Last 2 Weeks Flashcards
Response to a complaint
Support Acknowledge Investigate Notify / document Respond Implement Communicate Evaluate
Open Disclosure
Acknowledgement of event Expression of regret Factual explanation Further treatment Potential consequences Steps taken to manage / prevent recurrence
TV ultrasound - visible cardiac activity, CRL and expected BHCG
5.5 weeks, CRL 5 mm, BHCG 1500
Expect gestational sac at 1500
Criteria for pregnancy failure
Mean sac diameter > 25 mm and no foetal pole
CRL > 7 mm with no FHR
Steps to support impaired colleague
Assure confidentiality Relieve of duty Support time off Seek cause Assist with NOK APHRA notification Notify director Documentation
Depression screening questions
Mood? Sleep? Activity enjoyment? Appetite? Concentration? Irritable / interpersonal conflict? Suicide / self harm?
Design of protocol
Plan: research, benchmark, stake holders
Do: draft.
- Indications / Contraindications
- Preparation & supervision
- Description
- Outcome
- Complications
Study: input / feedback from stakeholders
Act: implement
Cycle: follow up and review
Disaster Management
Space - clear, allocate
Personelle - retain / call in / roster. Form teams. Brief teams. Other teams - surg / ortho
Equipment
Drugs
Organisation - media, exec, ED leadership, security
Post disaster - stand down, restocking, debriefing
Describe when to give epipen
If mild-moderate reaction (swelling of lips/face/eyes, hives, tingling of mouth) - locate epipen. Given antihistamine. Phone emerg contact.
If anaphylaxis:
- swelling of tongue / tightness of throat
- difficulty breathing, wheezing of persistent coughing. Hoarse voice.
- persistent dizziness or collapse (pale and floppy child)
Lie down, give adrenaline. Phone ambulance. Phone emerg contact. Repeat at 5 min.
CPR if not responsive and not breathing normally.
Calculate A-a gradient
PAO2 - PaO2
FiO2 (Patm - Pwv) - PaCO2 / 0.8
FiO2 (713) - PaCO2 x 1.25
150 - PaCO2 x 1.25
Normal < age/4 + 4
FiO2 2L & 4L min NP
0.28 & 0.36
FiO2 6L & 8L HM
0.4 & 0.6
FiO2 NRBM 15L min
0.9
Warfarin reversal
INR > 1.5 critical bleeding Stop warfarin IV vitamin K 10 mg Prothrombin complex concentrate 50 IU/kg FFP 300 mls
Rivaroxaban / apixaban reversal
TXA 1g
PCC 50 IU / kg
Andexanet if available
Dabigatran reversal
Idarucizumab 5g
TXA 1g
VT vs SVT
NW axis
Very broad (>160 msec)
AV dissociation
Capture / fusion beats
Positive or negative concordance precordial leads
RSR’, taller left r wave ear
Brugada sign (onset R to nadir S) > 100 msec
Josephsons sign: notching / slurring near nadir of S
Initial R wave in aVR (Vereckei)
Age > 35, structural or ischaemic heart disease, IHD, FHx SCD.
Nexus criteria
Normal alertness No intoxication No painful distracting injury No focal neurological deficit No midline tenderness
Alt: canadian C-spine rule.
Metabolic Alkalosis
H+ loss: vomiting, NGT drainage, renal diuretic - frusemide, or bartters synd.
