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acute care > Objectives > Flashcards

Objectives Flashcards

1
Q

Causes of airway obstruc

A 
Tongue
Anaphylaxis
FB
Ext comp eg tum
Trauma
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2
Q

Upper airway anatomy

A 
Upper airway-
Nose and paranasal sini
Oral cavity
Nasopharynx base skull to soft palate
Oropharynx to superior epiglottis
Hypopharnx to inferior cricoid cartilage
Larynx
Lower airway-
Trachea
Principle, secondary and segmental bronchi
Terminal bronichiole
Respiratory bronchiole
Avleolar ducts and sacs
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3
Q

Identify resp failure

A

Hypoxia- dyspnoea, restless, agitated, confused, cyanosis. If chronic then polycythemia, pulm HTN.
Hypercapnia- headache, periph vasodilation, tachyc, bounding pulse, flap, drowsy.

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4
Q

Causes acute resp failure

A

T1- pneumonia, PO, PE, asthma, ARDS
Chronic eg COPD, fibrosis
T2- very severe asthma or COPD or pneum, end stage fibrosis, OSA, anaphylaxis
Also sedatives, CNS tum, trauma, NMDs, chest wall, compl obstruc

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5
Q

Resp failure

A

T1- paO2 under 8kPa, normal or low pCO2
Due to VQ mism
T2- pO2 under 8, pCO2 over 6kPa
Due to alv hypoventil +/- VQ mism

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6
Q

Resp failure mx

A

T1- O2, assisted ventilation
T2- controlled O2, assisted ventil, maybe intubation
O2 eg nasal under 4L, simple over 5L, venturi 24-8 for COPD, NRB
Monitoring- bloods, ABG, CXR, sputum and blood cult, spirom.

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7
Q

Hypoxia

A

Hypoxaemic- resp fail
Anaemic- low Hb or CO
Circulatory- shock, PVD
Cytotoxic- cyanide

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8
Q

Bradypnoea causes

A 
Airway obstruction and exhaustion- asthma, COPD, OSA, oedema
RICP
Obesity
Alcohol, drugs, sedation
Cardiogenic shock
CNS disorder
Hypothyroid
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9
Q

tachypnoea causes

A 
Obstructive disorders- asthma, COPD
Pneumonia
Fibrosis
PE
Pneumothorax
pleural effusion
HF
Anxiety
Arrhythmia
Anaemia
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10
Q

Resp ix

A

Bloods- FBC, UE, CRP, ABG or VBG, LFT, clotting, D dimer, CA markers, a1 antiT
CXR
Sputum and blood cult
Spirometry

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11
Q

ABG interp

A

PH low and CO2 high- resp acidosis
PH low and CO2 low and HCO3 low- metab acid
PH high and CO2 low- resp alk
PH high and HCO3 high- metab alk

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12
Q

NIV ventil indics

BIPAP and CPAP

A

COPD resp acidosis pH 7.25-7.35
T2 RF
Cardiogenic PO unresp to CPAP
Tracheal intubation weaning

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13
Q

techs to assist ventil

A

CPAP- usually nasal, constant pos press, upper airways splinted open, improves VQ match
CPAP IS NOT NIV
BiPAP- 2 levs of pos press (IPAP and EPAP)

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14
Q

Modified wells score

A 
3- symps eg swell, pain
3- other dx less likely than PE
1.5- HR over 100
1.5- immob over 3d, or surg in last 4wk
1.5- prev PE or DVT
1- haemoptysis
1- malig

Score over 4 means PE likely, 4 or less means unlikely

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15
Q

shock px

A 
Hypot under 90
Tachyc usually over 100
Alt conciousness or syncope
Poor periph perfus- cool, clammy, pallor, high CRT
Oliguria under 50ml/hr
Tachyp
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16
Q

Shock causes

A

Hypovol- bleed, DNV, burns, pancreatitis, sepsis
Cardiogenic-
Primary eg MI, arrhythmia, valve, myocarditis
mechanical or Secondary eg tamponade, massive PE, tens pthorax
Distributive- septic more comm in eld or v yng, DM, renal/liver fail, imm comprom. Anaphylactic

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17
Q

Shock mx

A 
ABCDE
High O2
IV access and take bloods
Obs
ABG
ECG
CXR
Catheter and UO
Fluids if req
Ionot or vasoactive meds
Assisted ventil
Specif- lap, thrombolysis, PCI, pericardiocentesis, antidotes, abx
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18
Q

Acute renal failure causes

A

STOP most comm- sepsis, toxin, obstruc eg prostate, parenchymal eg ATN
Pre- DEHYD, shock eg sepsis, A stenosis
Intrinsic- ATN, drugs (Mb, ACEi, AG, NSAID), HTN, infec, nephritis, vasculitis
Post- obstruc eg prostate, stones, CA, stricture, fibrosis.

