Peri-Op Flashcards
1
Q
List the cardinal features of bowel obstruction
A
Vomiting Colicky pain Distension Constipation \+ anorexia, faeculent vomit, tinkling bowel sounds
2
Q
List causes of small bowel obstruction
A
Adhesions
Herniae
Malignancy
3
Q
List causes of large bowel obstruction
A
Malignancy
Diverticular disease
Volvulus
4
Q
Describe X-ray changes that would be seen with small bowel obstruction
A
Central gas shadow
Valvulae conniventes
No gas in large bowel
Dilated small bowel >3cm
5
Q
Describe X-ray changes that would be seen with large bowel obstruction
A
Peripheral gas shadow proximal to blockage
Haustra
Dilated bowel >6cm or >9cm at caecum
6
Q
List investigations relevant in suspected bowel obstruction
A
Bloods (FBC, U&E, CRP)
G&S
AXR, erect CXR
CT
7
Q
List the management of bowel obstruction
A
Surgery (if LBO/strangulated)
Drip and suck (IV fluids, NGT)
Catheter (fluid balance)
Analgesia
8
Q
List complications of bowel obstruction
A
Ischaemia
Perforation –> faecal peritonitis
Renal impairment
9
Q
Describe the conditions (paralytic) ileus, pseudo obstruction
A
Paralytic ileus - adynamic bowel, absence of peristalsis and bowel sounds due to abdominal surgery/pancreatitis/spinal injury/low K+ or Na+, drugs (TCA)
Pseudo obstruction/Ogilvie’s syndrome - signs and symptoms of bowel obstruction without any lesion in the intestinal lumens, myopathic/neuropathic cause
10
Q
Describe presentation, appearance on X-ray and management of sigmoid volvulus
A
Bowel twists on its mesentery leading to strangulation
Elderly, constipated
AXR = coffee bean
–> sigmoidoscopy, flatus tube/colectomy
11
Q
List some causes of abdominal perforation
A
Peptic ulcer disease Foreign body Infection Ischaemia Colitis (fistula/toxic megacolon) Trauma
12
Q
List signs and symptoms of perforation
A
Peritonism (rigid abdomen, guarding)
Fever, pallor, tachycardia, hypotension
Acute onset, crescendo severity, constant, radiates to back/shoulders, worse on movement
13
Q
List investigations required in a suspected perforation
A
Bloods Amylase G&S Urinalysis eCXR, AXR (Rigler's sign, psoas sign) CT +/- contrast swallow
14
Q
Describe management of perforation
A
Medical - IV fluids, analgesia, broad spectrum ABx, NBM, NGT, catheter
Surgical - thorough washout, perforation repair, resection +/- stoma formation
15
Q
What is a Graham patch?