HCO3 inc: citrate, admin HCO3, laxatives, milk alkali
Cushings: adrenal tumour, ectopic ACTH, steroids
PDA murmur
continuous, left infraclavicular
HCM murmur
midsystolic, inferior left sternal border, increase with valsalva / standing
VSD murmur
pan systolic murmur, inferior left sternal border
Diastolic murmur
Aortic regurgitation or mitral stenosis
Anion gap
Na - Cl + HCO3 = 12 +/-4
Corrected Na
Na + (glucose - 5) / 3
Delta ratio
Increase in AG / Dec in HCO3 AG - 12 / 24 - HCO3 0.4-0.8 = normal + HAGMA 1-2 = pure HAGMA > 2 = HAGMA + resp acidosis / met alkalosis
Expected HCO3 in respiratory acidosis
Acute = 1, chronic = 4
For every 10 increase in PaCO2, HCO3 goes up 1 / 4 depending if acute / chronic
Expected HCO3 in respiratory alkalosis
Acute = 2, chronic = 5
For every 10 decrease in PaCO2, HCO3 goes down 2 / 5
Urea: creatinine ratio
Urea : Creatinine (divided by 1000)
> 100 = prerenal
< 40 = renal
Metabolic alkalosis, expected CO2
20 + 0.7 x HCO3 (+/- 5)
Consent
Informed
Specific to procedure / treatment
No coersion
Have capacity
Capacity
Understand facts
Weight up consequences
Communicate choice
Triage in disaster
RR, SBP and GCS each aspect given a score of 0-4 Score < 10 - priority 1, resus Score 11 - priority 2, monitored bed Score 12 - priority 3 - observed area
Phone call for external emergency
Major disaster declared? Exact location? Type of incident? Hazards Access No of casualties Emerg services present / needed
Requirements for transfer
Patient with monitoring
Equipment and drugs, anticipation of complications
Staff with appropriate skills set
Department safe
Thrombolysis in CVA
IV tPA/alteplase 0.9mg/kg to 90 mg, 10% initial bolus and then remaining over 60 min
Thrombolysis in PE
Massive PE (arrest, SBP < 90 15 min)
tPA / Alteplase IV 90 mg over 2 hrs
Arrest - 50 mg bolus
Thrombolysis in STEMI
Suggestive Hx, ECG diagnosis, Chest pain > 30 min < 12 hrs, no PCI within 90 min
Tenecteplase IV 1000 units / kg to 10,000 units.
Contraindications to thrombolysis
HTN > 180/110
Active bleeding / coagulopathy / anticoagulation
CNS: ICH, CVA, CNS tumour, AVM
Major surgery < 1 month
GI / GU bleeding < 1 month
Life limiting illness: advanced liver disease, dementia
DDx right heart strain
Pulmonary hypertension Pulmonary embolism Chronic lung disease Mitral stenosis Congenital heart disease (PS or TOF) ARVD
Signs of PE on ECG
Sinus tachycardia Anterior (V1-v3) TWI Right axis deviation Right bundle branch block S wave I Q wave and TWI in III
Causes of LBBB
Ischaemic heart disease Anterior MI HTN Aortic stenosis Cardiomyopathy Myocarditis Hyperkalaemia
Causes of LAD
LAFB LBBB LVH Inferior MI WPW Pacing / VEs
Causes of RBBB
RVH Pulmonary embolism Ischaemic heart disease Congenital heart disease (ASD) Myocarditis Cardiomyopathy
Causes of RAD
LPFB RVH Lateral MI Lung disease / PE VT Hyperkalaemia Sodium channel blockade
How to give urinary alkalinisation
1-2 mEq/kg Sodium bicarbonate
150 mmol NaHCO3 in 950 mls 5% glucose at 250 mls/hr, add 20 mmol/KCL
Target urine pH > 7.5
ECG findings in TCA poisoning
IVCD - QRS > 100 msec RAD RS Ratio > 0.7 in aVR Sinus tachy (muscarinic) Prolonged QT
Causes of high osmolar gap
Tox -ethanol, ethylene glycol, methanol - polypropylene glycol - mannitol Non-tox - ketoacidosis - alcoholic, DKA - renal failure - hyperlipidaemia and hyperproteinaemia - Severe lactic acidosis, trauma, burns
Examination elements in cerebellar disease
Vital signs - fever, hypotension
Speech - staccato, slurred
Gait - wide based, ataxia. normal rhombergs.
CnNv - associated abn, nygstagmus, ophthalmoplegia, RAPD, facial weakness
Limb neuro - hypotonia, cooridnation - disdiadochokinesis, intention tremor, pendular reflexes
Ear - HZV lesions
Eye - papilloedema
CVS - PR & rhythm, postural hypotension, murmurs, carotid bruits, pulses
Disdiadochokinesis, Ataxia, Nystagmus, Intention tremor, Slurred/staccato speech, Hypotonia
Examination elements in vertigo
Vital signs
Speech - slurred / staccato
Gait - ataxia, normal rhombergs
Nystagmus
Head impulse
Test of skew
CnNv - specifically opthalmoplegia, RAPD, facial weakness, hearing loss
PNS - hypotonia, coordination - disdiadochokinesis / intention tremor, pendular reflexes
Ear - obstruction canal, cholesteatoma, HZV
CVS - postural BP, HR and rhythm, pulses, murmurs, carotid bruits
BPPV - dix hallpike / epley
Causes of complete heart block
AMI - inferior / anterior
Hyperkalaemia
Drug toxicity - ca / b-blocker
Inflammatory - myocarditis, rheumatic fever
Infiltrative - sarcoid, haemochromatosis
Autoimmune - SLE
Idiopathic fibrosis
