PATHOOOO Flashcards
where is adrenaline released from
the adrenal glands
explain the pathway of adrenaline
- SNS massage from hypothelamus
2.acetycholine (pre synaptic neuron) binds to nicotinic receptos (post sympatin) - noradrenaline binds to adrenergic receptors in target organs
- one of the target organs is the adrenal gland and adrenaline is released into the bloodstream
Adrenergic receptor B1 memory trick
1 HEART beat stimulated by B1
Adrenergic receptor B2 memory trick
2 lungs to Breath, B 2
A1 role
stimulates all SM, organs and glands except cardiac tissue
B1 role
cardiac tissue stimulation
B2 role
inhibits all SM organs and glands
patho of adrenaline in anaphylaxis
airway constriction, B2 stimulation, causes brocodliation
vasodilation (HTN)- A1 stimulation- vasoconstriction resolves HTN
adrenaline increases HR and contractility via B2= also assists with HTN
patho of adrenaline in brococonstriction
B2 stimulated = brocodilation
when are prostagliands released
when cells in an area of direct blood supply are damaged, pro-inflammatory mediadtors such as prostoglands are rebased
state the COX 2 prostaglandins functions
inflammation, fever, pain and stimulation of platelet aggregation
state COX 1 prostaglandin functions
maintains stomach mucosa, maintains renal perfusion, inhibits platelet aggregation
what type of prostaglandin is aspirin
equally cox 1 and 2, but cox 1 is good for platelet aggregation inhibition
inflammation occurs any time….
there is damage to vascular tissue
what is glycogen
stored glucose
Glucagon tells the liver cells too…
break down glycogen into glucose
where is histamine predominately stored
in the mast cells, that are dense populated in the skin, lungs, and GI tract
how prednisone stops inflammatory response
inhibit the synthesis of multiple inflammatory proteins through suppression of the genes that encode them.
nausea is triggered when
serotonin is released into the GI tract at a faster rate then it can be digested
where in the brain dose nausea come from
the chemoreceptor trigger zone
how opitate stimulation blocks pain
inhibition of firing and the release of substance P, a neurotransmitter involved in pain transmission, thereby blocking pain transmission.
how tramadol works
opiate stimulation stops acending pain signals and reuptake of serationin and noradrenaline blocks decending signals
what is pnemonia
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
pneumonia presentation
fever
productive cough
fatigue
chills
chest pain
bronchitis presentation
sore throat
persistent cough
body aches
what causes pluertic chest pain
when the pleura ( 2 tissue that separated lungs from chest wall) becomes inflamed and rub together causing a sharp pain when breathing
difference between prednisone and prednisolone
prednisone- pre- metabolised non active form
prednisolone- active steroid
what is chronic bronchitis
inflammation of the bronchioles and excess mucus production
what is emphysema
damage to alveolar sacks (loose elasticity, become floppy, don’t inflate)
what is asthma
chronic reversible inflammation of the airway caused by inflammatory state of the lungs
patho of asthma
- exposed to allergen
- vasodilation, increased permeability and odema
- increased mucus production via goblet cells
- bronco constriction due to vagal stimulation
alpha cells in the pancreas creates…
glucagon
beta cells in the pancreas create…
insulin
DKA occurs when
adipose tissue is broken down for energy, fat is broken down to fatty acids
what is a seizure
a period when the neutrons in the brain are active at the same time, when they are not supposed to do
patho of anapahlaxisi
exposure to an antigen, secondary exposure leads to a big dump of histamine, causing SM contraction, vasodilation
what is cellulitis
a bacterial skin infection causing inflammation to subcutaneous tissue causing tenderness, fever and tight glossy skin
what causes fever
temp is regulated by the hypothalamus, when infection, body increases temp to help kill bugs.
what is shock
inadequate p[refusion to the tissue
categories in systemic inflammatory response syndrome
temp, HR and RR
what is sepsis
sirs plus conformed infection
clinical features that indicate antibiotics
new mental status
new need for 02
hypotension
elevated HR
skin mottled
when is IGEL appropriate
morot score less than 5 or arrest
if there is a risk of aspiration or airway swelling
igel or higher
what is the role of the kidneys
regulate the blood
remove waste
steady electrolyte balace
remove waste
regulate water levels
what its acute kidney injury
rapid deterioration in kidney function due to a sudden decrease in GFR
what is rhabdomyolysis
breakdown of muscle tissue due to schema/direct damage or hyperthermia
what is autonomic dysreflexia
sensory stimuli gets stuck at the level o0f injury, below injury SNS activation and PONS above
what is an aneurysm
abnormal dilation of a blood vessel
what is aortic dissection
endothelial of blo0od vessel rips off, separating layers of vessels, blood pools between
what is Diverticullits
inflammation of small pockets of colon.
what is renal coplic
pain that occurs when solids pass through the urinary system
what is gastric ulceration
break in the tissue lining of the stomach
what is cholesterols;ecystits
inflamed gall bladder
what is a hernia
weakness in the abdominal wall allowing fat or intestine to bulge through
steps of shoulder dystocia
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.
what is croup
viral infection of the upper airway
what is glycogenolysis
(Glycogen → glucose)
gluconeogenesis is..
