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WFA CPGs > PATHOOOO > Flashcards

PATHOOOO Flashcards

1
Q

where is adrenaline released from

A

the adrenal glands

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2
Q

explain the pathway of adrenaline

A
  1. SNS massage from hypothelamus
    2.acetycholine (pre synaptic neuron) binds to nicotinic receptos (post sympatin)
  2. noradrenaline binds to adrenergic receptors in target organs
  3. one of the target organs is the adrenal gland and adrenaline is released into the bloodstream
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3
Q

Adrenergic receptor B1 memory trick

A

1 HEART beat stimulated by B1

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4
Q

Adrenergic receptor B2 memory trick

A

2 lungs to Breath, B 2

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5
Q

A1 role

A

stimulates all SM, organs and glands except cardiac tissue

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6
Q

B1 role

A

cardiac tissue stimulation

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7
Q

B2 role

A

inhibits all SM organs and glands

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8
Q

patho of adrenaline in anaphylaxis

A

airway constriction, B2 stimulation, causes brocodliation

vasodilation (HTN)- A1 stimulation- vasoconstriction resolves HTN

adrenaline increases HR and contractility via B2= also assists with HTN

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9
Q

patho of adrenaline in brococonstriction

A

B2 stimulated = brocodilation

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10
Q

when are prostagliands released

A

when cells in an area of direct blood supply are damaged, pro-inflammatory mediadtors such as prostoglands are rebased

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11
Q

state the COX 2 prostaglandins functions

A

inflammation, fever, pain and stimulation of platelet aggregation

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12
Q

state COX 1 prostaglandin functions

A

maintains stomach mucosa, maintains renal perfusion, inhibits platelet aggregation

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13
Q

what type of prostaglandin is aspirin

A

equally cox 1 and 2, but cox 1 is good for platelet aggregation inhibition

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14
Q

inflammation occurs any time….

A

there is damage to vascular tissue

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15
Q

what is glycogen

A

stored glucose

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16
Q

Glucagon tells the liver cells too…

A

break down glycogen into glucose

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17
Q

where is histamine predominately stored

A

in the mast cells, that are dense populated in the skin, lungs, and GI tract

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18
Q

how prednisone stops inflammatory response

A

inhibit the synthesis of multiple inflammatory proteins through suppression of the genes that encode them.

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19
Q

nausea is triggered when

A

serotonin is released into the GI tract at a faster rate then it can be digested

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20
Q

where in the brain dose nausea come from

A

the chemoreceptor trigger zone

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21
Q

how opitate stimulation blocks pain

A

inhibition of firing and the release of substance P, a neurotransmitter involved in pain transmission, thereby blocking pain transmission.

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22
Q

how tramadol works

A

opiate stimulation stops acending pain signals and reuptake of serationin and noradrenaline blocks decending signals

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23
Q

what is pnemonia

A

infection in the lung tissue alveoli or bronicoles , where a microbe had successfully colonised in a normally sterile environment, causing inflammation brings fluid or and mucus into the lungs

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24
Q

pneumonia presentation

A

fever
productive cough
fatigue
chills
chest pain

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25
Q

bronchitis presentation

A

sore throat
persistent cough
body aches

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26
Q

what causes pluertic chest pain

A

when the pleura ( 2 tissue that separated lungs from chest wall) becomes inflamed and rub together causing a sharp pain when breathing

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27
Q

difference between prednisone and prednisolone

A

prednisone- pre- metabolised non active form

prednisolone- active steroid

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28
Q

what is chronic bronchitis

A

inflammation of the bronchioles and excess mucus production

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29
Q

what is emphysema

A

damage to alveolar sacks (loose elasticity, become floppy, don’t inflate)

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30
Q

what is asthma

A

chronic reversible inflammation of the airway caused by inflammatory state of the lungs

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31
Q

patho of asthma

A
  1. exposed to allergen
  2. vasodilation, increased permeability and odema
  3. increased mucus production via goblet cells
  4. bronco constriction due to vagal stimulation
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32
Q

alpha cells in the pancreas creates…

A

glucagon

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33
Q

beta cells in the pancreas create…

A

insulin

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34
Q

DKA occurs when

A

adipose tissue is broken down for energy, fat is broken down to fatty acids

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35
Q

what is a seizure

A

a period when the neutrons in the brain are active at the same time, when they are not supposed to do

