Other shit Flashcards
Caldicott 8 principles of sharing confidential information
-justify purpose
-necessary
-minimum necessary
-only those who need to know
-staff w/ access know rules
-obey the law
-sharing is as important as confidentiality
-tell the pt what their data has been used for
Initial settings for NIV (BTS)
EPAP 3 IPAP 15 (20 if pH<7.25)
Titrate up IPAP to 20-30 til symptomatic relief over 10-20mins
Obese pt’s may need higher EPAP
NIV for AHRF in AECOPD is indicated when
pH <7.35 & pCO2 >6.5 despite optimal medical therapy
AMTS- 10 questions?
1-age
2 Time (nearest hr)
3 Remember 42 West Street
4 What is the year
5 Name of the hospital
6 recognise 2 people
7DOB
8 when did WW2 start
9 Name of the King/prime minister
10 Count backwards from 20
Pleural fluid: transudate vs exudate
Transudate due to systemic disease
Exudate due to pleural infection/inflammation.
Fluid is exudate if:
-LDH>2/3 over upper limit of normal
-pleural LDH:serum LDH >0.6
-pleural protein: serum protein >0.5
Normal alveolar to atrial gradient (AA gradient)
5-10mmHg in young healthy individuals
Priapism definition
Erection lasting >4hrs despite ejaculation & no ongoing sexual stimulation.
Ischemic/ low flow is painful & represents 95%. Treated by aspiration of corpus cavernosum +/- injection of phenylepherine
Non ischemic/high flow may be traumatic & may be be neurogenic, sometimes managed conservatively. Is not painful.
Autonomic dysreflexia
Injuries T6 & above
Uncontrolled sympathetic response
Hypertension, headache, flushing & sweating above the level of the injury
Likely triggers are urinary retention & constipation.
Trigger sends sympathetic signal RE: bladder/bowel issue, then parasympathetic response is blocked at level of injury. Sothey end up with too much sympathetic stimulus below the injury & too much parasympathetic above.
Hypothermia classification
Mild: 35-32C, shivering, confusion, tachycardia, then bradycardia
Mod: 32-28C,stupor, shivering stops, atrial arrythmias, J-waves, insulin ineffective at 30C, progressively falling GCS
Severe: 28-20C Ventricular arrythmias, O2 consumption reduced by 50%, acid-base disturbances.
Profound: 20C, pulse 20% normal
Ideally temp is measured with a vascular or bladder probe! (RCEM learning)
Hypothermia in cardiac arrest
-Rewarm as fast as possible
-Can defib up to 3x, if unsuccessful re-warm to 30C before further attempts.
-Need slower ventilation to maintain a normal CO2 (low CO2 may cause cerebral vasoconstriction)
-Drugs below 30C are pretty useless (something to do with temp & metabolism) From 30-35C give but w/ twice the time interval.
-If frozen solid, this is unsurvivable surprising!!
Bradycardia in hypothermia
Only externally pace when normothermic, may be a physiological response to cold.
Bloods in hypothermia
-Use VBG set to 37C to be consistent, the temp calcs are based in little evidence & add an extra variable.
-Possible hypoglycaemia
-Hypokalaemia due to a shift of potassium into the cells, this will improve w/ warming, so don’t over treat.
-Hyperkalaemia >10 = cell necrosis & resus is not viable
-May have spuriously high Cr
-May have a DIC like coagulopathy
-Thrombocytopenia from bone marrow suppression & hepatosplenic sequestration.
-Haematocrit should be high (2% rise per 1C drop), if not suspect bleeding
Rewarming techniques
Passive:
-Bair hugger
-take off wet clothes
-hat
Active
-Warmed IVI
-Bladder irrigation
-gastric/peritoneal lavage
-haemofiltration
-cardiopulmonary bypass
malampati
1=hard+soft pallet, entire uvula, pillars
2= uvula maskd by tongue
3=soft palate only
4=hard palate only
Calculate anion gap…
(Na + K) - (bicarb + Cl)
normal is <16
If no K+ included <12 is normal.
Lower the upper limit of normal by 0.25 for every fall of 1 below 40 in albumin.
High anion gap acidosis causes
Cyanide/CO
Alcoholic ketoacidosis
Toluene
Methylene/metformin
Urea
DKA
Paracetamol/paradyhide/propylene glycol
Iron/izoniazid
Lactate
Ethanol/ethylene glycol
Salcilates
Kings Criteria for liver transplant
pH<7.3
INR>6.5
Cr>300
Grade III-IV encephalopathy
Bouchama’s definition of heat stroke
Core temp >40
CNS involvement
Hot dry skin
Tx aim in hypertensive emergency
Reduce MAP by -25% in 1st hr, if no sign of hypoperfusion, aim to normalise within in 24hrs.
MAP calculation
(2x diastolic + systolic)/3