(Glucose formation from carbs/sources)
main causes of stridor
croup, anaphylaxis, upper airway obstruction, epiglottis
what is Meningococcal
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.
what is ACPO
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
what causes the elevation of the ST segment in a stemi
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.
what is the most common cause of vt
ischemic heart disease
patho of VT
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.
name the mechanism of SVT
SVT is caused by 1 of 3 mechanisms: reentry, increased automaticity, or triggered activity
patho of AF
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
abdo pain red flags
- 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).
A patient with abdominal pain who calls an ambulance should usually be assessed in an ED, unless there is….
nless there is an obvious benign cause such as urinary tract infection, menstruation or recurrent constipation.
Abdominal pain radiating to the spine or flank may result from conditions such as….
pancreatitis, gastric or duodenal ulceration, cholecystitis, pyelonephritis, or a leaking abdominal aortic aneurysm.
An abdominal aortic aneurysm is usually asymptomatic prior to….
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.
what is Rigors and what dose it indicate
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.
Perforated bowel (for example from cancer, diverticular disease or ulceration) usually presents with
non-specific abdominal pain for 1-2 days followed
by signs of peritonitis (abdominal tenderness with pain made worse by movement).
falls red flags
- 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.
Postural hypotension is present if there is a fall of greater than
20 mmHg in the systolic BP or greater than 10 mmHg in the diastolic BP when standing.
treatment of fever under 12 months
Clearly recommend that all children aged less than 12 months with a fever are transported to an ED by ambulance.
fever under 5 red flags
- 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.
fever over 5 red flags
- 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.
headache red flags
- 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.
migrane presentation
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.
opioates and migrants
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.
Subarachnoid haemorrhage may present with
sudden onset of severe headache (thunderclap headache) and/or headache associated with neck stiffness.
cluster headache presentation
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.
Meningitis may present with
headache, fever, neck stiffness, photophobia, nausea and vomiting.
Anticoagulants include
warfarin and dabigatran, but not antiplatelet agents such as aspirin, clopidogrel or ticagrelor.
Non-traumatic lumbar back pain red flags
- 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.
A prolapsed disc presentation
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.
syncope red flags
- 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.
The three main causes of vertigo are
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.
The Epley manoeuvre
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.
why dose RR increase in sepsis
As tissue hypoperfusion ensues, the respiratory rate also rises to compensate for metabolic acidosis.
management of arrest if VT or VF persists despite 3 shocks
-change pad placement to anterior/posterior
- dude sequential defibrillates
-withhold adrenaline
in arrest what ETC02 are we aiming for
above 20mmHg
a sudden increase in ETC02 in arrest suggests….
ROSC
changes in management for drowning arrest
ventilate 15:2
prolonged resus inappropriate
changes in management for asthma arrest
priorities IV adrenaline
ventilate 6b/m to avoid dynamic hyperinflation
changes in management for anaphylaxis arrest
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
changes in cyclic antidepressant OD arrest
- drug blocks sodium channels, thus use sodium bicarb
do not give amiodarone
pregnancy arrest changes
left lateral tilt
CPR on route if applicable
hyperkalemia arrest changes
priortise calcium chloride and sodium bicarb
patho of CPO
-increased pressure in the heart
-increased pressure in the pulmonary capillaries
-fluid shifts into the interstitial space of the lungs
-pulmonary oedema
ACPO presnets with
dyspnoea (difficulty breathing), cough, pink sputumn,m cardiac chest pain
when dose ACPO occur
when there is an increase of pulmonary pressure secondary to ineffective filling/pumping of the heart
pathoi of MI
-Atherosclerosis in vessel
- compromised blood-flow
- ischemia
why is there ST elevation in a MI
ischemic cardiac cells depolarise faster than perfused cells
what is hyperkalamia
serum potassium concentration greater than or equal to 6 mmol/L.
causes of hyperkelemia
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.
ECG changes in hyperkalemia
Tall T wavers wide QRS, no ST segment
treatment of hyperkalemia
-Continuous nebulised salbutamol stimulates beta 2 receptors, causing potassium to move into the intracellular space
-sodium bicarb
what happens when an ischemic stroke occurs
acute blockage of the vessel leading to necrosis
what happens when hemmoragic stroke occurs
artery in the brain ruptures causing necrosis
what is a TIA
transient blockage of a vessel that self resolves
mild epistaxis treatment
Firmly compress the fleshy part of the nose for 15 minutes.
If the bleeding is not controlled administer adrenaline IN as below.
moderate/severe epistaxis treatment
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.
