Part B 07 Flashcards
Most common
Transfusion transmitted bacterial infx
Yersinia enterocolitica
HEART score
Used for
Cardiovascular disease assessment tool
Predicts 6 week adverse events
HCO3-
Normal values
22-26mmol
Giardiasis
Ix
Stool ova and parasite examination
Brugada syndrome
Genetics and defect
Autosomal dominant
Na channel defect
Brugada syndrome
Dx
> 2mm ST elevation in >1 lead V1-3
Followed by negative T wave
Plus 1 of fHx sudden death fHx ECG changes VF or VT episode Suncopal episode
Brugada syndrome
Tx
ICD
Implantable cardioverter defibrillator
qSOFA score
sBP<100
RR>22
Reduced GCS
Amiodarone
Action
Membrane stabiliser
Increases duration of refractory period
Cough with red rash on face, exposure to birds
Dx and name of rash
Chlamydia psittaci
Horders spots
Pleural aspiration
Process
Upright Mid scapular line (~10cm lat to spine) Needle above upper border to rib (1-2 ribs below fluid level)
Pleural aspiration
Indication
Tx: symptomatic relief
Ix: suspected unilateral educative effusion
Boerhaaves syndrome
Sx
Resp distress
Subcutaneous emphysema
Acute abdomen
Haematemesis
Duodenal ulcer
Complication
Perforation
GI haemorrhage
(Gastro duodenal artery)
Strictures causing obstruction
Acute diverticulitis
Nice reasons for admission
Pain not managed Hydration not maintained Cannot tolerate oral Abx Frail patient, +++ comorbidity Complication - transfusion, perf, abscess, fistula Sx >48h despite conservative management at home
Raised amylase
Causes
Pancreatitis Renal failure DKA Mesenteric ischaemia Perforated duodenal ulcer Ectopic Pancreatic Ca Mumps
Genital warts
Aka
Condylomata acuminata
Signs fetal distress
Reduced movements
Increased/decreased HR
Decreased variability in HR
Late decelerations
Placental abruption without PV bleed
Aka
Concealed placental abruption
Digoxin therapeutic levels
1-1.5nmol/L
Von willebrands ds
Tx
Mild
- desmopressin
> releases vWF from endothelial cells
Severe > cryoprecipitate
ECG
Calculate rate
300/no large sq (R-R)
Atropine uses
Increase HR
Mydriatic
Decreases secretions
Tx organophosphate OD
Delayed haemolytic reaction
Cause
Low titre Ab too weak to detect in X match
Delayed haemolytic reaction
Ix
Positive Coombs test on presentation
Delayed haemolytic reaction
Management
Benign course
Monitor renal function and Hb
TACO
Stands for
Transfusion associated circulatory overload
HEART score
0-2 for each History ECG Age (>45,>65) RF (>1,>3) Troponin (>normal limit, >3x)
HEART score
Management
0-3: discharge w’ FU
4-6: admit, serial trop, further Ix
>7: early PCI
Status epilepticus
Management
2x benzo
Phenytoin infusion
GA
Status epilepticus
If GA started continue for how long
- anaesthesia continued for 12-24h after last clinical or EEG seizure
Status epilepticus
Dose phenytoin infusion
15mg/kg
50mg/min
Abx that increase effect of warfarin
Ciprofloxacin Co trimoxazole Doxycycline Macrolides Metronidazole
LBBB
ECG appearance
Dominant S wave in V1
Broad monophonic R wave in lateral leads
QRS>120
Diagnose st elevation in presence of LBBB or paced rhythm
Sgarbossa criteria
Pericarditis
Sx
SOB
Pleuritic CP
Tachycardia
Pericardial friction rub
Pericarditis
ECG
Saddle ST elevation
PR depression
Pericarditis
Causes
80% viral
Eg coxsackie virus
Uraemia, Dressler’s syndrome, traumatic, autoimmune, paraneoplastic, drug induced
Pyelonephritis
Tx
Gent or cipro
?ceftriaxone
Seizures
Medical Tx
Benzo x2
+/- glucose +/- pabrinex
Phenytoin infusion
GA (propofol)
Digoxin toxicity
Precipitating factors
Renal failure, Mi, Hypothyroid
Low: k, mg
High: Na, Ca, acidosis
Drugs: CCB, amiodarone, K lowering (loop diuretics)
Normal anion gap
10-15
Dabigatran
Action
Direct thrombin inhibitor
Ascitic tap
CI
Pregnancy Uncooperative patient Nil consent Skin infection overlying Coagulopathy Bowel overlying