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36
Q

patho of anapahlaxisi

A

exposure to an antigen, secondary exposure leads to a big dump of histamine, causing SM contraction, vasodilation

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37
Q

what is cellulitis

A

a bacterial skin infection causing inflammation to subcutaneous tissue causing tenderness, fever and tight glossy skin

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38
Q

what causes fever

A

temp is regulated by the hypothalamus, when infection, body increases temp to help kill bugs.

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39
Q

what is shock

A

inadequate p[refusion to the tissue

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40
Q

categories in systemic inflammatory response syndrome

A

temp, HR and RR

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41
Q

what is sepsis

A

sirs plus conformed infection

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42
Q

clinical features that indicate antibiotics

A

new mental status
new need for 02
hypotension
elevated HR
skin mottled

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43
Q

when is IGEL appropriate

A

morot score less than 5 or arrest

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44
Q

if there is a risk of aspiration or airway swelling

A

igel or higher

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45
Q

what is the role of the kidneys

A

regulate the blood
remove waste
steady electrolyte balace
remove waste
regulate water levels

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46
Q

what its acute kidney injury

A

rapid deterioration in kidney function due to a sudden decrease in GFR

47
Q

what is rhabdomyolysis

A

breakdown of muscle tissue due to schema/direct damage or hyperthermia

48
Q

what is autonomic dysreflexia

A

sensory stimuli gets stuck at the level o0f injury, below injury SNS activation and PONS above

49
Q

what is an aneurysm

A

abnormal dilation of a blood vessel

50
Q

what is aortic dissection

A

endothelial of blo0od vessel rips off, separating layers of vessels, blood pools between

51
Q

what is Diverticullits

A

inflammation of small pockets of colon.

52
Q

what is renal coplic

A

pain that occurs when solids pass through the urinary system

53
Q

what is gastric ulceration

A

break in the tissue lining of the stomach

54
Q

what is cholesterols;ecystits

A

inflamed gall bladder

55
Q

what is a hernia

A

weakness in the abdominal wall allowing fat or intestine to bulge through

56
Q

steps of shoulder dystocia

A

Legs up. Ask the patient to grab her knees, pull them to her chest and push as hard as she can with the next two contractions.
Pressure. With the legs still up (as above), place the heel of your hand directly above the patient’s pubic bone and push slowly but firmly straight back toward the patient’s lower back. This is designed to reposition the baby’s shoulder, which is usually what is preventing delivery.
Enter manoeuvres. This refers to internal rotation manoeuvres that are not within delegated scopes of practice and personnel must seek urgent clinical advice if these are thought to be required.
Remove the posterior arm. Place the fingers of your hand into the posterior aspect of the vagina (adjacent to the anus), feel for the posterior arm and manipulate it until the arm is able to be pulled through the vagina.
Roll. Ask the patient to move on to her hands and knees and push as hard as she can with the next two contractions.

57
Q

what is croup

A

viral infection of the upper airway

58
Q

what is glycogenolysis

A

(Glycogen → glucose)

59
Q

gluconeogenesis is..

A

(Glucose formation from carbs/sources)

60
Q

main causes of stridor

A

croup, anaphylaxis, upper airway obstruction, epiglottis

61
Q

what is Meningococcal

A

Meningococcal disease is a rare, serious illness caused by a bacteria (Neisseria meningitidis). It can cause meningitis, which is an infection of the brain and spinal cord, and it can also cause blood infections.

62
Q

what is ACPO

A

when there is an increase in pulmonary pressure leading to fluid shift into the interstitial as a result of ineffective filling or pumping of the heart

63
Q

what causes the elevation of the ST segment in a stemi

A

Ischemia decreases ATP production, which leads to faster potassium export through the K-ATP channel. This increased potassium export leads to faster depolarization of ischemic tissue, creating a current between ischemic and non-ischemic myocardium.

