number related things to learn Flashcards
ABPI measurements and interpretation
> 1.3: stenosis
1.0-1.3: normal
0.9-0.99: probable PAD
<0.9: PAD
< 0.5: severe and limb threatening ischaemia
abdominal aorta screening programme
3.0-4.4cm: annual ultrasound
4.5-5.4cm: 3 monthly ultrasound
>5.5cm: consider surgery or 3 monthly ultrasound
opioids in CKD
no renal impairment: morphine (more is fine)
mild-to-moderate renal impairment: oxycodone (we can condone oxycodone)
severe renal impairment: fentanyl, alfentanil, buprenorphine (fentaNIL, alfentaNIL, bupreNOrphine)
transdermal fentanyl patch 12mg? oral morphine equivalent
30mg
transdermal 20mg buprenorphine patch. oral morphine equivalent?
24mg
when increasing dose of morphine, it must be by…?
30-50%
stage 1 hypertension
clinic reading > 140/90
ABPM > 135/85
stage 2 hypertension
clinic: >160/100
ABPM: > 150/95
stage 3 hypertension
clinic > 180/120
major bleed on warfarin
stop warfarin, give IV Vit K 5mg & prothrombin concentrate complex or 2nd line, fresh frozen plasma
INR > 8.0 & minor bleeding
stop warfarin, give IV Vit K & recheck INR after 24 hours and give another dose.
restart warfarin at < 5.0
INR > 8.0 and no bleeding
stop warfarin, give oral vit K and another dose after 24 hours if INR too high
restart warfarin when INR < 5.0
INR 5.0-8.0, minor bleeding
stop warfarin, recheck after 24 hours and give another dose if needed. restart at <5.0
INR 5.0-8.0, no bleeding
skip 1-2 warfarin doses, reduce subsequent maintenance dose
CSF opening pressure
10-18cm H2O if lying on side; 20-30cm H20 when sat up
routine maintenance IV fluids
- 25–30 ml/kg/day of water and
approximately 1 mmol/kg/day of potassium, sodium and chloride
and
approximately 50–100 g/day of glucose to limit starvation
ketosis
HOWEVER
Consider prescribing less fluid (for example, 20 to 25 ml/kg/day fluid) for patients
who:
* are older or frail
* have renal impairment or cardiac failure
* are malnourished and at risk of refeeding syndrome
discharge criteria for pneumonia
NICE recommend that patients are not routinely discharged in the past 24 hours if they have had 2 or more of the following findings:
* T > 37.5
* RR > 24
* HR > 100
* BP systolic < 90
* O2 < 90 on RA
* Abnormal mental status
Inability to eat without assistance
interpretation or CRB-65
0: discharge with oral Abx
1-2: consider admission
3-4: urgent admission
CURB-65
confusion
urea > 7
rr > 30
bp < 90/60
65 (aged over 65)
CURB-65 interpretation
0 or 1: home based care
>2: intermediate risk
>3: consider ITU assessment
COPD severity
Long term oxygen therapy indications COPD
Offer LTOT to patients with a pO2 of < 7.3 kPa
to those with a pO2 of 7.3 - 8 kPa and one of the following:
secondary polycythaemia peripheral oedema pulmonary hypertension
serum osmolality equation
Serum Osmolality = 2(Na) + Urea + Glucose
Hyperosmolar hyperglycaemic state criteria
This patient, therefore, fulfils the three main criteria that are often quoted in the diagnosis of HHS:
1. Marked Hyperglycaemia (> 30 mmol/L) without significant ketonaemia 2. Raised Serum Osmolality (> 320 mOsmol/kg)
- Hypovolaemia