A
Patch of omentum used to cover stomach in peptic ulcer perforation
16
Q
Describe Hartmann’s procedure
A
Surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy
17
Q
List red flag symptoms for oesophageal problems
A
Dysphagia Weight loss Abdo pain Dyspepsia >55 years \+ early satiety, malaise, decreased appetite, reflux --> refer to endoscopy
18
Q
List causes of peptic ulcer disease
A
NSAIDs H. pylori infection Excessive alchohol intake Steroids Zollinger-Ellison syndrome
19
Q
Differentiate between symptoms of gastric and duodenal ulcers
A
Gastric - worse on eating, nausea, anorexia, weight loss, epigastric pain
Duodenal - worse after eating (2-5hrs) OR worse when fasting and alleviated by eating, central back pain
20
Q
List treatment options and complications of peptic ulcer disease
A
Lifestyle advice
PPI 8 weeks OR triple therapy 7 days (PPI + amoxicillin + metronidazole/clarithromycin)
Partial gastrectomy/selective vagotomy
Complications - acute upper GI bleed, iron deficiency anaemia, perforation, gastric outlet obstruction, pyloric stenosis
21
Q
List causes and pathophysiology of acute appendicitis
A
Obstruction - trauma, faecolith, tumour, lymphadenitis, worms
Inflammation –> raised intraluminal pressure –> lymphoid swelling, decreased venous drainage, thrombosis, bacterial invasion –> abscess –> gangrene –> perforation –> peritonitis
22
Q
List clinical features, investigations and management of acute appendicitis
A
Pain, fever, anorexia, abdo pain when moving (central –> RIF), nausea, vomiting, diarrhoea/constipation, fever, tachypnoea, furred tongue, abdo tenderness (++ at McBurney’s point), guarding, Rosving’s sign, psoas sign
Investigations - pregnancy test, bloods, CT (>65 or unclear diagnosis), USS (eliminate gynaecological cause)
Management - appendicectomy, IV ABx, analgesia
23
Q
Name a scoring system that can be used in appendicitis
A
Alvardo
Appendicitis Inflammatory Response (AIR)
24
Q
What anatomical position is the appendix in in most people
A
RIF, end of caecum
Retrocaecal
(Can be pelvic, retroileal, retrocolic)
25
Define the terms diverticulum, diverticulosis, diverticulitis, diverticular disease
Diverticulum - out-pouching of bowel wall composed of mucosa
Diverticulosis - presence of diverticulum
Diverticulitis - inflammation of diverticula
Diverticular disease - symptomatic diverticulum
26
List risk factors of diverticular disease
```
Low fibre diet
Obesity
Smoking
FH
NSAID use
```
27
List clinical features, investigations and management of diverticular disease
CF - colicky LIF pain, relieved by defecation, altered bowel habit, flatulence, (painless) PR bleeding, anorexia, nausea, vomiting
Ix - bloods, G&S, ABG (lactate), urine dipstick, flexi sig. (not itis), AXR, eCXR, CT PA, barium enema
Mx - broad spectrum IV ABx, fluids, bowel rest, stool softener, analgesia, surgery (if perforation, sepsis, failure to improve) --> Hartmann's/laparascopic peritoneal lavage
28
List complications of diverticular disease
Pericolic/paracolic mass/abscess
Peritonitis
Fistula (colovesical/colovaginal)
Stricture formation
29
List risk factors for developing colorectal cancer
```
Age >60
Family history (APC gene --> FAP)
IBD
Low fibre diet
Smoking
Increased alcohol intake
```
30
List clinical features of colorectal cancer
Rectal - PR bleeding (deep red on stool surface), tenesmus, altered bowel habit
Descending/sigmoid - PR bleeding (dark, mixed with stool, clotted), mucus on PR, bloating, flatulence
Right sided - iron deficiency anaemia, RIF mass
31
List red flag symptoms of colorectal cancer that would require urgent investigation
>40 with weight loss and abdominal pain
>50 with PR bleeding
>60 with iron deficiency anaemia/altered bowel habit
+ve faecal occult blood test
32
List investigations and management of colorectal cancer
Ix - FBC (microcytic anaemia), tumour marker CEA (to monitor), colonoscopy with biopsy, CT CAP/MRI rectum/endoanal US (for staging)
Mx - regional colectomy (right/left/sigmoid/anterior resection/abdominoperineal resection), chemotherapy, radiotherapy, palliative
33
Explain Duke's staging
A - invasion into but not through bowel wall (limited to mucosa)
B - invasion through bowel wall but no lymph involvement
C - lymph involvement
D - distant metastases
34
Describe different types of bowel resection
Right hemicolectomy - caecum, ileocaecal valve, hepatic flexure, splenic (extended)
Left - splenic flexure --> sigmoid
Hartmann's - emergency, rectosigmoid removal, no anastamosis, rectal stump
Anterior resection - sigmoid --> rectum
Abdominoperitoneal - rectum and anus removed
35
Describe the pathogenesis of acute pancreatitis
1. Premature and exaggerated activation of digestive enzymes --> inflammation
2. Increased vascular permeability = 'third spacing'
3. Autodigestion of fats and vessels
4. Necrosis
36
List causes of acute pancreatitis
```
Gallstones
Ethanol (alcohol)
Trauma
Steroids
Mumps
Autoimmune (e.g. SLE)
Scorpion venom
Hypercalcaemia
ERCP
Drugs (azathioprine, NSAIDs, diuretics)
```
37
Describe clinical features, investigations and management of acute pancreatitis
CF - sudden onset, severe epigastric pain, radiates to back, nausea, vomiting, fever, hypotension, tachycardia, tender and rigid abdomen, tetany, jaundice
Ix - bloods (amylase 3x upper limit of normal), LFTs, USS, AXR, contrast CT
Mx - oxygen, fluids, NGT, catheter, opioid analgesia, imipenem, ERCP if necessary
38
What are Grey-Turner's and Cullen's signs?
