Part B 04 Flashcards
1
Q
Clinical test prior to ABG/ART line
Name and procedure
A
Allen’s test Occlude both radial and ulnar artery’s Make fist open hand - white Remove occlusion ulnar artery <6s = good collateral circ
2
Q
Ventilation in HI
PCO2 aim for
Normally vs deteriorating
A
PCO2 = 4.7
Deteriorating patient
<4.3kPa
3
Q
Radial nerve block
Process
A
Wrist dorsiflexion Lidocaine Radial/dorsal wrist ~ 3cm prox to radial styloid Aim medially toward radial artery
4
Q
ASA classification
A
1: healthy
2: mild systemic ds
3: severe systemic ds
4: severe systemic ds that is constant threat to life
5: moribund pt not expected to survive w/o operation
6: brain dead: organ donation
5
Q
BiPAP
Stands for
A
Bilevel positive airway pressure
6
Q
BiPAP
Types
A
Timed cycled
or flow cycled
7
Q
BiPAP
Name of 2 different pressures
A
IPAP: inspiratory positive airway pressure
EPAP: expiratory positive airway pressure
8
Q
CPAP equivalent to which pressure of BiPAP
A
EPAP
9
Q
CPAP/EPAP
Assists breathing how?
A
Inspiration
- recruits alveoli -> increase gas exchange
Expiration
- stents alveoli open -> increases functional residual capacity -> increases gas exchange
10
Q
IPAP
Assists breathing how?
A
Higher IPAP pressure
- recruits alveoli as per CPAP
- decreases work of breathing , fatigue, myocardial O2 demand
- increases tidal volume -> washes out CO2
11
Q
Pressure support =
A
IPAP-EPAP
12
Q
Starting pressure for NIV
A
CPAP - 5cm H20
13
Q
Starting pressure for NIV
BiPAP
A
10/5cm H2O
14
Q
Increasing NIV pressure
How much
A
Increase 2cm every 5 min until response
15
Q
Max NIV pressure
A
15-20cm H2O
16
Q
C.I. to NIV
A
Resp arrest Cardiac arrest Nil consent Uncooperative pt Unable to tolerate Facial trauma/burns Reduced GCS Untreated pneumothorax Basal skull # Intractable vomiting Untrained staff
17
Q
Knee ligament injury mechanism ACL PCL MCL LCL
A
ACL - pivoting PCL - dashboard injury - blow to tibia w’ flexed knee MCL - blow to lat knee (Valgus stress) LCL - blow to med knee (Varus stress)
18
Q
Mechanism of injury
ACL
A
Pivoting
19
Q
Mechanism of injury
PCL
A
Dashboard injury
Blow to tibia with flexed knee
20
Q
Mechanism of injury
MCL
A
Blow to lateral knee
Valgus stress
21
Q
Mechanism of injury
LCL
A
Blow to medial knee
Varus stress
22
Q
Unhappy triad
A
ACL
MCL
Medial meniscus
23
Q
Emergency thoracotomy indication
A
Penetrating injury
- witnessed cardiac arrest
- unresponsive hypotension
Blunt injury
- chest drain >1500ml
- unresponsive hypotension
24
Q
Massive haemothorax
Defined
A
> 1/3 blood vol in chest
> 1500ml blood
25
APLS
Anaphylaxis
Range of adrenaline dose
150-500mcg IM
26
APLS
Anaphylaxis
Range of chlorphenamine dose
2.5-20mg IM
27
APLS
Anaphylaxis
Range of hydrocortisone dose
25-200mg
28
APLS
Non shockable rhythm
Adrenaline dose
10mcg/kg adrenaline
| IV/IO
29
Posterior shoulder dislocation
| X-RAY signs
Light bulb sign
Absence ext rotation
Trough line sign
Rim line sign
30
Trough line sign
Post dislocation
| - vertical dense line in medial humeral head
31
Rim line sign
Widened glenohumeral joint
| >6mm
32
HI and GCS<13 in ED
| Imaging
CT head and neck
33
Commonest hip pain
| < 10yo
Transient synovitis
Septic arthritis
Perthes
Congenital hip dysplasia
34
Tetanus prone wound requiring
| Ig
```
Puncture
Wound >6h
Dirty wound
Significant devitalised tissue
Avulsion
Open #
Gunshot
Crush injury
Burns
```
35
Ulnar neuritis
| Sx
Paraesthesia/numb little finger
| Hand weakness
36
Ulnar neuritis
| Most common cause
Cubital tunnel syndrome
37
Ulnar neuritis
| Ix
Nerve conduction study
38
Ulnar neuritis
| Tx
Surgical decompression
39
Cubital tunnel
| Location
Medial epicondyle
| Under osbournes ligament
40
Fight bite abx
Co amoxiclav
Or
doxy and metronidazole
41
Peri anal haematoma
| Pathology
Rupture of small vein
> small collection of blood
> firm clot w/i 1h
42
Peri anal haematoma
| Tx
Needle aspiration blood w/i 1h
Spontaneously resolves w/i days
Or
I+D if too painful
43
Scoring system for
| Acute appendicitis
Alvorado score
44
SIGN guideline
Lower GI bleed
Admit for early endoscopy if:
```
>60yo
Haemodynamic instability
Evidence of gross rectal bleed
Aspirin/NSAID
Significant comorbidity
```
45
AAA
| RF
```
Age
Male
Smoking
HTN
PVD
fHx
Connective tissue ds
```
46
Commonest cause LBO
Malignancy
47
Tripod #
| Includes
Lat orbit
Zygoma
Maxilla
48
Tripod #
| Aka
zygomaticomaxillary complex
49
Tripod #
| Tx
Severe angulation or comminuted = ORIF
Otherwise conservative
50
Mandible #
| Location
30% condyle
25% angle
25% body
15% mental
51
Mandible #
| Complications
Osteomyelitis
Paraesthesia
Malocclusion
52
malocclusion
| Define
malocclusion is a misalignment or incorrect relation between the teeth of the two dental arches when they approach each other as the jaws close.
