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Specialty Flashcards

1
Q

Name 3 methods of estimating burns

A

Lund and browder
Wallace’s rule of 9s
Palm of hand =1%

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2
Q

What is the parklands formula

A

Crystalloid
4mls /kg /%TBSA Over 24 hours
First half given in 8 hours

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3
Q

What grades of spinal subluxation are there

A

Grade 1-4
1 is <25% of the vertebral body anteroposterior width
4 is > 75%

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4
Q

Why does bradycardia occur in neurogenic shock

A

High thoracic injuries causes paralysis to the thoracic sympathetic outflow leading to un opposed vagal stimulation

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5
Q

When and why should you use sux after a spinal cord injury

A

72 hours after a spinal injury life threatening hyperkalaemia can occur

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6
Q

What is the components of qSOFA score

A

BP < 100
RR > 15
GCS <15

Score of 2 suggests high risk of death or prolonged itu stay

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7
Q

What is the sofa score

A 
Resp- PF ratio
Coag- platelets
Liver - bili
Heart - MAP
Cns- GCS 
Renal - creat +uop

Score 0 to 4 on each Parameter
An increase in 2 points is a 20% increase in mortality

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8
Q

How useful is lactate as an addition to qSOFA and why is it not included

A

Performs well as a parameter
Not all hospitals have access to it
Could increase qSOFA ability to predict mortality

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9
Q

Define sepsis and septic shock

A

Life threatening organ dysfunction cause by a dysregulated host response to infection

Septic shock occurs when vasopressors are required for a MAP > 65, lactate >2 in the absence of hypovolaemia

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10
Q

What features would indicate the need for intervention in hepatic trauma

A

Haemodynamic instability
Sentinel clot
Extravasation of contrast
Score > 3 liver injury scale (grade 1-5)

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11
Q

When and what vaccinations and prophylaxis should a patient receive post splenectomy

A 
2 weeks post 
Haem influenza b
Pneumococcal
Meningococcal
\+ flu

Life long abx
<16 >50 years
Post response to vaccine
Invasive pneumococcal disease

Pen V or erythro

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12
Q

When and what vaccinations and prophylaxis should a patient receive post splenectomy

A 
2 weeks post 
Haem influenza b
Pneumococcal
Meningococcal
\+ flu

Life long abx
<16 >50 years
Post response to vaccine
Invasive pneumococcal disease

Pen V or erythro

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13
Q

How do you estimate a child’s weight

A

Age + 4 x2

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14
Q

How do you estimate an endotracheal tube size

A

Age / 4+ 4

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15
Q

How does the size difference between a cuffed and uncuffed ET

A

0.5 to 1 size smaller internal diameter tube

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16
Q

Common causes of retroperitoneal haemorrhage

A 
Trauma
Ruptured abdominal aortic aneurysm
Interventional procedures
Haemorrhagic pancreatitis
Spontaneous- anticoagulant/ low plts
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17
Q

How long does it take for grey turners sign to appear

A

24-48 hours

Bruising to flanks

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18
Q

Complications of retroperitoneal Haematoma

A 
Compartment syndrome
Femoral neuropathy 
Renal impairment 
Infection 
Hypovolaemia
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19
Q

Reversal agents of DOACs

A

Idarucozumab - Dabigatran
Haemodalysis
Pct

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20
Q

Risk factors for DIOS

A 
Severe CF genotype 
Pancreatic insufficiency 
Inadequate salt intake
Dehydration 
Poorly controlled fat malabsorption 
History of meconium ileus
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21
Q

Definition of DIOS

A

Acute onset of pain in central or right lower quadrant over days associated with pain and nausea.

Can be palpable mass.
Grade 1 ->3 mild to severe

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22
Q

Management of DIOS

A 
Hydration 
Fecal disempation protocol
Add in Kleen prep 
NG tube 
Surgical advice
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23
Q

What is the pathophysiology of thyrotoxicosis

A

Overproduction of the thyroid hormone via direct causes or precipitants

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24
Q

Causes of thyrotoxicosis

A

Graves (autoimmune thyroid stim immunoglobulin binds to tsh receptor -> thyroid hormone production )

