Misc Flashcards
what are the management priorities for renal stone with septic features?
As with all sepsis:
1 -Fluid resuscitation/inotropic support aim MAP >65 in patient with severe sepsis
- Broad spectrum ABs – early administration reduces mortality
- 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 50-250mg/hr (0.6-3mg/kg/hr)
Droperidol 10mg IM
doses of sodium bicarb and hypertonic saline
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
insulin treatment for
hyperK
Calcium channel OD
hyper k - 10 units in 50% dextrose 50ml
Ca - 1unit/kg + 50% dextrose 50ml
Then 0.5units/kg/hr and dextrose 50% 50ml/hr
Adrenaline dose for newborns
Adrenaline concentration
Paeds ALS
Adult ALS
Anaphylaxis
Paeds Brady
Paeds 10mcg/kg 1:10000
Adult 1mg 1.10000
Anaphylaxis 0.5mg 1:1000
Newborn 1:10000
Paeds Brady 1:10000
How do you calculate osmolar gap
What is normal
What causes high?
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