53
LMN facial nerve palsy
| Ddx
```
Bells
Ramsey hunt synd
Trauma
Parotid bland tumour
Vestibular schwanomma
Middle ear infx
Cholesteatoma
Sarcoidosis
```
54
Traumatic aortic rupture
| % RTA deaths
15-20%
55
Traumatic aortic rupture
| Most common location
Incomplete laceration
| Next to ligamentum arteriosum
56
Traumatic aortic rupture
| CXR signs
Widened mediastinum
| Trachea deviated to Right
57
De Quervains tenosynovitis
| Sx
Thickened and inflamed tendons
| Radial side of wrist
58
De Quervains tenosynovitis
| Tendons involved
Extensor pollicis brevis
| Abductor pollicis longus
59
De Quervains tenosynovitis
| Test
```
Finkelsteins test
Flx wrist
w ulnar deviation
And thumb flx across palm
Stretches tendons > pain
```
60
De Quervains tenosynovitis
| Tx
Rest
| Thumb splint to immobilise
61
Barton’s #
| Define
Intra articular # distal radius
W’ dislocation of radiocarpal joint
Distal fragment can be displaced dorsal or volar
62
Barton’s #
| Tx
Inherently unstable#
| Needs ORIF
63
Consider SBP if
Any patient with ascites that is deteriorating
Asymptomatic cases have been reported
64
% patients with ascites that develop SBP per year
30% per year
65
Tx
| SBP
Ceftriaxone or cipro
+
IV albumin (reduces renal failure)
66
Ascetic tap
| Process
- Find flank dullness
- Lateral to rectus abdominis
- 5cm superior and medial to ant superior iliac spine
67
Arctic tap fluid analysis that suggests SBP
```
WCC >500 cells/ml
Neut>250
Lactate >25mg/dl
pH<7.35
Bacteria on gram stain
```
68
Prophylactic abx for SBP
Norfloxacin
69
WPW causes what type of tachyarrhythmia
AVRT
| Atrioventricular re-entrant tachycardia
70
WPW
| ECG features
Short PR<120ms
Delta wave
Widened QRS
71
Types WPW
Type A; features sim RBBB
Tube B; sim LBBB
72
Drop INR by 1
| Decrease warfarin dose by
15%
73
Types transfusion reaction
```
Acute haemolytic reaction
Febrile transfusion reaction
Allergic reaction
TRALI ~6h
Delayed haemolytic reaction (4-8d)
GVHD (1-4w)
```
74
Cause of
| Acute haemolytic reaction
ABO mismatch error
75
Cause of
| Febrile transfusion reaction
Cytokines in blood
76
Cause of allergic reaction to blood transfusion
Eg due to anti IgA Ab
77
Cause of TRALI
Ab in donor blood vs recipient
78
Theophylline
Type of drug
And risk using
Phosphodiesterase inhibitor
Narrow therapeutic window
79
Theophylline
| OD sx
Headache, N+V
Seizure, low electrolytes
High BG
80
Cannabinoid hyperemesis syndrome
Time to develop
Average 16 years of chronic use
V rare for cannabinoid toxicity
81
Cannabinoid hyperemesis syndrome
Improves with
Hot baths
82
Cannabinoid hyperemesis syndrome
Complications
Cannabinoid hyperemesis acute renal failure
Hypovolaemic
83
Paracetamol OD
Toxin
And how it accumulates
NAPQI
Hepatotoxic
Glutathione used up allowing NAPQI to damage liver
84
Paracetamol OD
Amount taken that can cause severe Damage
>12g
Or
150mg/kg
85
Paracetamol OD
Time to
- abnormal LFT
- hepatic failure
- abnormal LFT ~18h
| - hepatic failure ~48h
86
Paracetamol OD
Significant ingestion
What dose
>75mg/kg
87
Start NAC Tx
| If
4h level over Tx line
Or
>8h and significant OD (75mg/kg)
88
NAC
| Effectiveness reduced if over x h since OD
8h since OD
89
NAC
| Tx dose, vol, time
1) 150mg/kg in 200ml over 1h
2) 50mg/kg in 500ml over 4h
3) 100mg/kg in 1L over 16h
