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2nd year > PBL - emergency treatment and triage > Flashcards

PBL - emergency treatment and triage Flashcards

1
Q

What is a NEWS2 score?

A

track and trigger system used to identify adult patients at risk of clinical deterioration

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2
Q

what makes up the NEWS2 score?

A 
respiratory rate
oxygen saturation 
temperature
systolic BP
heart rate 
level of consciousness
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3
Q

NEWS2 scoring

A

score of 0-3 is allocated to each physiological parameter
the magnitude of score reflects how extreme the parameter varies from norm
additional 2 points given for those requiring oxygen
total = 0-20
not diagnostic

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4
Q

oxygen saturation

A

scale 1 and scale 2

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5
Q

scale 1 oxygen saturation

A

target sats >96% and used for most patients

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6
Q

scale 2 oxygen saturation

A

target sats 88-92%
used for patients at risk of hypercapnic respiratory failure
e.g. COPD

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7
Q

interpreting NEWS score

A

aggregate score 0-4 = low risk, ward-based response
red score - score of 3 in any individual parameter = low-medium risk, urgent ward-based response
aggregate score 5-6 = medium risk, key threshold for urgent response
aggregate score 7 or more = high, urgent/emergency response

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8
Q

what causes hyperglycaemia?

A 
type 1 or 2 diabetes
stress
flu and other illnesses similar type 
lack of exercise 
missing diabetic medication 
overtreatment of hypoglycaemia 
steroids
diabetic ketoacidosis 
hyperosmolar hyperglycaemic state 
cushing's syndrome
pancreatitis 
pancreatic cancer 
CF
diuretics
gestational diabetes 
surgery
trauma
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9
Q

raised glucose in pneumonia

A

may help predict death

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10
Q

Raised lactate

A

type a, b1 or b2 or b3

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11
Q

type A raised lactate

A

inadequate oxygen delivery
anaerobic muscular activity
tissue hypoperfusion
reduced tissue oxygen delivery

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12
Q

type B raised lactate

A

no evidence of inadequate tissue oxygen delivery

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13
Q

B1 raised lactate

A 
leukaemia
lymphoma
thiamine deficiency 
infection 
pancreatitis 
short bowel syndrome 
hepatic failure 
renal failure
diabetic failure
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14
Q

B2 raised lactate

A 
phenformin 
cyanide
beta-agonists 
methanol
adrenaline 
salicylates 
nitroprusside infusion 
ethanol intoxication in chronic alcoholics 
anti-retroviral drugs
paracetamol
salbutamol
biguanides 
fructose 
sorbitol 
xylitol
isoniazid 
lactate-based dialysate in RRT 
congenital forms with various enzyme defects
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15
Q

B3 raised lactate

A

associated with inborn errors of metabolism

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16
Q

causes of raised lactate

A
  • increased in any condition that decreases the amount of oxygen available to body tissues
  • any disease increasing lactate production
  • any disease decreasing lactate removal – impaired hepatic metabolism
  • strenuous exercise
  • shock
  • infections
  • inherited metabolic disorders
  • mitochondrial disorders
  • certain medicines = metformin and isoniazid (TB)
  • greater increase in lactate the greater severity of condition
  • not diagnostic
  • meningitis – suggests bacterial if raised
  • sepsis
  • heart attack
  • congestive heart failure
  • severe lung disease
  • respiratory failure
  • fluid build-up on lungs – pulmonary oedema
  • severe anaemia
  • liver disease
  • kidney disease
  • uncontrolled diabetes
  • leukaemia
  • AIDs
  • deficiency in vitamin B1
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17
Q

initial triage measurements

A 
temperature
RR
HR
BP
capillary refill time
O2 saturations
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18
Q

normal RR

A

12-16

19
Q

normal capillary refill

A

<2 seconds

20
Q

normal O2 sats

A

95-100%

21
Q

Airway

A 
patency 
ability to vocalise
dyspnoea 
secretions 
foreign body 
trauma
22
Q

breathing

A 
adequacy of breathing and gas exchange 
breathing rate 
chest wall movements 
use of accessory muscles 
breath sounds 
cyanosis
tachycardia 
BP
23
Q

circulation

A 
function of CVS
pulse quality and rate 
capillary refill time
adequate blood volume 
skin colour 
temperature
24
Q

disability

A 
assess neurological system
level of consciousness - GCS
AVPU
pupils
physical or psychological problems identified 
assess pain
25
Q

AVPU

A

patient is alert
patient responds to voice
patient responds to pain
patient is unresponsive

26
Q

primary survey

A

ABCD

27
Q

secondary survey

A

EFGH

28
Q

EFGH

A

exposure
full vital signs
give comfort measures
head-to-toe assessment

29
Q

full vital sounds

A 
temperature
HR and rhythm
pulse quality
RR
oxygen saturation 
BP 
ECG
scans - MRI, CT, CAT, X-rays 
urinalysis 
blood lab studies
blood glucose levels
comprehensive neuro evaluation 
neurovascular function 
height
weight 
BMI 
sensory perception 
skin assessment 
mental health assessment 
pain assessment
30
Q

give comfort measures

A 
NSAIDs 
IV opioids 
analgesics
imagery
distraction 
repositioning 
breathing techniques heat packs
31
Q

what is GCS

A

glasgow coma scale

32
Q

GCS

A 
consistent evaluation of consciousness 
used in head trauma 
identifies early signs of deterioration 
3 aspects 
score the highest response the patient elicits
33
Q

highest GCS score

A

15 - fully conscious

34
Q

lowest GCS score

A

3 - coma/dead

35
Q

what are the aspects of GCS?

A

motor responsiveness
verbal performance
eye opening

36
Q

eye opening

A

4 points = eye opening spontaneously
3 = eye opening to sound
2 = eye opening to pain
1 = no response NT = not testable

37
Q

Verbal response

A 
ask patient:
- name 
- where they are right now 
- today's date 
5 = orientated 
4 = confused conversation 
3 = inappropriate words
2 = incomprehensible sounds
1 = no response
NT = not testable
38
Q

motor response

A 
scoring based on highest scoring response patient elicits in any single limb 
ask patient to perform a 2-part request 
6 = obeys command
5 = localises to pain 
4 = withdraws to pain 
3 = flexion decorticate posture
2 = abnormal extension decerebrate posture 
1 = no response 
NT = not testable
39
Q

overall GCS

A

add all scores and calculate GCS

document results

40
Q

what is flexion decorticate posture?

A

abnormal flexion response to pain
adduction of arm, internal rotation of shoulder
pronation of forearm
wrist flexion
indicates damage to cerebral hemispheres, internal capsule and thalamus

41
Q

what is decerebrate posture ?

A 
abnormal extension response to pain
head extension 
arms and legs extended 
internal rotation of limbs
rigid patient 
teeth clenched 
indicates brainstem damage, exhibited with lesions or compression of midbrain and cerebellar lesions
42
Q

what is coning?

A

progression from decorticate posturing to decerebrate posturing
uncar/tonsillar brain herniation

43
Q

When is ABG needed over VBG?

A

accurately determine PaCO2 in severe shock
determine PaCO2 if hypercapnic - >45mmHg
accurately determine arterial lactate >2mM
determining PaO2
acute respiratory distress syndrome

2nd year (48 decks)

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