Other Flashcards
Hypothermia ECG
ST elevation
J waves (Osborn waves)
*rapid rewarming can lead to shock
Complication of NIV e.g CPAP
Pneumothorax
Which drugs to stop during AKI
DAMN drugs
- Diuretics
- ACEi and ARBs
- Aminoglycosides e.g. gentamicin
- Metformin
- NSAIDs (apart from low dose aspirin)
pH change in salicylate poisoning (early and late)
- Early: stimulation of respiratory centre, respiratory alkalosis (blowing off CO2)
- Late: metabolic acidosis
Features of salicylate poisoning
- Tachypnoea (raised RR)
- Tinnitus
- Pyrexia
- NV
- Seizure and coma
Salicylate poisoning mx
- Activated charcoal (< 1 hr)
- IV sodium bicarbonate
- Haemodialysis §
ECG in PE
- Sinus tachycardia
- S1Q3T3
Indications for RRT (dialysis)
AEIOU
- Acidosis (refractory)
- Electrolytes (hyperkalaemia)
- Intoxicants (lithium and salicylates)
- Oedema (fluid overload)
- Uraemia (pericarditis and encephalopathy)
Signs of right-sided heart failure (e.g. cor pulmonale)
- Raised JVP
- Ankle oedema
- Hepatomegaly
Hypothermia causing cardiac arrest
3 shocks
chest compression till temp > 30
then more shocks
When abx in bronchitis
- Pre-existing comorbidities
- CRP raised
- Systemically unwell
*Doxycycline first line
1st line imaging for suspected perforated peptic ulcer
Erect chest x-ray (pneumoperitoneum)
Staph toxic shock syndrome
- Pyrexia
- Erythematous and desquamating rash (palms and soles)
- Hypotension (rash)
- confusion, renal impairment, NV
Systemic reaction to staphylococcus exotoxin TSST-1 superantigen toxin
*tampons
Staph toxic shock mx
- Remove source of infection
- IV abx
- IV fluids
CURB65
Confusion (AMS ≤ 8)
Urea > 7 (secondary care)
RR > 30
BP < 90/60
Age ≥ 65
CRB65 treatment
0 - treat at home, give oral abx
1-2 consider hospital, give abx
3-4 urgent hospital admission
AF + acute ischaemic stroke
14 days 300mg aspirin, then anticoagulation (DOAC)
Neutropenic sepsis abx
IV tazocin
If central line - + IV vancomycin
Hypovolaemic shock
BP, cardiac output ↓
Systemic vascular resistance, HR ↑
Turner syndrome cardiac abnormality
- Bicuspid valve (crescendo-decrescendo)
- Coarctation of aorta
Causes of Torsades de Pointes and Mx
Causes:
- Erythromycin, Hypothermia, hypokalaemia, hypocalcaemia
- Subarachnoid haemorrhage
- Myocarditis
Mx: IV magnesium sulphate
Persistent ST elevation after MI and no chest pain
Left ventricular aneurysm
Acute haemolytic reaction after blood transfusion sx
Hypotension
Fever
Abdominal pain
Acute haemolytic reaction after blood transfusion mx
- Stop
- check pt and blood bag ID
- Bloods for DCT and crossmatching
- Fluid resuscitation
*when in doubt ACS
Monitor troponin I trend
False positive TnI
- Severe CHF
- Large PE
- Myocarditis
- Aortic dissection
- Aortic stenosis
- Hypertrophic cardiomyopathy
- Advanced renal failure
ACS Ix
- Full A-E
- 12 lead ECG
- Troponin I (again in 1hr)
- FBC, lipid profile, HbA1c, UE
ACS mx
MONA
Morphine + anti-emetic
O2 (if <94%)
GTN sublingual
Aspirin 300mg
STEMI and PCI available within 2hrs
- 300mg Aspirin
- Praugrel
- Radial access + unfractionated heparin (+ bailout glycoprotein iib/iiia)
- Drug eluting stents used
STEMI and PCI not available within 2hrs :(
- 300mg Aspirin
- Alteplase (fibrinolysis)
- Ticagrelor
*if ST elevation persists after fibrinolysis, send for PCI!
Antiplatelet changes when on anticoagulant
Praugrel -> clopidogrel
STEMI presents >12hrs after onset of symptoms
PCI if ongoing myocardial infarction
NSTEMI management
300mg Aspirin + fondaparinux (if no immediate PCI)
High risk
- PCI (immediate or within 72hrs)
- Prasugrel or ticagrelor
- unfractionated heparin
Low risk
- Ticagrelor
*anticoagulants, swap prasugrel for ticagrelor/ ticagrelor for clopidogrel
**Give unfractionated heparin regardless of fondaparinux
Secondary management of ACS
- Dual antiplatelet (aspirin + prasugrel/ ticagrelor) for 12 months
- ACEi (or ARB) continue indefinitely
- Beta-blocker (or diltiazem/ verapamil if contraindicated
- Statins
Conservative
- Cardiac rehabilitation
- Smoking cessation
- Diet
- Physical activity
Causes of clubbing
- coeliac disease
- inflammatory bowel disease
- lung malignancy
Causes of Dupuytren’s contracture
- alcoholic liver disease
- familial
- DM