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19
Q

Acute renal failure px

A

Malaise, lethargy, nausea, reduc UO
High urea and cr
Elec imbal
Signs of cause eg sepsis, dehyd, vol overload, mass, renal bruit, pos dip or cult

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20
Q

Acute renal fail mx

A 
Tx cause
Tx fluid balance
Tx elec imbal and acidosis
Review meds
Monitor- UE, VBG, urinalysis, USS, UO
Indics for dialysis- hyperK, fluid overload, acidosis, dialysable toxin, uraemia (pericarditis, LOC, NV)
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21
Q

Acidosis causes

A

Resp- hypoventil in COPD, asthma, PO, CNS depression, obesity, GB, MG
Metab-
With normal anion gap (3-12)- reataining H (RTA, addisons) or losing HCO3 (diarr)
With high anion gap- methanol, uraemia, DKA, lactate, other poison

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22
Q

alkalosis causes

A

Resp- hyperventil eg anx, hypoxia, PE, pneumonia, asthma, PO
Metab-
Chloride responsive eg vom, diuretic, CS
Chloride resis eg cushings, hypoK

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23
Q

Acidosis px

A 
Fatigue, drowsy
Confusion
SOB, rapid shallow breathing
Headache
Lack appetite
Jaundice
Tachyc
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24
Q

alkalosis px

A 
Confusion
Tremor, tetany
Light headed
NV
Numbin and tingling
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25
Q

Mx of acid base disturbance

A

Tx cause
Oxygen if req
Tx elec imbal
Acidosis- sodium bicarb, CPAP

26
Q

Tachyc causes

A 
Arrhythmia- ST, SVT, flutter, atrial tachyc, AF, AVRT, VT, pre excited AF, torsades, VF
HTN or hypot
IHD
Valve dis
Anaemia
Exercise
Stress
Cardiomyopathy
Infection and fever
Smoking
Drugs eg alc, caffeine, cocaine, medications
Elec imbal
Hyperthyroid
27
Q

Bradyc causes

A 
Arrhythmia- SAN dis, HB AVN dis
IHD
Congenital heart dis
Myocarditis
Hypothyroid
Elec imbal
OSA
Rheumatic dis
Meds
28
Q

Oliguria causes

A 
Dehydration
Obstruc
Sepsis and other vasc collapse
Low CO
Intrinsic renal eg ATN, glom dis, vasc lesions
29
Q

Hypotension causes

A 
Dehyd eg DNV
Blood loss
Severe inflammation 
Myocarditis
Valve dis
PE
Tamponade
Bradyc
30
Q

Hypernatraemia

A

Causes- iatrogenic, DNV, burn, DI, DKA, conns
Px-lethargy, weak, thirst, irrit, confus, coma, seiz, dehyd
Mx- hydration, maybe saline if hypovol
Tx cause

31
Q

hyponatraemia

A

Causes- hypovol, diuretics, addisons, kidn inj, DNV, burn, SIADH, hypothyr, CCF, low alb
Px- NV, malaise, headache, irrit, confus, weak, reduc GCS, seiz, CCF, oedema
Mx- fluids, maybe hypertonic saline
Tx cause

32
Q

hyperCa

A

Causes- thiazide, lithium, high PTH, high vit D, bone CA, myeloma, hyperthyr, sarcoid, dehyd
Px-NV, abdo pain, constip, polyU/D, dep, wl, weak, tired, HTN, confus, pyrexia, renal stones, short QT, bone pain
Mx- fluids, bisP
Tx cause

33
Q

hypoCa

A

Causes- loops, CKD, low vit D, low PTH, bisP, alkalosis, pancreatitis
Px- spasmodic
Mx- Ca gluconate, sandocal supplems. Vit D (colecalciferol, alfacalcidol)
Tx cause

34
Q

HyperK

A

Causes- transfusion, trauma, acidosis, addisons, K sparing diuretic, ACEi, A/CKD
Px- fast irreg pulse, CP, weak, palpit, dizziness, tall T, small P, wide QRS, VF.
Mx- Ca gluconate 10ml 10% IV 5 mins, actrapid 10U in 250ml 10% dextrose, neb salb, Ca resonium, maybe haemodialysis
Tx cause

