May 25th, 2021 Flashcards
55M, farmer left lower leg laceration 1/24 ago, tourniquet, 7 aspects of history
- allergies to medications?
- on any anticoagulants?
- sensory deficit in affected limb?
- how was his leg laceration sustained?
- most recent tetanus vaccination?
- smoker?
- weight bear?
- diabetes?
55M, farmer left lower leg laceration 1/24 ago, tourniquet, 4mx?
- irrigate the wound with normal saline
- suture wound under local anaesthesia
- ADT booster, IM, stat
- Paracetamol 1G, PO, QID, PRN
- review in 7-10 days
55M, farmer left lower leg laceration 1/24 ago, tourniquet, wound not healing, now ulcer, 6 management
- foam/hydrocolloid dressing
- check ABI
- graduated compression bandage after checking arterial supply
- elevate leg
- dressing changes 2-3 days
- optimise nutrition
37F family planning, hx depression on rx, hypothyroidism, obesity, non smoker, 2-3SD, G0P0, no gyne hx, CST-NAD, 4ya from Pakistan, on paroxetine, thyroxine, bMI 36, BP is 115/60, thyroid exam-NAD, 8 advice
f,g,h,i,l,o,
- transition from paroxetine to sertraline
- commence 5mg folic acid
- iodine supplementation 150microg.day
- advise 5-10% weight loss
- cease alcohol
- thyroid function will need monitoring
- preconception genetic screening
- importance of antenatal care
- discuss safe exercise
37F family planning, hx depression on rx, hypothyroidism, obesity, non smoker, 2-3SD, G0P0, no gyne hx, CST-NAD, 4ya from Pakistan, on paroxetine, thyroxine, bMI 36, BP is 115/60, thyroid exam-NAD, 6/12 later, not conceived, 4 female factors
- timing of ovulation
- symptoms of PCOS- irregular periods
- symptoms of endometriosis - dyspareunia
- symptoms of prolactinoma: galactorrhea
- hypothyroidism, weight gain
- symptoms of PI, vaginal discharge
65F, rural 300km, sudden SOB/CP 30/60 ago, pmhx: COPD, CCF, 50py smoker, Spiriva, salb, perindopril, atorvastatin, bisoprolol, spironolactine, afeb, rr-30, BP 105/60, HR 98, O2: 90% on RA, 5 ddx
- spontaneaous pneumothorax!
- pulmonary embolism
- acute coronary syndrome
- arrhythmia
- acute pulmonary odema
- pericardial tamponade
- acute heart failure
65F, rural 300km, sudden SOB/CP 30/60 ago, pmhx: COPD, CCF, 50py smoker, Spiriva, salb, perindopril, atorvastatin, bisoprolol, spironolactine, afeb, rr-30, BP 105/60, HR 98, O2: 90% on RA, pneumothorax: 4 mx
- O2 to maintain sats between 88-92%
- insert right sided chest drain
- obtain IV access
- transfer to tertiary hospital via road ambulance
- monitor vital signs
65F, rural 300km, sudden SOB/CP 30/60 ago, pmhx: COPD, CCF, 50py smoker, Spiriva, salb, perindopril, atorvastatin, bisoprolol, spironolactine, afeb,3/12 later, 2-3 weeks of dyspnoea, HR-80, BP 130/84, rr-15, 02-95% RA, pitting oedema, bibasal crepe, 2kg weight gain, 5 management
- commence 20-40mg, frusemide, PO daily
- fluid restrict 1.0-1.5L daily
- daily weights
- increase spironolactone to 25mg, PO, daily
- review in 24 hours to assess response
- limit sodium <2G per day
58M irregular heartbeat, butterfly in chest, 10/7 ago while riding bike, spontaneously resolve after 15/60, BP 155/85 3/12 ago, had DMII, 20ya smoker, BP 150/90, HR is 80, irregular, HSDNM, BMI 32, ECG, 6 risk factors
- hypertensive heart disease
- diabetes
- smoking
- increase BMI-obesity
- coronary artery disease
- OSA
- male sex
58M irregular heartbeat, butterfly in chest, 10/7 ago while riding bike, spontaneously resolve after 15/60, BP 155/85 3/12 ago, had DMII, 20ya smoker, BP 150/90, HR is 80, irregular, HSDNM, BMI 32, ECG shows AF, 5 management
- commence metoprolol 25mg, PO, BD
- commence apixaban 5mg, PO, BD
- cease smoking
- weight loss 5-10%
- commence perindopril 5mg, PO, daily
- Recheck Hba1C
58M irregular heartbeat, butterfly in chest, 10/7 ago while riding bike, spontaneously resolve after 15/60, BP 155/85 3/12 ago, had DMII, 20ya smoker, BP 150/90, HR is 80, irregular, HSDNM, BMI 32, ECG shows AF, 3/12 later, erectile dysfunction, 5 risk factors
- obesity
- diabetes
- smoking
- hyperlipidaemia
- hypertension
- Betablocker commencement
- anxiety/depression
- substance use