64
Q

what is the most common cause of vt

A

ischemic heart disease

65
Q

patho of VT

A

Premature ventricular complexes (PVCs) are often the events that lead to ventricular tachycardia. These premature beats may occur as a result of either a change in automaticity or a conduction defect.

66
Q

name the mechanism of SVT

A

SVT is caused by 1 of 3 mechanisms: reentry, increased automaticity, or triggered activity

67
Q

patho of AF

A

But in atrial fibrillation, the signals in the upper chambers of the heart are chaotic. As a result, the upper chambers tremble or shake. The AV node is flooded with signals trying to get through to the lower heart chambers. This causes a fast and irregular heart rhythm

68
Q

abdo pain red flags

A
  • Severe pain.
  • Abnormal vital signs.
  • Pain radiating to the back.
  • Loin or flank pain.
  • Temperature > 40°C.
  • Rigors.
  • Female aged 14-50 years and last menstrual period (LMP) more than
    four weeks ago.
  • Pregnant.
  • Abdominal tenderness on palpation.
  • Pain made worse by movement.
  • Indigestion or epigastric pain.
  • Persistent or recurrent vomiting.
  • Aged < 5 years.
  • Aged ≥ 65 years.
  • Immunocompromised (for example on steroids or immunotherapy).
69
Q

A patient with abdominal pain who calls an ambulance should usually be assessed in an ED, unless there is….

A

nless there is an obvious benign cause such as urinary tract infection, menstruation or recurrent constipation.

70
Q

Abdominal pain radiating to the spine or flank may result from conditions such as….

A

pancreatitis, gastric or duodenal ulceration, cholecystitis, pyelonephritis, or a leaking abdominal aortic aneurysm.

71
Q

An abdominal aortic aneurysm is usually asymptomatic prior to….

A

leaking. Although many references describe a pulsating mass, this may not be palpable. A leaking abdominal aortic aneurysm usually presents with abdominal pain that radiates to the back and signs of shock.

72
Q

what is Rigors and what dose it indicate

A

Rigors indicate that bacteria may be present in the blood. episodes in which your temperature rises while experiencing severe shivering accompanied by a feeling of coldness.

73
Q

Perforated bowel (for example from cancer, diverticular disease or ulceration) usually presents with

A

non-specific abdominal pain for 1-2 days followed
by signs of peritonitis (abdominal tenderness with pain made worse by movement).

74
Q

falls red flags

A
  • Clinically significant injury.
  • Clinically significant pain.
  • Abnormal vital signs.
  • Signs of stroke.
  • Seizure without a history of epilepsy.
  • Headache.
  • New onset of visual disturbance.
  • Unable to mobilise.
  • Unstable medical condition contributing to the fall.
75
Q

Postural hypotension is present if there is a fall of greater than

A

20 mmHg in the systolic BP or greater than 10 mmHg in the diastolic BP when standing.

76
Q

treatment of fever under 12 months

A

Clearly recommend that all children aged less than 12 months with a fever are transported to an ED by ambulance.

77
Q

fever under 5 red flags

A
  • Colour:
    ū Pale or ashen.
    ū Mottled.
    ū Cyanosed.
  • Activity:
    ū No response to social cues.
    ū Difficult to rouse or does not stay awake when roused.
    ū Weak cry.
    ū Exhaustion.
  • Respiratory: ū Grunting.
    ū Respiratory rate > 50/minute.
    ū Moderate or severe chest indrawing.
    ū SpO2 < 94% on air.
  • Circulation and hydration:
    ū Reduced skin turgor.
    ū Severe tachycardia.
    ū Peripheral capillary refill time > three seconds.
    ū Bradycardia (an extremely late sign).
  • Other:
    ū Temperature > 40°C.
    ū Neutropenia.
    ū Chemotherapy within the last four weeks.
    ū Pain in a single joint or a single muscle area.
    ū Rigors.
    ū Petechiae or purpura.
    ū Neck stiffness.
    ū Focal neurological signs.
    ū Significant concern regarding neglect or non-accidental injury.
78
Q