35
Q

hypoK

A

Causes- conns, DNV, diuretics, alkalosis, RTA, salbutamol
Px- weak, hypotonia and reflexia, cramps, tetany, palpit, dizzy, constip, arrhthmia, small or inv T, promin U, long PR, STD.
Mx- sandoK oral, K supplem IV fluid
Tx cause

36
Q

bleeding diathesis causes

Susceptability to haemorrhage

A 
warfarin
liver fail
vitK defic
DIC
haemorrhgaic virus, meningitis
leukaemia
AI eg antiPlipid, vasculitis
Genetic eg haemophilia, VWD
impaired skin heal eg scurvy and cushings
Vascular malformations
37
Q

bleeding diathesis mx

A 
Tx cause
Plasma exchange
Pl transfusion
Anticoagulants
Packing an active bleed
38
Q

Circulation ix

A

Bloods- UE, clotting, ABG, eGFR, CRP, FBC, culture, trop
Obs incl standing lying BP
Swabs sputum or urine dip if suspect sepsis
USS, CT (angio), CXR
ECG
Echo

39
Q

clinical assessment of cardiac output

A

Signs of low CO-
BP under 90, UO under 0.5ml/kg/hr, HR under 60 or tachyc, fatigue, confusion, thready pulse, high JVP, SOB, hypoxaemia, pulm and periph oedema, metabolic acidosis
Ix-
Doppler, electromagnetic flowmeter, echo, ABG

40
Q

Pathophysiology of atherosclerosis

A 
Endothelial damage
Lipop oxidation
Foam macrophage
Cytokines
Fat and sm infilt
Plaque formation
41
Q

Pathophysiology of TE

A 
Virchows triad- wall, flow, components
Platelets aggregation and adhesion
Cytokines, clotting cascade
Localised thrombus, vasoconstriction
Lodge in artery- ischaemia
42
Q

Mx of epistaxis

A

Body forward mouth open
Pinch cartilaginous part of nose 10-15min
Naseptin cream if this works
If above doesnt work- cautery with silver nitrate stick if bleeding pt can be seen, or packing
Then naseptin aftercare (chlorhex and neomycin)

43
Q

GCS score

Eyes 4, voice 5, motor 6

A

Eyes-
4 spont, 3 to speech, 2 to pain, 1 none
Voice-
5 orientated, 4 confused, 3 innap words, 2 sounds, 1 none
Motor-
6 obeys, 5 loc pain, 4 withdraw from pain, 3 abn flex decorticate, 2 abn ext decerebrate, 1 none

44
Q

Causes of low GCS

A 
Drugs, alc
Epilepsy
Hypoglycaemia
CVA
Brain hypoxia
Dementia
Head trauma
Brain tumour
Heart dis
Liver dis
Uraemia
Shock
Sepsis
45
Q

Delirium causes

A

Predisp-
Eld, male, sensory impair, psych comorb eg dementia or dep, func imapir, malnutrition, other comorb eg CVS and PD
Precip-
Meds eg cholinergics, infections, metab abn (gluc, Ca, Na, thyr, liver or renal fail), hypoperfusion, hypoxia, shock, anaemia, sleep depriv, pain, surgery, neurol illness, head injury, dehydration

46
Q

Seizure causes

A 
Neuro-
Epilepsy, tumour, meningitis, enceph, CVA, head trauma, congenital abn, peri natal hypoxia
Metab-
Hypoglycaemia, hypoNa, hypoCa, hyperuric
Drugs-
ODs, abuse, alc withdrawal, toxins
Febrile convulsions
Eclampsia
47
Q

Causes of acute focal neurol deficit

A 
Ischaemic CVA, or TIA
Intracerebral of subarachnoid haemorrhage 
Head injury or periph nerve injury
Menignitis or enceph
Vascular malformation
48
Q

headache causes

A 
Tension
Cluster
Migraine
Trigeminal neuralgia
GCA
Meningitis, enceph
Brain haemorrhage, haematoma or abcess
RICP
Venous sinus thrombosis
Glaucoma
Sinusitis
Drugs and withdrawal
49
Q

