Planning management Flashcards
what are some adverse features of a tachycardia? and what do you do in that case?
shock
syncope
MI
HF
*synchronised DC shock
what are some examples of irregular broad complex QRS tachy?
AF with BBB
pre-excitation AF
Torsades
how do you manage torsades?
magnesium 2g over 10 min
what is a broad QRS regular tachy?
ventricular tachy - amiodarone
SVT with BBB
what are some examples of narrow QRS tachys?
regular - SVT
irregular - AF
how do you determine if you should treat pneumothorax or not?
secondary with lung disease always treat
- chest drain >2cm
- or if over 50, SOB, <2cm aspirate
primary
- <2cm and not SOB discharge with f/u 4w
- >2cm OR SOB then aspirate and if unsuccessful attempt again and then chest drain if unsuccessful again
tension - emergency mx then drain
what does CURB65 stand for?
Confusion
Urea >7.5
RR >30
Bp <90 systolic
65+ age
how do you interpret CURB65?
none - home tx
2+ hospital tx with oral or IV abx
3+ ITU
what are the 8 C’s of managing GI bleed?
cannulae
catheter and fluid monitoring
crystalloid bolus
crossmatching 6u
clotting abnormalities correcting
camera - endoscopy
culprit drugs stopping - NSAIDs, aspirin, warfarin, heparin
Call surgeons
how are you managing a seizure before medications are indicated?
ensure airway patency
recovery position with oxygen to prevent aspiration
perform bedside tests for triggers: blood glucose, electrolytes, drugs, sepsis
how is osmolality calculated?
(2xNa + 2xK) + urea + glucose
what target blood pressures are you aiming for with antihypertensives?
<80 patients aim for <140/90 for clinic and <135/85 at home
over 80 add 10mmHg to systolic values
what medications are added to CHF patient to help with mortality etc?
ACEI
BB
spironolactone if needed
nitrates if needed
what does CHA2DS2-VASc stand for?
stroke risk!
Ccf or LHF
Hon
Age >75 (2 points)
Dm
Stroke or TIA (2 points)
Vascular disease (PAD or IHD)
Age 65-74
Sex (female)
how do you interpret CHA2DS2-VASc scores?
0 - not require
1 - consider in men
2 or more - consider anticoagulant in men and women
what is HAS-BLED score?
risk of anticoagulation in AF
Htn - uncontrolled BP
Abnormal renal function and liver function
Stroke
Bleeding tendency or predisposition
Labile INR
Elderly >65
Drugs like aspirin or NSAIDs
how is HAS-BLED interpreted?
0 - low risk, consider anticoagulant
1-2 - moderate so consider
3< - high risk, consider alternatives to anticoagulants
In AF who is considered for rhythm control?
<48h since onset, young, symptomatic, first episode or due to precipitant
*cardioversion or pharmacological
who is considered for rate control in AF?
> 48h presentation
what are the aims of angina management?
GTN spray for sx relief
secondary prevention
anti-anginal drug - BB or CCB
What are some contraindication for BB?
hypotension
bradycardia
asthma
acute HF
what are some contraindications for CCB?
hypotension
bradycardia
peripheral oedema
what does diabetic annual review include? and why?
albumin-creatinine ratio
- early indicator of diabetic neuropathy, CVS disease predictor indicating need for ACEi
first line for Parkinson’s?
co-careldopa or co-beneldopa
very mild - dopamine agonists
first line: myoclonic seizures?
valproate male
levetiracetam female
first line: tonic?
valproate male
lamotrigine female
first line: focal?
carbamazepine or lamotrigine
first line: absence?
ethosuximide or valproate
first line: generalised tonic clonic?
valproate male
lamotrigine female
how are you inducing remission if crohns?
mild flare - prednisolone 20-40mg oral
severe - hydrocortisone IV
how is crohns remission maintained?
azathioprine or 6-mercaptopurine
CHECK TPMT and if low start lower dose, if absent methotrexate
what are some stool softeners?
docusate sodium - good for impaction, reduced gut motility
what are some bulking agent?
isphagula husk - can take days and not in impaction!
stimulant laxatives?
Senna and bisacodyl
not in acute abdomen, may exacerbate cramps
osmotic laxatives?
lactulose, phosphate enema
enema not in acute abdomen, may exacerbate bloating
RA during flare?
short term glucocorticoids IM methylpred
short term NSAIDs with PPI
DMARD restart after