fever over 5 red flags

A
  • Significantly abnormal vital signs.
  • Pain or tenderness in the flank or back.
  • Rigors.
  • Neutropenia.
  • Chemotherapy within four weeks.
  • Abdominal pain with tenderness on palpation.
  • Pain in a single joint or a single muscle area.
  • Severe muscle tenderness.
  • Temperature > 40°C.
  • Drowsiness.
  • Severe or worsening headache.
  • Neck stiffness.
  • Petechiae or purpura.
79
Q

headache red flags

A
  • Headache or neck pain following neck manipulation.
  • Neck pain or neck stiffness.
  • Sudden onset of severe headache.
  • Temperature > 38°C (in the absence of influenza symptoms).
  • Persistent vomiting.
  • Focal neurological signs.
  • Altered level of consciousness, including a history of altered level of
    consciousness with the onset of the headache.
  • New onset of an altered mental status.
  • Worsening headache following recent trauma to the head.
  • Taking an anticoagulant or has a known bleeding disorder.
  • Signs of temporal arteritis.
  • Hypertension during pregnancy.
  • Previous history of intracranial bleeding.
  • Family history of cerebral vascular abnormalities.
  • Onset during sexual activity or exercise.
  • Headache associated with seizure.
80
Q

migrane presentation

A

The pain is usually unilateral (but may be bilateral), throbbing, made worse by activity, associated with nausea and vomiting and may be associated with sensitivity to light and noise.

81
Q

opioates and migrants

A

Some patients with migraines call for an ambulance and request opiate pain relief. Opiates are strongly discouraged in this setting and should not be administered.

82
Q

Subarachnoid haemorrhage may present with

A

sudden onset of severe headache (thunderclap headache) and/or headache associated with neck stiffness.

82
Q

cluster headache presentation

A

Cluster headaches are recurrent, unilateral headaches centred around one eye or the temporal area. They are often associated with watering of the eye and/ or congestion/running of the nose.

83
Q

Meningitis may present with

A

headache, fever, neck stiffness, photophobia, nausea and vomiting.

84
Q

Anticoagulants include

A

warfarin and dabigatran, but not antiplatelet agents such as aspirin, clopidogrel or ticagrelor.

85
Q

Non-traumatic lumbar back pain red flags

A
  • Loss of bladder or bowel control.
  • Temperature > 38°C.
  • Rigors.
  • Abnormal vital signs.
  • Pain in the thoracic spine or chest.
  • Abdominal pain or tenderness.
  • Altered sensation in the saddle area.
  • Altered sensation and/or power in both legs.
  • Unable to mobilise.
  • Signs or symptoms of generalised illness.
  • Pain radiating down both legs.
86
Q

A prolapsed disc presentation

A

may compress a nerve root causing altered sensation and/
or motor power in one leg. Pain that radiates into one or both legs is usually
a sign of sciatic nerve involvement. If the altered sensation and/or power are only in one leg, the patient does not need immediate transport to ED provided no red flags are present.

87
Q

syncope red flags

A
  • Abnormal vital signs.
  • Failure to recover to normal.
  • Chest pain.
  • Abnormal 12 lead ECG with abnormalities of concern.
  • New or unexplained shortness of breath.
  • Clinically significant injury.
  • Occurred during exertion.
  • Pregnancy.
  • Headache.
  • Known valvular or congenital heart disease.
88
Q

The three main causes of vertigo are

A

cerebellar stroke, benign paroxysmal positional vertigo (BPPV) and vestibular neuritis. Cerebellar stroke is less common but much more serious and can easily be missed. BPPV and vestibular neuritis are both common and benign.

89
Q

The Epley manoeuvre

A

There are several variations, but the following is recommended:
a) Sit the patient upright on a bed or stretcher and rotate their head to face one side, preferably toward the side that makes symptoms worse.
b) Assist the patient to lie back, keeping their head turned. Recline their head, using a pillow under their shoulders or with their head hanging off the end of the bed/stretcher, and their ear parallel with the floor.
c) Hold the patient’s head in this position for 60 seconds.
d) Quickly turn the patient’s head to face the opposite side and hold this
position for 60 seconds.
e) Turn the head further, so that the patient is facing downward (this may
require the patient to move their body to accommodate this). Hold this
position for 60 seconds.
f) Assist the patient into a sitting position and rotate their head forward.
* Repeat the Epley manoeuvre once if the symptoms do not resolve.