Ascitic tap
Indications
Ix vs Tx SBP Aeitiology ascites Malignancy Transudate vs exudate
Therapeutic relief pain/ resp distress
ALS
Unstable tachyarrhythmia
Tx
3 shocks
300mg amiodarone 15min
Repeat shock
900mg amiodarone infusion over 24h infusion
C. difficile
Tx
Oral metronidazole
2nd Oral Vanc
SVCO
Tx
O2
Steroids
Thromboylsis
Recommended drug
Alteplase
Part of conducting system affected by Mobitz T2
His purkinje system below AV node
Giardiasis
Sx
Chronic diarrhoea
Giardiasis
Organism
Giardia lamblia
Giardiasis
Ix
Stool sample often negative
?parasite and ova screen
Small bowel biopsy:
subtotal villous atrophy
Giardiasis
Tx
Metronidazole
Bifasicular block
Types
RBBB + left ant fasc block
(Most common)
RBBB + left post fasc block
Bifasicular block
RF
IHD
HTN
AS, anterior MI, lenegres ds
Bifasicular block
Comp and Tx
1% progress to complete HB
Tx pacemaker
Bloody diarrhoea
Tx
Clarithromycin (campylobacter)
Or
Ciprofloxacin
Bloody diarrhoea
Causes
Campylobacter jejuni Shigella spp Salmonella spp Clostridium difficile Enteroinvasive e coli Amoebiosis Yersenia spp Shistomiasis
Amoebiasis
Pathogen
Entamoeba histolytica
Passive rewarming
Methods
Blanket and bair hugger
Active re warming
Methods
Warmed humidified O2
Warmed IV fluids
Cardiopulmonary bypass
Pneumothorax (primary)
Tx
Tx if large
(>2cm between lung and chest wall at level of hilum)
Aspirate > chest drain if unsuccessful
CURB65
BP score
BP <90/60
Canadian c spine rules
Low risk factors allowing c spine range of movement assessment
Simple rear ended RTA Sitting position in ED Ambulatory at time Delayed onset neck pain No midline tenderness
Jefferson #
Aka
C1 bust #
Jefferson #
Neurological signs
Usually no neurological deficit
Jefferson #
Tx
Conservative management
Immobilise in hard collar
Swiss staging hypothermia
1: conscious, shivering
2: low GCS, no shivering
3: unconscious
4: not breathing
5: death due to irreversible hypothermia
Croup steroid dose
Dex: 0.15mg/kg
Budesonide 2mg in 5ml saline
BP contraindication
Thromboylsis
> 180/110
Tx reduce BP
In stroke
For thrombolysis
10mg IV labetolol (1-2min)
Or
Nitrate infusion
(1-10mg/hr: titrate to BP)
ECG leads
Anteroseptal
V1-3
ECG leads
Anterior
V2-4
ECG leads
Anterolateral
V5-6
ECG leads
Lateral
I, II, aVL, V6
ECG leads
Right ventricle
VI, V4R
ECG leads
Posterior
V7-9
Right ventricle infarction
Changes to management
Hold nitrates
V preload sensitive
Causes severe hypotension
Tx with fluid loading
Induction agents
And dose
Propofol 2mg/kg Ketamine 2mg/kg Thiopental sodium Etomidate Midazolam
Froments sign
Demonstrates
Ulnar nerve palsy
Froments sign
Positive sign due to..
Unable to adduct (ulnar palsy)
Compensation with thumb flexion
Flexor pollicis longus
IPJ flexes
SALTER Harris #
Define
1: same
2: above (away from end)
3: low (toward end)
4: through
5: ram
Most common Salter Harris #
Type 2
Schedule 1 drug
Not used medically
Possession and supply prohibited
Schedule 2 drug
Subject to control
Requires prescription
Authorities that commission nhs services
NHS England
CCGs
(Clinical commissioning groups)
Travelers diarrhoea
Pathogen
80% enterotoxic e. Coli
Can cause bloody diarrhoea
SBP
Tx
Ceftriaxone
Ascitic tap
Aka
Diagnostic paracentesis
Whooping cough
Comp
Petechia
Subconjunctival haemorrhage
Hernia
Secondary pneumonia
Bronchiolitis
Most common age
3-6m
Bronchiolitis
Tx
O2 <92%
NG feed if cannot feed
Avulsion # ASIS
Pathology
Sartorius avulses attachment at ASIS
Avulsion # ASIS
Population
Usually adolescents
Avulsion # ASIS
Sx
Pop or snap Pain and weakness anterior thigh Tender ASIS Weak hip flx, knee ext Limping
Avulsion # ASIS
Ix
XR
CT or MRI
Avulsion # ASIS
Tx
Conservative
Analgesia and crutches
ORIF if displaced >3cm