Signs of intraabdominal bleeding
Grey-Turner - flank bruise
Cullen's - umbilicus bruise
39
List causes of a high amylase
```
Pancreatitis
DKA
Ectopic pregnancy
Cholecystitis
Perforated ulcer
Mesenteric ischaemia
```
40
Name and describe a scoring tool used in acute pancreatitis
```
Glasgow criteria = severity of acute pancreatitis
PaO2 <8kPa
Age >55
Neutrophils >15 x10^9/L
Calcium <2 mmol/L
Renal urea >16 mmol/L
Enzymes LDH >600 U/L or AST >200 U/L
Albumin <32 g/L
Sugar >10 mmol/L
+ APACHE II, Ranzen criteria, Balthazar score
```
41
List complications of acute pancreatitis
```
DIC
ARDS
Hypocalcaemia
Shock
Multi organ failure
Pancreatic necrosis
Pseudocyst
```
42
List causes of chronic pancreatitis
```
Chronic alcohol abuse
Idiopathic
Metabolic (hyperlipidaemia, hypercalcaemia)
Infection (viral, bacterial)
Hereditary (CF)
Autoimmune
Obstruction (stricture, neoplasm)
Congenital
```
43
Describe clinical features, investigations and management of chronic pancreatitis
CF - chronic epigastric pain, radiates to back, eased by leaning forward, nausea, vomiting, exocrine dysfunction (DM), endocrine dysfunction (steatorrhoea, malabsorption)
Ix - bloods, BM, serum calcium, LFTs, faecal elastase (low), USS, CT PA, MRCP/ERCP
Mx - analgesia, pancreatic enzyme supplements (Creon), ERCP, EUS (pseudocyst drainage), pancreatic sphincterotomy, Whipple's pancreatectomy
44
List complications of chronic pancreatitis
```
Pseudocyst
Malabsorption
Diabetes
Effusions (ascites, pleural)
Low vitamin A, D, E, K/clotting
Malignancy
```
45
List risk factors of pancreatic cancer
Smoking
Recent onset DM
Chronic pancreatitis
Alcoholism
46
Describe clinical features, investigations and management of pancreatic cancer
CF head - obstructive jaundice, epigastric/LUQ abdominal pain, radiates to back, hepatomegaly (mets), anorexia, nausea, vomiting, fatigue, malaise, pruritus, acute pancreatitis, thrombophlebitis migrans
CF body/tail - asymptomatic, weight loss, back pain, epigastric mass, diabetes
Ix - bloods (anaemia/thrombocytopenia), LFTs, CA19-9 tumour marker, abdo USS/EUS, CT contrast, ERCP
Mx - radical resection (Whipple's/panceatectomy) + adjuvant chemo, palliation
47
Explain Courvoisier's law
Jaundice + enlarged/palpable gallbladder = biliary tree or pancreas malignancy
48
List risk factors for gallstone disease
```
Fat
Female
>Forty
FH
Fertile/OCP
Pregnancy
Haemolytic anaemia
Malabsorption (ileal resection/Crohn's)
```
49
Differentiate clinical features of biliary colic and acute cholecystitis
Biliary colic - acute, dull, colicky RUQ pain, radiates to back/epigastrium, nausea, vomiting, precipitated by fatty foods
Acute cholecystitis - constant, persistent (despite pain relief) pain, raised WCC, fever, tachycardia, tender RUQ, deranged LFTs, +ve Murphy's sign
50
List investigations and management for gallstone disease
Ix - urinalysis, pregnancy test, bloods, LFTs, amylase, USS, MRCP
Mx BC - analgesia, antiemetic, lifestyle advice, elective cholecystectomy
Mx AC - IV ABx (co-amoxiclav + metronidazole), fluid, NGT, NBM, analgesia, antiemetic, laparoscopic cholecystectomy (72h-1 week)
51
List complications of gallstone disease
Gallbladder empyema
Chronic cholecystitis
Fistula --> obstruction (Bouveret's syndrome/Gallstone ileus)
Acute pancreatitis
52
Describe the clinical features, investigations and management of cholangitis
CF - Charcot's triad (RUQ pain, fever, jaundice), itching, pyrexia, RUQ tenderness, rigors, Reynold's pentad (Charcot's triad + hypotension + confusion)
Ix - bloods, blood culture, USS, ERCP
