Random Bits I Still Don't Know Flashcards
What echo signs would you be looking for in an MI
regional wall motion abnormalities
signs of complications: papillary muscle rupture, septal wall rupture, pericardial effusion
signs of old infarct: wall thinning
What echo signs would you be looking for in a PE
dilated RV
underfilled D shaped LV
tricuscpid regug
septal flattening
What echo signs would you be looking for in a tamponade
swinging heart
diastolic collapse of RA +/- RV later in disease process
IVC plethora: reduced IVC collapse on inspiration
What echo signs can exclude a pneumothorax
lung sliding
A and B lines
lung pulse (rhythmic motion of visceral along parietal pleura with each cardiac contraction)
What echo signs would indicate a pneumothorax
lung point - the point at which visceral pleura is no longer associated with parietal pleura
What are A and B lines on an echo
A - horizontal reflective lines which are artefact. Generated by pleural layers
B - They extend radially from the pleura and indicate that the parietal and visceral pleura are in apposition and therefore no pneuomothorax
What echo signs would indicate hypovolaemia
small hyperkinetic LV
kissing ventricles: LV is obliterated at the end of systole
small IVC with exaggerated collapse on inspiration
What ECG features would make you suspect a RV infarct and how could this be confirmed
ST elevation in V1 +/- depression in V2
confirm with ST elevation in V4R
Why is giving nitrates to inferior STEMI’s bad
With poor RV contractility the heart is preload sensitive so giving nitrates (reduces preload) lead to profound hypotension
What ECG features would make you suspect a posterior infarct and how would you confirm it
reciprocal changes (ST depression, upright T) in V1-V3 dominant R in V2 confirm: ST elevation in V7-V9
What could lead to a AV block following MI
ischaemia of the AVN following RCA infarct (AVN artery arises from RCA)
MOA of reteplase, aspirin, clopidogrel and LMWH
reteplase: recombinant TPA
aspirin: reduced thromboxane A2 so reduced binding to TXA2
clopidogrel: inhibit ADP binding to P2Y12 receptors
LMWH: indirect factor Xa inhibitor and direct thrombin inhibitor
elevated R in aVR =
Na channel blockers!!
causes of bidirectional VT
CPVT
severe digoxin toxicity
How far are you inserting an ET tube
small adult: 21cm
big adult: 22-23cm
child: age/2 + 12
what can be used to better look for epsilon waves
fontain bipolar precordial leads
define deffered consent
patient is randomised according to criteria that have been made clear in ethical review then request for patient/their representatives informed consent is done at a later stage
what is exception to informed consent with prior community consult
researchers consult with members of the community in which the research will be carried out prior to the research being done
what is transthoracic impedance and what effects it
the bodies resistance to current flow
inter-electrode distance, skin-electrode interface, ventilation
What benefits does TTM have on a cellular level
stops MPTP opening
preserves mitochondrial function
lower metabolic demand from tissues
Give an example of a hallogenated volatile anaesthetic and a depolarising neuromuscular relaxant
halogenated volated anaesthetic: halothane
depolarising neuromuscular relaxant: succinylcholine
What extra tests are needed for ROLE in hypostasis, rigor mortis, submersion
no heart sounds
asystole on ECG for 20 seconds
bilaterally absent pupil response
no pulse
False positive ETCO2 can be caused by:
exposure to acidotic fluid eg stomach contents or adrenaline
fizzy drinks or vigorous BM ventilation can give false +ve if tube in oesophagus
False negative ETCO2 can be caused by
low pulmonary flow - PE
describe cerebral performance categories 1-5
1: conscious, can work, may have minor deficit
2: conscious, can work in a sheltered environment
3: conscious, dependant on others for ADLs
4: coma, vegetative state, unaware, sleep wake cycles, may open eyes
5: brain dead
What does the cormack-Lehane intubation classification classifiy
views seen on direct laryngoscopy to determine how difficult intubation is likely to be
calculation for mean arterial pressure
1/3 systolic + 2/3 diastolic
NPA size for majority of adults
green 6mm
orange 7mm
NPA insertion method
advance along septum horizontally with the bevel towards the septum
OPA sizes
green = size 2 orange = size 3 red = size 4
how do you calculate the weight of a child
(age + 4) x 2
(months/2) +4
how do you calculate ET tube depth insertion for paediatrics
3 x tube size or
(age/2) + 12
If adrenaline is needed to maintain BP post ROSC, how much is given
50 micrograms
When should you feel for a pulse during ALS
only when an organised rhythm (narrow or regular) is seen at the end of a 2 minute cycle
lactate range
0.5-2.2
when would you measure lactate
post resuscitation - MABP should be targeted to achieve a normal or decreasing lactate
what are the 3 classifications of a newborn according to their initial assessment
1: vigorous breathing, HR > 100, crying, good tone
2: breathing inadequate, HR <100, normal-reduced tone
3: breathing inadequate, undetectable HR, floppy, pale
How would you treat a newborn categorised as 2 on initial assessment
dry and wrap and baby should improve with mask inflation
How would you treat a newborn categorised as 3 on initial assessment
dry and wrap, immediate airway control, lung inflation and ventilation. May need chest compressions
What would make you suspect a RV infarct
Patients with inferior infarct + clinical shock + clear lung fields
paeds adrenaline dose
0.1mg/kg of 1:10,000
GRADE
grading of recomendations, assessment, development and evaluation
SEERS
scientific evidence evaluation and review system
COSTR
consensus on science with treatment recommendations
