Part B 02 Flashcards
1
Q
Define sepsis
A
Life threatening organ dys
Due to host response
To infx
2
Q
Septic shock
Definition
A
Circulatory or metabolic ab which increases mortality
- vasopressors MAP>65
- lactate >2
Despite adequate fluid resus
3
Q
qSOFA
A
sBP<100
RR>22
GCS<15
> 2 = poor outcome
4
Q
Fluid bolus in sepsis
Volume
A
30ml/kg
5
Q
Ventilator settings
Tidal Vol
A
6-8ml/kg
6
Q
Ventilator settings
Rate
A
10-15
7
Q
Ventilator settings
Fi O2
A
0.21-1.00
8
Q
Ventilator settings
PEEP
A
0-20cmH2O
9
Q
Ventilator settings
Inspiratory flow rate
A
40-60L/min
10
Q
Ventilator settings
I:E ratio
A
<1:1
11
Q
Ideal body weight
male
Female
A
Male
Height cm - 100
Female
Height cm - 110
12
Q
Median nerve block
Process
A
Between palmaris longus and flexor Carpi radialis Or 1cm medial flexor carpi radialis 2.5cm from wrist crease 0.5cm deep 5-10ml 1% lidocaine
13
Q
Decreasing ETCO2
Causes
A
Cardiopulmonary arrest PE Hypotension Massive blood loss Cardiopulmonary bypass
14
Q
% people with no palmaris longus
A
15%
15
Q
Numbness lateral thigh
Dx
A
Meralgia paresthetica
16
Q
Meralgia paresthetica
Pathology
A
Lateral femoral cutaneous nerve
Often due to increase weight, pressure from belt
Also DM, trauma
17
Q
Ottawa ankle rules
A
Pain in malleolar region +
- tender distal 6cm posterior edge (lat/medial)
- inability to weight bear immediately and in ED
18
Q
Ottawa foot rules
A
Pain in mid foot +
- tender base 5th metatarsal
- tender navicular
- Inability to weight bear immediately and in ED
19
Q
Exclusion to Ottawa rules
A
Pregnancy
HI or intoxicated
(+ unable to follow test)
Children <6
20
Q
CI to knee joint aspiration
A
Cellulitis
Coagulopathy
Joint prosthesis
21
Q
Knee joint aspiration
Process
A
Clean, drape, lidocaine Approach med/lat/superior/inferior 1cm from patella Direct needle posterior to patella toward joint space Aspirate +/- milk joint space
22
Q
Knee aspirate
Send for
A
Cell count
Culture and sens
Gram stain
Crystal analysis
23
Q
APLS
Shock strength
A
4J/kg
24
Q
APLS
Adrenaline dose
A
10mcg/kg
25
APLS
| Amiodarone dose
5mg/kg
26
APLS
| fluid bolus volume
20ml/kg
| N saline
27
Paeds
CT head criteria
w/i 1 hour for any of these
```
Suspected NAI
Post traumatic seizure
Initial GCS<14 or <15 (<1yr)
At 2h post injury GCS <15
?depressed/basal skull #
Tense fontanelle
Focal neuro deficit
(<1yr) with >5cm injury to head
```
28
Manipulate colles’ # if
>10• posterior tilt (lat view)
Displaced ulnar styloid
Ulnar angulation distal fragment
Visual deformity (not swelling)
29
Entonox
Time to act
Time to wear off
Time to act - 30s
| Time to wear off - 60s
30
Suxamethonium
Type drug
Onset time and length of action
Depolarising NM blocker
30s to onset
3-5 mins action
31
CI to suxamethonium
Malignant hyperthermia
Hyperkalaemia
Severe burns
Severe muscle trauma
32
Suxamethonium dose
~1mg/kg
33
Causes of
| Rising ETCO2
Hypoventilation
High temp (increased metabolism)
Pain
34
Sharkfin or sawtooth
Capnography
Indicates
Bronchospasm or
| Airway obstruction
35
Drugs for conscious sedation
Opioids or Benzos
36
Curare cleft
Notch in ETCO2
Due to spontaneous breathing
NM block wearing off
37
Mallampati score
1: soft palate, uvula, Fauces, pillars
2: as above, no pillars
3: s palate, Base uvula
4: hard palate only
38
Path external jugular vein
Inferior from ear lobe to mid clavicle
39
Ulnar nerve block
| Process
```
Needle under flexor carpi ulnaris
Distal to styloid process
Advance 5-10mm
3-5ml lidocaine 1%
Further 2-3ml at ulnar aspect of wrists for dorsal branch
```
40
Atracurium
| Type drug
Non depolarising
| Cf sux
41
Atracurium
Intubating dose
V
Maintenance dose
```
Intubating dose
0.3-0.6mg/kg
V
Maintenance dose : 1/3 above
0.1-0.2mg/kg
```
42
Cause of
| Horners syndrome
Disruption of sympathetic chain
43
90% sialoliths
| Found in
Whartons duct
| Submandibular gland
44
Scoring system
| Sore throats
```
FeverPAIN
Facet over last 24h
Purulence
Attended in <3d
Inflamed tonsil
No cough/coryza
```
45
When to give abx
| For sore throat
FeverPAIN
0-1 nil abx
2-3 delayed script
>4 abx
46
Tx strep throat
Phenoxy...