Mx - sepsis six if septic, endoscopic biliary decompression, ERCP +/- sphincterotomy, stunting, percutaneous transhepatic cholangiography (PTC), cholecystectomy
53
Describe the pathophysiology, risk factors, clinical features, investigations and management of cholangiocarcinoma
Cancer of the biliary system, most common site is bifurcation of R/L hepatic duct (Klatskin tumour), higher incidence in south-east asia
RF - PSC, excessive alcohol intake, UC, diabetes, infective (liver flukes, HIV), toxins (rubber, aircraft), congenital
CF - asymptomatic until late, post hepatic jaundice - pruritus, pale stools, dark urine, cachexia, Courvoisier's law
Ix - LFTs, tumour markers CEA, CA19-9, USS, MRCP, CT (staging)
Mx - complete surgical resection (Whipple's/partial hepatectomy), radiotherapy, chemotherapy, ERCP stenting
54
What is a hernia?
Protrusion of a whole or part of an organ through the wall of the cavity that contains it into an abnormal position
55
Differentiate between different types of hiatus hernia
Sliding - gastrooesophageal junction above diaphragm
| Rolling - gastric funds lies alongside normal gastrooesophageal junction
56
List risk factors, clinical features, investigations and management of hiatus hernias
RF - age, pregnancy, obesity, ascites
CF - (severe and treatment resistant) GORD, vomiting, weight loss, bleeding +/- anaemia, hiccups/palpitations, swallowing difficulties
Ix - OGD, CT/MRI, contrast swallow
Mx - conservative = PPIs, lifestyle advice, surgical = curoplasty, fundoplication
57
What is Bouchardt's triad
Signs of gastric volvulus:
Severe epigastric pain
Retching with no vomiting
Inability to pass NGT
58
Differentiate between direct and indirect hernias
Direct - through weakness of Hesselbach's triangle, medial to inferior epigastric vessels
Indirect - via deep inguinal ring, incomplete closure of processes vaginalis, lateral to inferior epigastric vessels
59
List risk factors, clinical features and management of inguinal hernias
RF - male, age, obesity, increased intraabdominal pressure (chronic cough, heavy lifting, constipation)
CF - groin lump, pain, tender, erythematous
Mx - conservative (if asymptomatic), Lichtenstein mesh open/laparoscopic surgery
60
Describe how you would undertake a hernia examination
Offer chaperone
Examine standing, front, side
Look - size, shape, scrotal extension, cough impulse
Feel - scrotal lump (can get above it?), site, size, shape, consistency, contours, colour, tenderness, temperature, transillumination, cough impulse, reducibility
Percuss, auscultate for bowel within lump
61
List risk factors, clinical features and management of femoral hernias
RF - female, age, pregnancy, increased intraabdominal pressure
CF - groin lump (inferolateral to PT, medial to femoral pulse), unlikely to be reducible
Mx - surgical (risk of strangulation) reduction and narrowing of femoral ring
62
Define different hernias including epigastric, paraumbilical, spigelian, obturator, littre's, richter's incisional
Epigastric - midline through fibres of linea alba
Paraumbilical - through linea alba around umbilicus
Spigelian - at semilunar line around level of arcuate line
Obturator - of the pelvic floor at obturator foramen into obturator canal, mass in upper medial thigh
Littre's - herniation of Meckel's diverticulum (inguinal canal)
Richter's - only anti mesenteric border becomes strangulated --> tender, irreducible mass
Incisional - after operation through previously made incision
63
What size is an abdominal aorta aneurysm?
