Part B 08 Flashcards
Henoch schonlein pupura
Complications
Nephritic/nephrotic
Renal failure
Seizures
Intussusception
Advance directive
Define
Decisions Re EoL care ahead of time
BRUE
Low risk features
> 2m old (>40/40)
No CPR
1st event
Lasted <1min
BRUE
Ix
ECG
Pertussis swab
CI to flying
Cardiovascular
MI w/i 7 days CABG w/i 10d Unstable angina CVA w/i 3d Decompensated HF Uncontrolled arrhythmia Uncontrolled HTN Severe valvular heart ds
Indications for O2 on airline flight
Hb<7.5 Regular O2 Angina >class III CCF >class III Cyanotic congenital heart ds
Cluster headache
Autonomic involvement
Conjunctival injection Rhinorrhea Lacrimation Miosis Ptosis
Cluster headache
Tx
High flow O2
6mg sumatriptan SC
Torsade de pointes
Tx
IV magnesium sulphate
Loud S2
Cause
Systemic HTN
High output state
Soft S2
Cause
Aortic regurg
Widely split S2
Deep inspiration
RBBB
Reversed splitting S2
Deep expiration
LBBB
Dabigatran
Action
Direct thrombin inhibitor
Moderate hyperkalaemia
6-6.4mmol/L
Meckles diverticulum
Comp
Haemorrhage
Obstruction
Diverticulitis
Perforation
Neuroleptic malignant syndrome
Sx
Fever
Low GCS
Severe rigidity
Extrapyramidal SE
Rigidity Bradykinesia Dystonia Tremor Akathesia Tardive dyskinesia
Surface rewarming hypothermia
Complication
Hypotension
Core temperature after drop
Bother due to cutaneous vasodilation
HEART score
Scoring
History 2- highly suspicious ECG 1- non specific Age 1: 45-60 RF 1: 1-2RF Trop 1: 1-3x normal limit
HEART score
Management
0-3: discharge w early F/U
4-6: admit further Ix
(Provocative testing)
>6 early PCI
Troponin level peaks at
24h
4th HS
Due to
Vibration w/i ventricles
Usually due to resistance to filling due to stiff walls
4th HS
Sign of
Hypertrophy 2nd HTN
Cardiomyopathy
CURB score BP
<90/60
Brugada syndrome
Drugs to avoid
TCA
Lithium
LA
Propofol
Cricothyroidotomy
Process
Large canula (12G) Between thyroid and cricoid Aspirate air High flow O2 1s on 4s off Up to 45mins
Biers block
Process
Elevate arm 3min (Exsanguinate) Double cuff Inflate 100mmHg above sBP - or max 300mmHg (whichever greater) Check absent pulse Inject prilocaine (5m) Reduce > XR Min 20m max 45m
Biers block
Max and min time cuff up
Min 20m max 45m
Biers block
Cuff pressure
100mmHg above sBP
Or 300mmHg
Whichever greater
Biers block
After injection prilocaine
How long until reduction
5 mins
LA toxicity
Tx
Intralipid 20%
1.5ml/kg bolus
LA toxicity
Sx
Low GCS Agitation Peri oral anaesthesia Muscle twitching Convulsions Arrhythmia, Bradycardia, Hypotension
Placental abruption
Abdo signs
Hard woody
Frequent contractions
Contracts on touch
Difficulty palpating fetal parts
Placental abruption
Definitive Tx
C section
Prilocaine
Comp
Methaemaglobinaemia
AACG
Tx
Top pilocarpine drops (every 15 min) Top timolol IV morphine + anti emetic IV acetazolamide 500mg Refer ophthalmology
Etomidate
SE
Pain
N+V
Apnea
Adrenocorticoid suppression
Salter Harris #
Comp
Growth plate arrest
AVN
Supracondylar humural #
Tx
Manipulation under anaesthesia
Backslab
Collar cuff
6-8w
Haemorrhaging shock
Class I
Volume lost and %
<750ml
<15%
Haemorrhaging shock
Class I
Bpm
RR
Pulse pressure
Bpm <100
RR<20
Normal pulse pressure
Haemorrhaging shock
Class I
U/O
> 30ml/h
Haemorrhaging shock
Class I
Mental state
Anxious
Haemorrhaging shock
Class III
Vol lost and %
1500-2000ml
30-40%