or
Clarith
10d
47
BRUE
| Stands for
Brief resolved unexplained incident
48
BRUE
| Criteria
```
Brief resolved unexplained incident
<12m
Last<1m
Resolved
No clinical explanation
Altered level responsiveness
```
49
BRUE aka
ALTE
| Apparent life threatening event
50
BRUE
| RF
```
Prematurity
<10w
Recent anaesthesia
Airway obs
GORD
Previous apneic episode
```
51
Paeds
| Trauma analgesia
```
Intranasal diamorphine
0.1mg/kg in 0.2ml H20
IV morphine
0.1mg/kg
Oral paracet
20mg/kg
Oral ibuprofen
10mg/kg
```
52
Paeds
| Femoral # immobilisation
Distal:
Padded long leg splint
Proximal
Skin traction (weight 10% body weight)
53
Coopers sign
Meniscal tear
Pain when changing position even w/I weight bearing
Arthritis usually with weight bearing
54
MCL attached to
Medial meniscus
55
Causes of T1 resp failure
```
PE
Atelectasis
P edema
ARDS
High altitude
```
56
Cause T2 resp failure
```
Ex COPD
Life threatening asthma
OSA
Obesity
Kyphoscoliosis
CF
NM disorder
```
57
Causes of
Airway obstruction in
Maxillofacial trauma
```
FB: teeth, vomit
Bleeding
Swelling airway
Mid face # displaces posteriorly
Bilat mandible #
Trauma larynx/trachea
```
58
Thiopental sodium
| Type drug
Barbiturate
| Non depolarising anaesthetic
59
Dose
| Thiopental sodium
5mg/kg
60
Thiopental sodium
| SE
```
Hypotension
Arrhythmia
Myocardial depression
Laryngeal spasm
Cough
Rash
```
61
Manoeuvres to aid
| Intubation
```
Position:
Neck flex 35’, face ext 15’
Gum elastic bougie
BURP
Alternate laryngoscope
Reduce cricoid pressure
```
62
3-3-2 rule
Fingers between
3: incisors
3: hyoid to chin
2: thyroid notch to floor mouth
63
Factors that cause
| Difficult intubation
```
C spine injury
Arthritis c spine
Mid face #
Mandibular #
Limited mouth opening
Receding chin
Overbite
Short/muscular neck
```
64
Oxygen requirement calculation
Ventilated patient
(During transfer)
FiO2xMV + ventilator O2
X
2x transfer time
65
Amount O2 ventilator uses per min
1L O2/min
66
Bells phenomena
Bell’s palsy
Ask or close eye
Eye rolls up and out
Cannot close eye
67
Bell’s palsy
| Tx
Prednisone
| 25mg BD for 10d
68
Subconjunctival haemorrhage
| Associated with
HTN
Basal skull #
Blood dyscrasia
69
Subconjunctival haemorrhage
| Time to resolve
Improves w/i 10-14d
70
Cause of optic nerve lesions
```
MS
Trauma
Malignancy
Infection
Inflx - GCA
B12 deficiency
```
71
Dendritic eye ulcer
| Tx
```
HSV t1
Aciclovir drops 5x/day
for 10d
High dose vit c
Eye clinic
```
72
Mydriatic eye drops
| CI
Hx AACG
73
Mydriatic eye drops
| List drugs
Atropine
Phenylephrine
Cyclopentolate
Tropicamide
74
Causes of
| Pathological mydriatic pupil
Holmes Addie
Traumatic iris damage
3rd nerve palsy
Rubeosis iridis
75
Gout
| RF
```
Medications - diuretics
FHx
Lifestyle - etoh, bmi
Metabolic syndrome
Renal ds
Trauma/surgery
```
76
Indication for joint aspiration
```
?septic joint
?crystal arthropathy
Unexplained arthritis and effusion
Check response septic arthritis to Tx
Check joint capsule integrity post trauma
```
77
Unwell or with surgical abdomen
No time for CT
Tx
Explorative laparotomy
78
Most common spinal cord infarction
Anterior spinal arteries
| Anterior cord syndrome
79
Anterior cord syndrome
| Sx
Loss of motor functions
| + some sensory
80
Lisfranc injury
| Define
Tarsometatarsal # dislocation
81
Lisfranc injury
| Tx
Bacslab POP
Non weight bearing
Ortho referral
Likely ORIF
82
SAH + 3rd nerve palsy
| Indicates
Likely ruptured posterior communicating artery aneurysm
83
HASBLED
| Acronym
```
HTN (sBP>160)
Abnormal liver/renal
Stroke hx
Bleeding predisposition
Labile INR
Elderly >65
Drugs (NSAIDS, EtOH)
```
84
HASBLED score
| Indicates
>3 indicates high risk bleeding
Consider anticoagulation
Increase review
85
Q fever
| Organism
Coxiella Burnetti
| Zoonotic infection
86
Q fever
| Tx
Doxycycline 2w
87
Q fever
| Complications
Atypical pneumonia
88
HIV seroconversion illness
% who get it
When
40%
| 1-6w Post exposure
89
HIV seroconversion illness
| Ix
p24 antigen tear
HIV RNA levels
NB: Ab test will be negative
90
Thyroid storm
| Tx
```
IV fluids
Paracetamol
Benzodiazepine
Steroids for adrenal suppression
Abx for infx
Propranolol 80mgPO
High carbimazole 50mg/day
Potassium iodide 200mg IV over 1h
(Blocks release thyroid hormones)
```
