Misc Flashcards
what are the management priorities for renal stone with septic features?
1 -Fluid resuscitation/inotropic support aim MAP >65 in patient with severe sepsis
2. Broad spectrum ABs – early administration reduces mortality
3. Urgent operative intervention with Urology to insert stent/relieve obstruction
four differentials?
- Ruptured AAA
- epidrual abscess with shock
- perforated DU
- Aortic dissection
- renal colic
- lumbar back pain
why may you get a difference in brachial and radial pulses?
cuff not good at low BPs
in a ruptured AAA what are pros and cons of US V CT
US
Pro - fast and no radiation
Con - user dependent, not as reliable, low sen and spe
CT
Pro - high sensitibity and specificy, allows surgical planning, rules out other things
cons - radiation, time consuming, danger of going in scanner
what criteria is used by ambos to decide whether to bypass a hospital to go to trauma centre
MIS
Mechanism
eg over 60km
fatality in same accident
state of vehicle
children
Injuries
penetrating
severe burns
head injury with coma
Signs
shock
resp distress
with trauma, why is including mechanism of injury in triage difficult
poor specificity so over triage
advantages and disadvantages of trauma bypass
Advantages
* reduces mortality
* concentrate resources
* staff retention
Disadvantages
* deskilling of staff
* over triage of injuries
* longer transit times
* harder for family to accesss
what is permissive hypotension
in penetrating injury and short transit times to care its allowed
aim is not to disrupt clots
what makes a psych patient high risk for retrieval?
what drugs can you use to ease transfer?
- threats of violence
- active thought disorder
- medication non compliance
- intoxicated
- history of violence
- evidence of self harm
- previous assault
Diazepam 10mg oral prn
Ketamine 20mg aliquots prn, or infusion
Droperidol 10mg IM
