MACS Flashcards
immediate drug management for anaphylaxis
give 500 micrograms IM adrenaline 1:1000
indications for long term oxygen therapy
chronic hypoxaemia:
- COPD
- interstitial lung disease
- CF
- bronchiectasis
- pulmonary arterial disease
- pulmonary HTN
- severe HF
–> when PaO2 is consistently at/below 7.3 kPa
use of nasal cannulae O2
mild hypoxia, usually non-acute
prongs positioned in nose
flow rate of nasal cannula O2
24-30% O2 –> max 4L/min
issues with nasal cannula O2
high flows will dry and irritate nasal passages
do not allow close control of FiO2
flow rate of non-rebreather mask
~70% when used with 15L O2 flow rate
who are venturi masks used on
those with COPD due to risk of T2 resp failure
what are the colours of venturi mask and their flow rates?
blue venturi
2-4 L/min, 24%
white venturi
4-6L/min, 28%
yellow venturi
8-10L/min, 35%
red venturi
10-12L/min, 40%
green venturi
12-15L/min, 60%
how do you interpret the bradens score?
out of 24, low score =high risk
some risk=15+
moderate risk=13-14
high risk=10-12
very high risk=9 or below
what factors does the Bradens score take into account
sensory perception
moisture
activity
mobility
nutrition
friction/shear
components of MUST tool
BMI score
weight loss score
acute disease effect score
–> added together calculate overall malnutrition risk
scoring in MUST tool
0 = low risk
1 = medium risk
2 + = high risk
normal urine output in health individual
between 0.5-1.5ml/kg/hr
should urinate at least every 6 hours
oliguria definition
production of inadequate urine volumes
<500ml/day in adults
composition of NaCl 0.9%
isotonic
154 mmol/L of Na+
154 mmol/L of Cl-
composition of Hartmann’s
isotonic
131 mmol/L of Na+
5 mmol/L of K+
111 mmol/L of Cl-
29 mmol/L of HCO3-
composition of NaCl 0.18% + glucose 4%
hypotonic
30 mmol/L of Na+
30 mmol/L of Cl-
40 g/L of glucose
composition of 5% dextrose fluid
hypotonic
50g/L of glucose
what are the daily maintenance fluid requirement
- 25-30ml/kg/day of water
- ~ 1mmol/kg/day of K, Na, Cl
- ~ 50-100g/day of glucose to limit starvation ketosis
what is obstructive shock?
Shock that occurs when there is a block to blood flow in the heart or great vessels, causing an insufficient blood supply to the body’s tissues.
what is distributive shock?
Shock due to a shift of fluid from blood to tissues
when would there not be an increase in HR in shock
if on beta blockers
clinical conditions associated with obstructive shock
- cardiac tamponade
- tension pneumo
- PE
- coarctation of aorta
- air embolus
- aortocaval compression
what is malar flush associated with
mitral stenosis
what is a narrow pulse pressure
<25mmHg between
what is a wide pulse pressure
more than 100mmHg between
what is the difference between a central line and an arterial line?
arterial-into artery
central-into large vein eg internal jugular, subclavian going into the vena cava.
examples of medications which need central line
amiodarone
inotropes
high conc electrolytes
what is the surgical site bundle
- antibiotic prophylaxis within last 60 mins
- patient warning
- hair removal
- glycaemic control
types of adrenaline
1/1000 = anaphylaxis
1/10000 = cardiac arrest
atropine use
symptomatic bradycardia
bradydysrhythmias
what is the treatment for asymptomatic inguinal hernia?
routine referral for surgical repair-because most become symptomatic and have surgery anyway but obvs is not urgent
what are the 3 types of distributive shock?
septic
anaphylactic
neurogenic
(due to redistribution of body fluids)
what is a contraindication of bipap?
current smoking
what is a common cause of fever a few days after surgery?
pneumonia -especially in those who have undergone thoracic/abdominal procedures
what are the causes of post-op fever in the timeline of after the operation?
5Ws: wind, water, walking, wound, wonder about drugs
1-2 days: lungs -aspiration, pneumonia, atelectasis, PE
3-5 days: UTI, CAUTI (catheter associated UTI)
4-6 days: DVT/PE, immobility
7+ days: wonder about drugs -doesn’t fit the picture
what are used for reporting suspected adverse drug reactions to medicines, medical device incidents, and suspected fake or defective medicines?
yellow cards
what investigations imaging wise do you do for bowel obstruction?
CT abdo pelvis -gold standard for diagnosis. go straight to this if you’re pretty sure it’s bowel obstruction.
AXR -to rule it out
what substances do you use to clean wounds post op?
sterile saline -up to 48 hours after
past 48 hours -can shower
tap water past 48 hours if wound has seperated /has been surgically opened to drain pus
what is oliguria?
production of inadequate volumes of urine (<500ml/day in adults, <1ml/kg/hour in infants)
what are the types of post op bleeding?
primary =within intraoperative period
reactive =within 24h of operation
secondary =7-10 days post op
what is staging tool for pressure ulcers and the different stages?
NPUAP/EPUAP pressure ulcer classification system
stage 1-non blanchable erythema
stage 2-partial thickness skin loss
stage 3-full thickness skin loss
stage 4 -full thickness tissue loss