Dilation >3cm
64
List risk factors, clinical features and management of an AAA
RF - smoking, hyperlipidaemia, male, hypertension, age
CF - abdo/back/loin pain, distal embolisation, pulsatile abdominal mass
Mx <5.5cm - monitor via duplex USS yearly (3.0-4.4cm) or 3 monthly (5.0-5.4cm)
Mx >5.5cm/>1cm per year expansion/symptomatic - open repair/EVAR
*>6 cm - DVLA notification, smoking cessation, anti hypertensive therapy, statin, aspirin, lose weight
65
List clinical features and management of an AAA rupture
CF - sudden flank/back pain, hypotension, pulsatile abdominal mass
Mx - high flow O2, IV access, urgent bloods and X-match, vascular unit transfer (open/CT angiogram)
66
Explain the condition aortic dissection and the different types
Tear in intimal layer --> blood splits layers apart
Stanford classification A - Debakey types I + II
Stanford classification B - Debakey type III
Debakey type I - ascending aorta --> arch
Debakey type II - ascending aorta
Debakey type III - subclavian artery --> descending aorta --> diaphragm/AA
67
Describe clinical features, investigations, management and complications of aortic dissection
CF - tearing/stabbing chest pain, radiates to back, tachycardia, hypotension, murmur (AR), end organ hypo perfusion, paraplegia
Ix - bloods, troponin, coagulation, X-match, ECG, CT angiogram, TOE
Mx Type A = surgical (removal of ascending aorta, graft replacement)
Mx Type B = medical (B-blockers, CCBs) or surgical (EVAR)
*lifelong antihypertensives, surveillance imaging
Complications - aortic rupture, AR, MI (SCAD), cardiac tamponade, stroke/paraplegia
68
What is acute limb ischaemia?
Sudden decrease in limb perfusion, threatens limb viability <6 hrs
69
List the clinical features of acute limb ischaemia
```
Pain
Pallor
Pulselessness
Paraesthesia
Perishingly cold
Paralysis
```
70
Describe investigations, management and complications of acute limb ischaemia
Ix - bloods (serum lactate), thrombophilia screen, G&S, ECG, doppler USS +/- CT angiogram
Mx - high flow O2, IV access, heparin (infusion), surgical (thrombolysis/angioplasty/bypass surgery, embolectomy via Fogarty catheter, fasciotomy, amputation), OT/PT, rehab plan, decrease CVD mortality risk
Complications - death, repurfusion injury (compartment syndrome, hyperkalaemia, rhabdomyolysis/AKI, acidosis
71
Describe different categories of acute limb ischaemia
I - viable, no immediate threat, no sensory/motor loss, artery and vein on doppler
IIA - marginally threatened, salvageable if treated promptly, sensory loss in toes, no motor loss, no artery on doppler
IIB - immediately threatened, salvageable if revascularised promptly, sensory loss of more than toes, rest pain, mild/moderate motor loss, no artery on doppler
III - irreversible, permanent damage, profound sensory loss, paralysis, no artery or vein on doppler
72
What is chronic limb ischaemia
Peripheral vascular disease, decreased blood flow to limbs
73
Describe the Fontaine classification of chronic limb ischaemia
I - asymptomatic
II - intermittent claudication
III - ischaemic rest pain
IV - ulceration +/- gangrene
74
What is critical limb ischaemia?
