Monday [08/08/22] Flashcards
Steps to performing death confirmation [8]
- Confirm identity of patient by checking wrist band
- Speak to patient: “can you hear me”
- Inspect for signs of life including respiratory effort and chest movement
- assess response to pain: either fingernail/traps/supraorbital pressure
- assess pupillary reflexes using pen torch
- carotid pulse
- auscultate to identify heart/resp sounds [heart 2m, resp for 3m]
- Document each step of the process
Causes of AKI [3]
Prerenal = hypovolaemia, renal artery stenosis Intrinsic = toxins, sepsis, medications, ATN, glomuerlonephritis, rhabdomyolysis Postrenal = kidney stones, BPH, external compression
Define AKI with current NICE guidelines [3]
- A rise in serum creatinine of 26 micromol/litre or greater within 48 hours
- A 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
- A fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than
Stages of AKI [3]
- x2 baseline serum creatinine
- x2-3 baseline creatinine
- x3 baseline creatinine. Or eGFR <35ml/min. Or anuria.
Also urine output 6->12->24 hours [<0.3ml] less than 0.5ml/kg/hr
Safe to continue drugs AKI [5]
Aspirin, warfarin, statins, clopidogrel, beta blockers
Should stop AKI as may worsen renal function [5]
NSAIDs • Aminoglycosides • ACE inhibitors • Angiotensin II receptor antagonists • Diuretics
May have to be stopped in AKI as increased risk toxicity [3]
- Metformin
- Lithium
- Digoxin
When is renal replacement therapy used in AKI? [1]
Renal replacement therapy (e.g. haemodialysis) is used when a patient is not responding to medical treatment of complications, for example hyperkalaemia, acidosis or uraemia
Elements of the CIWA score for alcohol withdrawal [10]
- N+V
- tremor
- paroxysmal sweats
- anxiety
- agitation
- tactile disturbances
- auditory disturbances
- visual disturbances
- headache/fullness in head
- orientation/clouding of sensorium
Conditions that predispose you to refeeding syndrome [4]
- anorexia
- alcohol use disorder
- cancer
- difficulty swallowing
Electrolyte disturbances in refeeding syndrome [5]
- abnormal sodium and fluid levels
- changes in fat, glucose or protein metabolism [go from breaking down carbohydrates->fats]
- thiamine deficiency
- hypomagnesaemia
- hypokalaemia
- hypophosphotaemiav
Sx of refeeding syndrome [6]
- fatigue
- weakness
- confusion
- inability to breathe
- HBP
- seizures
- heart arrhtymias
- HF
- coma
- death
- Sx typically start within 4d of the refeeding process, some people not at risk but can’t tell which ones they are.
Tx of refeeding syndrome [4]
The repletion of calories should be slow and is typically at about 20 calories per kilogram of body weight on average, or around 1,000 calories per day initially.
Electrolyte levels are monitored with frequent blood tests. Intravenous (IV) infusions based on body weight are often used to replace electrolytes. But this treatment may not be suitable for people with:
impaired kidney function
hypocalcemia (low calcium)
hypercalcemia (high calcium)
In addition, fluids are reintroduced at a slower rate. Sodium (salt) replacement may also be carefully monitored. People who are at risk of heart-related complications may require heart monitorin
Features of alcohol withdrawal [3]
- symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
- peak incidence of seizures at 36 hours
- peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
Mx of alcohol withdrawal [4]
patients with a history of complex withdrawals from alcohol (i.e. delirium tremens, seizures, blackouts) should be admitted to hospital for monitoring until withdrawals stabilised
first-line: benzodiazepines e.g. chlordiazepoxide. Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose protocol
carbamazepine also effective in treatment of alcohol withdrawal
phenytoin is said not to be as effective in the treatment of alcohol withdrawal seizures