90
Q

why dose RR increase in sepsis

A

As tissue hypoperfusion ensues, the respiratory rate also rises to compensate for metabolic acidosis.

91
Q

management of arrest if VT or VF persists despite 3 shocks

A

-change pad placement to anterior/posterior
- dude sequential defibrillates
-withhold adrenaline

92
Q

in arrest what ETC02 are we aiming for

A

above 20mmHg

93
Q

a sudden increase in ETC02 in arrest suggests….

A

ROSC

94
Q

changes in management for drowning arrest

A

ventilate 15:2
prolonged resus inappropriate

95
Q

changes in management for asthma arrest

A

priorities IV adrenaline
ventilate 6b/m to avoid dynamic hyperinflation

96
Q

changes in management for anaphylaxis arrest

A

IV adrenaline high priority
if in PEA and not immediately responding to resuscitations, increase adrenaline dosage to 3mg, then 5mg then back to 1

fluids high priority, 2-3L

97
Q

changes in cyclic antidepressant OD arrest

A
  • drug blocks sodium channels, thus use sodium bicarb
    do not give amiodarone
98
Q

pregnancy arrest changes

A

left lateral tilt
CPR on route if applicable

99
Q

hyperkalemia arrest changes

A

priortise calcium chloride and sodium bicarb

100
Q

patho of CPO

A

-increased pressure in the heart
-increased pressure in the pulmonary capillaries
-fluid shifts into the interstitial space of the lungs
-pulmonary oedema

101
Q

ACPO presnets with

A

dyspnoea (difficulty breathing), cough, pink sputumn,m cardiac chest pain

102
Q

when dose ACPO occur

A

when there is an increase of pulmonary pressure secondary to ineffective filling/pumping of the heart

103
Q

pathoi of MI

A

-Atherosclerosis in vessel
- compromised blood-flow
- ischemia

104
Q

why is there ST elevation in a MI

A

ischemic cardiac cells depolarise faster than perfused cells

105
Q

what is hyperkalamia

A

serum potassium concentration greater than or equal to 6 mmol/L.

106
Q

causes of hyperkelemia

A

The most common cause is end stage renal failure, particularly if the patient is on dialysis and has had their usual dialysis schedule disrupted.
Other causes can include:
Rhabdomyolysis associated with prolonged immobility.
Metabolic acidosis associated with severe sepsis.
Very severe diabetic ketoacidosis.
Haemolysis associated with blood transfusion.

107
Q

ECG changes in hyperkalemia

A

Tall T wavers wide QRS, no ST segment

108
Q

treatment of hyperkalemia

A

-Continuous nebulised salbutamol stimulates beta 2 receptors, causing potassium to move into the intracellular space
-sodium bicarb

109
Q

what happens when an ischemic stroke occurs

A

acute blockage of the vessel leading to necrosis

110
Q

what happens when hemmoragic stroke occurs

A

artery in the brain ruptures causing necrosis

111
Q

what is a TIA

A

transient blockage of a vessel that self resolves

112
Q

mild epistaxis treatment

A

Firmly compress the fleshy part of the nose for 15 minutes.
If the bleeding is not controlled administer adrenaline IN as below.

113
Q

moderate/severe epistaxis treatment

A

Instruct the patient to blow their nose to clear all blood clots.
Administer adrenaline IN into each bleeding nostril using a mucosal atomising device, and firmly compress the fleshy part of the nose for 15 minutes:
Administer 0.2 mg of adrenaline (2 ml of 1:10,000) per bleeding nostril for a patient aged 12 years or over.
Administer 0.1 mg of adrenaline (1 ml of 1:10,000) per bleeding nostril for a child aged 5-11 years.
Seek clinical advice if the patient is a child aged less than five years.
If the bleeding does not stop or recurs, a second dose of adrenaline IN may be administered after 20 minutes.

WFA CPGs (64 decks)

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