Misc Flashcards

1
Q

what are the management priorities for renal stone with septic features?

A

As with all sepsis:

1 -Fluid resuscitation/inotropic support aim MAP >65 in patient with severe sepsis

  1. Broad spectrum ABs – early administration reduces mortality
  2. Urgent operative intervention with Urology to insert stent/relieve obstruction
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2
Q

four differentials?

A
  • Ruptured AAA
  • epidrual abscess with shock
  • perforated DU
  • Aortic dissection
  • renal colic
  • lumbar back pain
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3
Q

why may you get a difference in brachial and radial pulses?

A

cuff not good at low BPs

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4
Q

in a ruptured AAA what are pros and cons of US V CT

A

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

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5
Q

what criteria is used by ambos to decide whether to bypass a hospital to go to trauma centre

A

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

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6
Q

with trauma, why is including mechanism of injury in triage difficult

A

poor specificity so over triage

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7
Q

advantages and disadvantages of trauma bypass

A

Advantages
* reduces mortality
* concentrate resources
* staff retention

Disadvantages
* deskilling of staff
* over triage of injuries
* longer transit times
* harder for family to accesss

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8
Q

what is permissive hypotension

A

in penetrating injury and short transit times to care its allowed

aim is not to disrupt clots

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9
Q

what makes a psych patient high risk for retrieval?

what drugs can you use to ease transfer?

A
  • 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 50-250mg/hr (0.6-3mg/kg/hr)
Droperidol 10mg IM

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10
Q

doses of sodium bicarb and hypertonic saline

A

Sodium Bicarb 8.4 %
* 50-100ml in arrest or hyperK
* 1-2ml/kg in TCA if seizing

Hypertonic saline 3%
* 100ml bolus to raise rapidly in seizures (2-3mmol)
* Acute - 1-2ml/kg/hr in acute low Na aim for 1-5mmol/l/hr
* Chronic - 10mmol/day
* 3ml/Kg ICH

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11
Q

insulin treatment for
hyperK
Calcium channel OD

A

hyper k - 10 units in 50% dextrose 50ml
Ca - 1unit/kg + 50% dextrose 50ml
Then 0.5units/kg/hr and dextrose 50% 50ml/hr

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12
Q

Adrenaline dose for newborns

A
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13
Q

Adrenaline concentration
Paeds ALS
Adult ALS
Anaphylaxis
Paeds Brady

A

Paeds 10mcg/kg 1:10000
Adult 1mg 1.10000
Anaphylaxis 0.5mg 1:1000
Newborn 1:10000
Paeds Brady 1:10000

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14
Q

How do you calculate osmolar gap

What is normal

What causes high?

A

Measured osmolality - calculated osmolality

Calculated osmolality = 2 x na + urea + glucose

Normal is less than 10

High:
* mannitol
* methanol
* ethylene glyco.
* Drugs - IV lorazepam/phenytoin

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