Disability ix

A 
Bloods- CRP, ESR, FBC, UE, LFT, clotting, gluc, ABG, culture
Obs and neuro assess
CT or MRI head
Urine dip, swabs
LP for mening
CXR
EEG
ECG
50
Q

delirium mx

A 
Tx cause
Early recog
Mx hypoxia, usch, dehyd and elec imbal
Review meds
Mx sleep
Geriatrician and psych input
Non pharm- family inv, consis staff, avoid transfer, explain interventions, calm, large notices, adjustable lights, particip in ADLs, remove catheter, avoid restrain, correct sensory deficit
Pharm- haloperidol, rarely BDZ and ACHEi
51
Q

poison px

A

NV
R upper abdo pain liver eg paracetamol
Reduced GCS
Coma
Hypoglycaemia
Asp- hyperventil, tinnitus, deaf, vasodilat, sweat
TCA- dry mouth, seiz, arrhyth, hypothermia, hypot, hyperreflex, resp fail, urin reten, pupil dilat
SSRI- agitation, tremor, nystag, tachyc
Renal failure rarely
Lithium- GI, ataxia, tremor, weakn, dysarthria, twitch, elec imbal, dehyd, convuls, hypot, renal fail
BDZ- dysarthria, ataxia, nystag, resp dep
Amphetamines- hyper init, hallucin, paranoia, HTN, convuls, hyperthermia
Cocaine- agitation, HTN, arrhythmia, tachyc, pupil dilat, hyperthermia and tonia, CP, MI
Opioid- drowsy, coma, resp dep, pinpoint pupil
Ecstasy- delirium, coma, hyperthermia, rhabdo, renal fail, hep, DIC, ARDS, hyperreflex, hypot, IC haemorrhage, hypoNa, convuls, arrhythmia.

52
Q

Poison diffs

A 
Neuro- epilepsy, RICP, IC bleed, trauma
Cardiac- arrhythmia, IHD
Renal or liver dis
Elec imbal
Sepsis
Resp dis
53
Q

Poison mx

A

Gen- gastric lavage or bowel irrigation, activ charcoal, somet haemodialysis
Specif-
Paracetmaol- N acetylcysteine. Charcoal under 4hr
Digoxin- digibind Ab frags
BDZ- flumazenil IV 0.2mg over 15 sec, max 3mg
Insulin, BB- glucagon
Opioids- naloxone us IV ev 2-3 min
Iron salts- desferrioxamine mesilate
Ethylene glycol or methanol- fomepizole, ethanol
TCA- gastric lavage under 2hr, activ charcoal. Maybe Vasopressors, Na bicarb.
Salicylate- Na bicarb, fluids. Maybe dialysis, pressors.
CO- hyperbaric O2
Cyanide- amyl nitrate, Na nitrate, Na thuosulfate
Heparin- protamine sulfate
OrganoP- atropine, pralidoxime
SU- octreotide

Psych review

54
Q

Hypothermia signs

A 
Shiver
Slurred speech
Slow shallow breathing
Weak pulse
Lack coord
Drowsy and lack energy
Confusion or amnesia
LOC
Bright red cold skin in infants
Low temp
55
Q

Hypothermia RFs

A 
Elderly and infants
Cold env
Mental illness
Alc and drugs
Exhaustion, fatigue
Comorb- hypothyr, malnutr, DM, CVA, sev arth, PD, trauma, SC injury
Infection
Meds- antiD, antiP, sedatives, narcotics
56
Q

Hypothermia init mx

A

Warm dry location
Heated insulating blankets
Blood removal and rewarming via haemodialysis
Warm IV fluids
Airway rewarming with humidif O2
Irrigation with warm saline- pleural and perit cavities

57
Q

Comm causes of pyrexia

A 
Virus or bact infec
Heat exhaustion
Rheumatoid and AI conditions, vasculitis
Malig
Hyperthyr
Meds- abx, AED, antiHTN
Some vaccines- DTP, pneumococcal
Shock
Collagen vasc dis
Fungus and parasite
Granulomatoud dis eg sarcoid, crohns, hep
PE
58
Q

Pyrexia ix

A 
Sepsis 6 if indicated
Bloods- FBC, ESR, CRP, LFT, ANA, RhF, TFT, culture
Labeled white cell scan
Cultures- urine, sputum, stool, CSF
CXR, CT, MRI, PET
LP
Skin biop
LN asp
Bm asp
Liver biop
Lap surg
59
Q

Notifiable dis

A 
Acute enceph, acute hep
Acute meningitis and mening septacaemia
Acute poliomyelitis
Anthrax
Botulism
Cholera
Diptheria
Thyphoid
HUS
Invasive grp A strep
Legionnaries
Leprosy 
Malaria
Measles
Mumps
Plague
Rabies
Rubella
SARS
Scarlet fever
Smallpox
Tetanus
TB
Typhus
Viral haemorrhgaic fever
Whooping cough
Yellow fever
60
Q

Sepsis in kids

A 
Later hypot
Cold peripheries, CRT delay
Mottled skin
Hypotonia
Vomit
Convulsions
Resp distress
Oedema
Rash
Bulging fontanelle mening
Temp instabil
Lethargy
Poor feeding
Reduc UO

acute care (6 decks)

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