Haemorrhaging shock
Class III
Bpm
Pulse pressure
RR
120-140
Reduced pulse pressure
RR 30-40
Haemorrhaging shock
Class III
U/O
5-20ml
Haemorrhaging shock
Class III
Mental state
Confused
Staghorn calculus
Tx
Percutaneous nephrolithotomy
Abx causing theophylline toxicity
Macrolides
Quinolones
MetHb
O2 says typically
80-85%
False reading
Intracapsular FNOF
Types
Subcapital
Transcervical
Intracapsular FNOF
Tx
Garden classification
1-2: DHS
3-4: hemiarthroplasty
Extracapsular FNOF
Types
Intertrochanteric
Subtrochanteric
Intracapsular FNOF
Tx
DHS
Or
IM nail
Canadian C spine rules
High risk factors
Requiring XR
Age >65
Paraesthesia in extremities
Dangerous mechanism
- bicycle, >3feet, 5 steps, axial loaf, high speed MCV, ejection
Canadian c spine rules
Apply to
GCS15
Stable trauma patients
With concern for c spine
Canadian c spine
Low risk factors allowing assessment of ROM
Rear end Sitting position ED Ambulatory at any time Delayed onset Absence mid line tenderness
Hyperemesis gravidum
Tx
1st:
Cyclizine, Promethazine
2nd
Metoclopramide, ondansetron
CTG
Stands for
Cardiotocography
CTG
Measures
Fetal HR
And
Contractions
CT head fro children if
1 major criteria
>1 minor criteria
1 minor criteria
> monitor for 4h
> CT head if
- GCS<15, further vomiting, abnormal drowsiness
Paeds
CT head
Minor criteria
LOC >5min Amnesia >5min Abnormal drowsiness >2 vomits Dangerous mechanism
Kawasaki ds
Comp
Coronary artery aneurysm
Kawasaki ds
Tx
IV Ig
Aspirin
Cricoid pressure
Aka
Sellick manoeuvre
Inflamed gland of penis
Aka
Balanitis
APLS seizure
Benzo drugs and doses
Loraz - 0.1mg/kg
Midaz/diaz - 0.5mg/kg
Paeds
DKA cerebral oedema
Tx
Hypertonic saline (3%) Mannitol infusion 3ml/kg
Graves ds
Shin rash aka
Pretibial myxoedema
Graves ds
Specific Ix
TSI assay
Thyroid stimulating immunoglobulin
Benign stridor in infancy
Laryngomalacia
TFCC
Aka
Triangular fibrocartilage complex
TFCC damage
Sign
Piano key sign
- protruding ulnar head
- can be pushed down
- come back up
TFCC damage
Ix
MRI
TFCC damage
Tx
Conservative
Splint/ plaster cast
Anterolateral thoracotomy
Approaches
Left sided approach
- traumatic arrest
- left sided injury
Right sided approach
- profound hypotension
- right sided injuries
Anterolateral thoracotomy
Process
Incision along 4-5th intercostal space
From sternum to posterior axillary line
Enter pleural cavity
Rib spreader to visualise
Clamshell thoracotomy
Aka
Bilateral anterolateral thoracotomy
Supraspinatus entrapment
Aka
Subacromial impingement
Thyroglossal cyst
Comp
Inflammation and pain
Infection
Thyroglossal fistula
Mannitol CI
Severe HF P edema Intracranial bleeding Dehydration Anuria
Loading dose keppra
1g IV
SUFE
Tx
Surgical pinning
Body responsible for training nationally
Health education England
5 year revaluation requirements
250 CPD credits 1 full audit cycle 1 colleague survey 1 pt survey R/V of all formal complaints
Body that ensures standards of confidentiality in NHS
Caldicott guardian
Digoxin toxicity
ECG signs
Brady
Downsloping ST depression
Prolonged PR, QRS
Digoxin toxicity
Precipitating factors
Low K
Renal failure
Flumazenil
Dose
IV 200micro gram
Flumazenil
CI
Dependent benzo users
Cause withdrawal seizures
Mechanism of antipsychotics and SE
Reduce dopamine
SE extrapyramidal SE
- parkisonism, dystonia, akathesia, tardive dyskineasia