostic Criteria
A
- Fasting blood glucose > 7.0 mmol/L
- OGTT 2h > 11.1 mmol/L
- HbA1c ≥ 6.5%
- Random plasma glucose > 11.1 mmol/L PLUS hyperglycaemic symptoms (polyuria, polydipsia, unexplained weight loss)
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
9
Q
Thrombocytopaenia
A
- < 150 x10^9/L
- Severe- < 50 x10^9/L
10
Q
Anaemia
A
- Hgb male < 130 g/L
- Hgb female < 120 g/L
< 80 g/L → transfusion
11
Q
Elevated lactate
A
- > 4 mmol/L
- < 2 is normal
12
Q
Elevated CRP
A
- > 5 mmol/L
- < 5 is normal
13
Q
Elevated ketones
A
- > 3.0 mmol/L is DKA
- < 0.6 is normal
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)
15
Q
Hypoglycaemia values
A
- Non-diabetic cap BG- < 3.3 mmol/L
- Diabetic cap BG- < 4.0 mmol/L
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
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
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
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
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
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
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
23
Q
Beck’s triad
A
- Distended neck veins (JVD)
- Hypotension
- Muffled heart sounds
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
25
Pulmonary embolism (PE) tx
* DOACs- Apixaban, Rivaroxaban
* Massive PE- thrombolysis with alteplase, surgical or catheter-directed thrombectomy
Unprovoked- 3 months tx
Provoked- 6 months tx
Lifetime maybe
26
Heart failure tx
* 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
27
Pneumonia tx
* 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
First-line hypertension tx
1. ACE/ARB
2. CCB
3. Thiazide
Hypertensive emergency:
* BB- labetalol
* CCB- nifedipine, nicardipine, nimodipine
* Only in aortic dissection- nitroprusside, GTN
29
Frailty assessment
30
Head injury assessment
31
Cerebral edema/ ICP tx
* Elevate head of bed 30°
* Hyperosmolar therapy- mannitol, hypertonic saline
* Intubation and ventilation- induce mild hyperventilation
* Neurosurgical consult- decompressive craniectomy, external ventricular drain
32
DKA tx
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
HHS tx
* FLUIDS!!!
* Correct K+
* If needed, use insulin (not always needed)
34
Hypernatraemia tx
35
Hyperkalaemia tx
* 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
Hypermagnesaemia tx
37
Asthma exacerbation tx
* Oxygen (target 94-98%)
* Salbutamol and ipratropium bromide nebulised
* Predinosolone PO or hydrocortisone IV
* Magnesium sulphate IV
* Consider aminophylline IV (after senior consultation)
38
Haemorrhage tx (major haemorrhage protocol)
39
Constipation tx
40
3 signs of anaphylaxis
1. Acute airway compromise- stridor, tachypnoea, wheeze
2. Skin reactions- rashes, urticaria
3. Circulatory compromise- hypotension/ shock, tachycarida
41
Delirium assessment (CAM- confusion assessment method)
1. Acute onset and fluctuating course.
2. Inattention.
3. Disorganized thinking or altered level of consciousness.
42
Dementia tx
43
AAA tx
*
44
Thoracic aortic aneurysm rupture
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
Esophageal varices tx
46
Esophageal rupture tx
47
PTX tx
* Needle thoracocentesis
* Chest tube insertion
* CXR after
48
Alcohol withdrawal tx
* Chlordiazepoxide
* Pabrinex (thiamine) IV
* Oral thiamine
* Oral multivitamin
* Hydration and electrolytes (magnesium and phosphates)
Do hematinics (iron studies)
49
Non-emergency hyperglycaemia tx
(no elevated ketones, no severe hyperglycaemia i.e. < 30 mmol/L)
* Corrective insulin- 2-5 units of short/rapid insulin
* Review ketones and BM after 4 hours
* Repeat correction as needed
50
Hypoglycaemia tx
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
MCA (mental capacity assessment)
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
Bradyarrhythmia tx
* Atropine
* Adrenaline
* Transcutaneous pacing
* Glucagon (if caused by BB or CCB)
* Aminophylline
53
Tachyarrhythmia tx
* Immediate synchronised cardioversion
* Pharmacological cardioversion- Adeonosine
* Rate control- BB, CCB
In regular, narrow tachyarrhythmia try vagal maneuvers first
54
Atrial fibrillation
* 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
Cellulitis
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
Back pain
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
What is cauda equina syndrome
* Leg weakness
* Urinary retention
* Decreased anal sphincter tone
* 'Saddle anaesthesia'
Massive midline disc herniation- immediate neurosurgical consult
58
Red flags in back pain
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
Cocaine tx
* 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
Paracetamol poisoning
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
Salicylate poisoning
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
Fall
* 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
Neutropenic sepsis
* ISOLATE in side room
* Antibiotics
64
Important cellulitis ddx
DVT
65
Sudden spike in oxygen demand
Pulmonary embolism
66
AAA presentation
65yo male with abdominal pain radiating to groin
Unexplained back/ loin pain
Syncope, shock
**Hypertension, smoker, male**
