OSCE 3 Flashcards
Machine test
- Connected to monitor / supply
- Monitoring device
etco2 - O2 anaylser - calibrate 100% + 21%
- Tug test
- Check pipe line pressure gauge
4 bar - O2 cyilnder
- Blanking plug fitted to empty cylinder yoke
- inserted into empty yokes to ensure that there is no leak out of the yoke when not in use. - Flow meters
Check all 3 operation o2 n2o air
check anti hypoxia valve working
o2 flush
9. Vaporiser Filled Sealed Leak Turn off when check complete
10 Precautions before fitting cylinder to machine
plastic dust cover removed sealing washer
gentle open to let some escape
- blow dust grit outlet that may damage
3.2 Biochemistry / Data interpration
COPD patient
4 Physical signs on exam
Signs on CXR
set of values for a COPD patient
Central cyanosis Clubbing tremor bounding pulse tachynpnoea raised jvp hyerpresonant percussion note displaced apex diffiuclt to palpate apex peripheral oedema hepatomegally widespread wheeze fine and or coarse cracks
Hyperinflation Flat diaphragm enlarged hilar vessels loss of peripheral vascular markings emphysematous bullae Enlarged heart
3.2
COPD Patient ECG changes
Peaked P waves RAD RVH RBBB AF
3.2 COPD bits
Disease charactised limitation airflow in airway not fully reversible
bronchitis
emphysema
congen - A1AT
Acq - smoking
SOB wheeze expectorating cough
Characterised fev1<80% predicted
decrease fev1 fvc ratio
(vs restrictive - FEV 1 FVC Down - FEV1 . FVC ratio normal or up)
abg - hypoxia and co2 retention
hypoxia stim EPO kidneys - polycythemia
cor pulmonale - change in structure + fxn of right ventrile - result resp disease
anatom change can impose right strain
3.3 ECG Pacemaker
LAD is dx how
LAD
Pos QRS I
Neg QRS III + aVF (common with PM_
3.3 ECG
what’s standard recording speed
Standard recording speed 25mm/sec
3.3 ECG
standard calibration
standard calibration 1mv = 1cm
3.3 ECG and Pacemakers
Electrical activity - deranged d/t initiaon impulse
failure condctuion
mechanical fails = reduction cardiac output
Temporary
- transcutaneous + transvenously
Perm pacing - Implant pacer
lead wires attached chambers
Bivent pm - improve sytolice fxn - DCM
intraventricular conduction delay - resynchonizing contraction
PM - preop
1 40% concom cor art disease
2 what was indication
3 sym prior and returned?
pm check up
ecg and cxr - structural integrity + electrical activity
3.3 Pacemaker code
1st letter - paced
A
V
D
2nd Sense
3rd reponse to sensing None trigger Inhib Dual
4 Rate moudlation Rate mod Communicating Multiprogrammable Simple (p) None
5 Antitachycardia fxn Paced Shocks Dual
3.4 Data - Biochemistry
normal plt range
acceptable values
trauma
dose
kids
Normal plt 150-300 Targeted >75 - acceptable in most situations >100 - Trauma / Head injury one pac or 10ml kg in kids
3.4 PT + APPT
<1.5 x mean control
and fib >1.0
Dose ffp 4 u
15ml kg i n kids
3.4 data
fibrogen
Fib <0.5 - a/w microvascular bleeding
low fib prolong pt and aptt
cryo - spec fibrogen
2x5 DONATION POOLS
F DBP - <5
D DImer
3.5 Neck vein / anatomy
3 structures when doing a trach
- Skin
- Strap muscles
- Isthmus thyroid
- Ant jug vein
- Thyroidea IMA artery
3.5 Anatomy relevant to trachy
Adult epiglot c2
voca cord c4
cricoid c6
Continue - page 170
3.5 Complications of trach
Immed
- Bleeding
- Air embolism
- Subcut emphysema
- Tube dislodgement
Delayed
- Infection
- Mediastinitis
- Tube blockage
Late
- tracheal stenosis
- Tracheo-cutaneous fistula