Ischaemic rest pain >2 weeks requiring opiate analgesia
Prescence of ischaemic lesions or gangrene
ABPI <0.5
75
Describe investigations and management of chronic limb ischaemia
Ix - Buerger's test, ABPI, CT angiography, CV risk assessment (BP, glucose, lipids, ECG)
Mx - CV risk modification (lifestyle, statin, anti platelet), supervised exercise, angioplasty +/- stenting, bypass surgery
76
Define ABPI
```
Ankle brachial pressure index - ratio of blood pressure at the ankle to blood pressure in the upper arm (systolic ankle/systolic arm):
Normal - >0.9
Mild - 0.8-0.9
Moderate - 0.5-0.8
Severe <0.5
*>1.2 = calcification
```
77
What are varicose veins?
Tortuous, dilated segments of vein with incompetent valves --> venous hypertension, dilatation
78
List risk factors, clinical features, management and complications of varicose veins
RF - prolonged standing, obesity, FH, pregnancy
CF - cosmetic issues (visible veins, skin discolouration), pain, aching, swelling, itching, skin changes, ulceration, thrombophlebitis, bleeding, venous insufficiency (haemosiderin deposits, lipdermatosclerosis, atrophie blanche, saphena varix)
Mx - patient education/lifestyle advice, compression sticking, four layer banding, vein ligation, stripping, avulsion, foam sclerotherapy, thermal ablation
Complications - haemorrhage, thrombophlebitis, recurrence, DVT, nerve damage
79
Describe the CEAP classification for venous insufficiency
```
C0 - no signs
C1 - telangiectasia/reticular veins
C2 - varicose veins
C3 - oedema
C4a - pigmentation/eczema
C4b - lipodermatosclerosis/atrophie blanche
C5 - healed venous ulcer
C6 - active venous ulver
```
80
Describe how you would undertake a varicose veins examination
Look (front/back) - colour changes, ankle swelling, venous insufficiency (haemosiderin deposits, eczema, lipodermatosclerois, venous ulcers, atrophie blanche, varicose vein distribution, colour, prominence
Feel - tenderness, hardness (phlebitis), saphenofemoral junction, cough impulse, rate of venous emptying, tourniquet test, calf tenderness (DVT)
Percuss (for incompetency) and auscultate (for turbulent flow)
Pitting oedema, JVP, arterial pulses
81
What is the purpose of a pre-operative assessment?
Identify comorbidities (2-4 weeks before surgery) that may lead to anaesthetic/surgical/post-op complications
82
List questions to ask in a pre-operative assessment
History - HPC, confirm procedure, R/L side, PMH (CVS, resp, renal, endocrine), pregnancy, sickle cell anaemia, PSH, PAH (PONV), DH (allergies), FH (malignant hyperthermia), SH (smoking, alcohol, exercise tolerance)
83
List some airway observations
Mouth opening - inter incisor distance >3cm
Teeth/dentures
Oropharynx (Mallampati classification I-IV)
Neck - thyromental distance >6.5cm
84
Describe the different ASA Grades
ASA I - normal, healthy
ASA II - mild systemic disease, smoker, pregnant, obese
ASA III - severe systemic disease, functional limitation e.g. COPD, pacemaker, ESRD with dialysis
ASA IV - severe systemic disease, constant threat to life, recent (<3 months) MI/CVA, sepsis, ESRD without dialysis
ASA V - moribund, not expected to survive without surgery, ruptured AAA, massive trauma, ischaemic bowel
ASA VI - declared brain dead, organs being removed for donor purposes
*E = emergency operation
85
List investigations necessary pre-operatively
Bloods - FBC, U&E, LFT, clotting screen, G&S, X-match
Imaging - ECG, CXR
Others - pregnancy test, sickle cell test, MRSA swabs, urinalysis
Routine HbA1c if diabetic
86
What advice should a patient be given pre-operatively about food and drink
No food - 6h
| No clear fluids - 2h
87
What drugs should a patient be told to stop/alter/start
Stop - clopidogrel (7 days), hypoglycaemics, OCP/HRT (4 weeks), warfarin (5 days)
Alter - insulin, steroids
Start - LMWH, AES, ABx prophylaxis
88
What are the indications for fluid?
