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Acute Medicine > Medical HDU > Flashcards

Medical HDU Flashcards

1
Q

airway

A

intact/risk to airway/adjuncts

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2
Q

breathing

A

RR, sats, FiO2, NIV
examination of chest
recent abg
recent CXR

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3
Q

circulation

A 
blood pressure, heart rate
inotropes/vasopressors/antihypertensives
examination - CRT, JVP, oedema, pallor, heart sounds
local ischaemia - arterial lines
peripheral ischaemia - vasopressors
haemoglobin 
ecg
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4
Q

renal

A

fluid input and output
hydration status
urinalysis
U+E, bicarb, calcium, Mg, phosphate

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5
Q

GI and nutrition

A 
weight
nutrition intake
risk of refeeding? pabrinex, thiamine
bowels, vomiting, diarrhoea
abdo and liver disease signs
LFT, BG and ketones
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6
Q

neurological

A

GCS/AVPU
pupils
neurological exam
swallow

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7
Q

sepsis

A 
lines - time since insertion 
culture
temp
CRP, WBC, lactate
antibiotics?
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8
Q

endocrine

A

diabetic? ketones and insulin

steroids

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9
Q

coagulation

A

platelets

thromboprophylaxis

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10
Q

Type 1 resp failure

A

PaO2 <8kPa and low or normal PaCO2

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11
Q

Type 2 resp failure

A

PaO2 <8kPa and PaCO2 >6kPa

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12
Q

acute hypercapnic resp failure

A

acidotic, high PaCO2

normal bicarbonate

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13
Q

chronic hypercapnic respiratory failure

A

near normal ph, high PCO2

high bicarbonate

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14
Q

causes of type 1 resp failure

A

V/Q mismatch

  • pneumonia
  • PE
  • acute asthma
  • pneumothorax/pleural effusion
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15
Q

Type 2 resp failure causes

A 
reduced ventilatory drive
- opiates
- COPD
- morbid obesity 
- head injury
reduced chest wall movement
exhaustion
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16
Q

oxygen for hypoxic patient

A

15L reservoir mask

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17
Q

target Sa)2

A

94-98%

hypercapnic resp failure = 88-92%

18
Q

how much oxygen can nasal cannulae provide?

A

2L/min

19
Q

cautions with NIV

A

basal skull fractures
CSF leak
undrained pneumothorax

20
Q

2 types of NIV

A

CPAP and BiPAP

21
Q

explain CPAP

A

reduces work of inspiratory muscles and overcomes negative intrathoracic pressure to prevent collapse of alveoli

22
Q

indications for CPAP

A

Type 1 resp failure

23
Q

Indications for BiPAP

A

Type 2 resp failure

  • acute COPD
  • pneumonia
24
Q

NIV contraindications

A

vomiting
recent facial surgery
(bowel obstruction, confusion)

25
Q

assessing NIV response

A 
O2 sats, RR, HR, bp
abg
conscious level
chest wall movement
accessory muscles use
26
Q

what is stroke volume affected by?

A

preload and afterload

27
Q

preload

A

according to starlings law
increased end diastolic volume increases stretch on myocardial fibres
increased contraction and increased SV

28
Q

afterload

A

systemic vascular resistance

as SVR increases the CO decreases

29
Q

signs of inadequate tissue perfusion

A 
oliguria/anuria
confusion 
cold, clammy skin 
reduced pulse volume
increased RR, HR
low bp
lactic acidaemia
prolonged CRT
30
Q

4 types of shock

A

obstructive
cardiogenic
hypovolaemic
distributive

31
Q

causes of obstructive shock

A

massive PE
tamponade
tension pneumothorax
R ventricular failure

32
Q

cardiogenic shock

A

MI, arrhythmia, valvular lesion

33
Q

hypovolaemic shock

A

blood or fluid loss

34
Q

distributive shock

A

septic, anaphylactic, neurogenic

35
Q

SIRS criteria

A

2 or more of

  • HR >90
  • Temp <36 or >38
  • RR >20
  • WCC
36
Q

sepsis definition

A

SIRS and infection

37
Q

severe sepsis

A

sepsis and inadequate organ perfusion

38
Q

septic shock

A

sepsis and hypotension/inadequate organ perfusion despite fluid resus

39
Q

Indications for CVC

A 
access for drugs - amiodarone, inotrope
poor peripheral access
chemotherapy
plasma exchange 
dialysis 
monitoring and blood sampling
40
Q

CI to CVC

A

coagulopathy
haemothorax
vessel thrombosis
pacemaker ipsilateral side

41
Q

complications of CVC

A 
haemorrhage
arrhythmia 
cardiac tamponade 
thoracic duct injury 
infection 
air embolus

Acute Medicine (2 decks)

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