Resuscitation
Replacement
Maintenance
89
What are the daily requirements for water, sodium, potassium and glucose?
Water - 25-35ml/kg/day
Na/K+ - 1 mmol/kg/day
Glucose - 50g/day
90
Describe the WHO analgesia ladder
Strong opioid e.g. morphine
Weak opioid e.g. codeine
Non-opioid e.g. paracetamol, NSAIDs
91
List side effects of NSAIDs
```
IGRAB:
Interactions (e.g. warfarin)
Gastric ulceration
Renal impairment
Asthma sensitivity
Bleeding risk
```
92
List side effects of opiates
```
Constipation
Nausea
Sedation/confusion
Respiratory depression
Tolerance/dependence
```
93
List risk factors for PONV
Patient - female, previous PONV/motion sickness, non smoker
Surgical - laparascopic, intracranial/middle ear, squint, gynaecological (ovarian), long duration
Anaesthetic - opiate analgesia, inhalationen agent, long duration, spinal, dehydration/bleeding, bag-mask overuse
94
Name different antiemetics and their method of action
5HT3 antagonist - ondansetron, metoclopramide
Dopamine antagonist - domperidone, prochlorperazine, metoclopramide
Histamine antagonist - cyclizine
Anticholinergic - hyoscine
95
Describe likely causes for post operative pyrexia and how you would investigate
```
Day 1-2 - respiratory (wind)
Day 3-5 - urinary (water)
Day 4-6 - VTE (walk)
Day 5-7 - surgical site/abscess (wound)
Iatrogenic - drug induced
Unknown - vasculitis, lymphoma
```
Investigations - septic screen, bloods, urine dip, culture, CXR, sputum
96
Describe management of different infections
LRTI - co-amox 625mg PO TDS 5/7
L urinary - trimethoprim 200mg PO BD 3/7 OR nitrofurantoin 100mg PO BD 3/7
U urinary - co-amox 625mg PO TDS 14/7
Surgical site - flucloxacilin 500 mg QDS 5/7
IV/central line - flucloxacillin 500mg QDS 5/7
Intraabdominal - cefuroxime 1.5g TDS + metronidazole 500 mg IV TDS
Septic arthritis - flucloxacillin 2gIV QDS
Unknown source - cefuroxime 1.5g IV TDS + metronidazole 500mg IV TDS + gentamicin 5mg/kg STAT
97
Describe classification and management of haemorrhage
I - <15% loss, <750mls, <100 HR, normal BP, 14-20 RR, UO >30 ml/hr, normal mental state
II - 15-30% blood loss, 750-1500mls, 100-120 HR, normal BP, 20-30 RR, UO 20-30 ml/hr, mild anxiety
III - 30-40% loss, 1500-2000mls, 120-140 HR, low BP, 30-40 RR, UO 5-15ml/hr, anxious and confused
IV - >40% blood loss, >2000mls, >140 HR, very low BP, >35 RR, UO negligible, lethargic or unconscious
Mamangement - A-E, >18G cannula, direct pressure, senior review, urgent blood transfusion