Toxic nodular goitre
Adenoma
Trauma
Too much thyroid hormone

Sepsis/ surgery/ mi / iodine contrast / poor DM control/ nsaids

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25
Presentation of thyrotoxicosis
Tachycardia AF or arrhythmia Flush / sweating High output cardiac failure Agitation Confusion Pyschosis Fever Rhabdo Dehydration Also pain / N+ V Lid retraction, proptosis exopthalmos Hair loss
26
What blood tests do you see in thyrotoxicosis
``` High t3 and t4 Low tsh High glucose Mixed or metabolic acidosis Aki Hypokalaemia ```
27
Treatment thyrotoxicosis
Oxygen Fluid Cool Remove any precipitants Propranolol Propylthiouracil Carbimazole Steroids Consider dig/ ami / vit B / plasma exchange
28
How does propranolol work in the treatment of thyrotoxicosis
Symptomatic control | Reduced conversion of T4 to T3
29
How does propylthiouracil work in the treatment of thyrotoxicosis
Blocks iodination of tyrosine and peripheral conversion of T4-> T3
30
How does carbimazole work in the treatment of thyrotoxicosis
Block thyroid hormone production.
31
What is a myxoedema crisis
Rare and life threatening syndrome caused by a deficiency in thyroid hormone
32
Causes of myxoedema coma
``` Iodine deficiency Hashimotos (autoimmune anti- thyroid antibodies) Thyroid surgery or radioactive iodine Amiodarone Thyroid or pituitary injury ```
33
Presentation of myxoedema coma
Hypoventilation Hypoxaemia Bradycardia, long qtc flat T waves Pericardial effusion Seizures, coma, slow reflexes Hypothermia, low Na, low phosphate, low glucose
34
Management of myxoedema coma
Abcde Fluid resus with na Correct electrolytes Stop precipitants Liothyronine Levothyroxine Corticosteroids
35
How does levothyroxine work
Manufactured form of T4
36
Fast scan views
Right upper quadrant - peri hepatic Left upper quadrant - peri splenic Subcostal - pericardium Suprapubic - pouch Douglas
37
Life threatening injuries on a Trauma
``` A- airway obstruction T- tension pneumothorax O open pneumothorax M massive haemothorax F flail chest C cardiac tamponade ```
38
What is in the Extended fast scan
Fast scan with bilateral lung bases
39
What is the dose of txa
1g over 10mins | 1g over 8 hours
40
Diagnostic criteria of pre eclampsia
Hypertension >140/90 Proteinuria >20weeks
41
Definition of severe pre eclampsia
``` Severe HTN 160/110 Proteinuria And Headache Visual disturbance Clonus RUQ pain Low platelet ```
42
Definition of eclampsia
Pre eclampsia + Seizures
43
Treatment of pre eclampsia
Delivery Mgso4 4g over 5mins then 1g over 24 Control BP with labetalol or hydralazine
44
Definition of hellp
Haemolysis Elevated LFTs Low platelets Third trimester to 7/7 post partum
45
Pathophysiology of hellp
Activation of compliment and coagulation cascade form generalised endothelial injury Increasing vascular tone Platelet aggregation
46
Hellp blood tests
Maha AST raised Aki
47
Pathophysiology pre eclampsia
Torturous spiral arteries Hypoperfusion and hypoxia Cytokine and inflammatory response Maternal endothelin dysfunction
48
Define acute fatty liver of pregnancy
Third trimester or early post partum Life threatening Presenting with nausea vomiting abdo pain ascites and jaundice
49
Blood tests of acute fatty liver of pregnancy
``` Raised bilirubin Raised alt Hypertension Hypoglycaemia High ammonia Raised creatinine Leucocytosis DIC ```
50
What is the Glasgow aneurysm score and cut off for morality
``` Age Shock MI disease cVa disease Renal disease ``` >78.8 is mortality of 8.7
51
What is the 4H and 4T
Hypoxia Hypothermia Hyper/ hypo kalaemia or glycaemia Hypovolaemia Tension pneumothorax Cardiac tamponade Toxins Thrombolic disease
52
At what gestation do you require left lateral tilt
20 weeks
53
When do you consider delivering a baby during maternal CPR
Consider after 4 minutes and before 5 minutes
54
How to calculate weight of child
Age + 4 x 2
55
Why does albumin contribute to the anion gap
It is a negatively charged anion and therefore you overestimate the gap if it is low. Every 1g decrease is 0.25 decrease in AA gap
56
What are the daily requirements for water carbs protein sodium calcium
``` Water 30mls/ kg Carbs 2g/kg Protein and fat 1g/kg Sodium and potassium 1mmol/kg Calcium 0.1mmol /kg ```
57
What is the composition of Pn
40% lipid 60% carb and glucose Low protein <3 days High post day 3
58
What electrolytes change in refeeding
Phosphate Potassium Magnesium
59
What is needed to start a fire
Heat Oxygen Fuel
60
Rate and depth of chest compressions.
100-120 compression | 5-6 cm or 1/3 depth chest
61
Plasma markers of Tumour lysis
``` Raised Uric acid Phosphate Urea Creatinine LDh High phosphate Low calcium High potassium ```
62
Treatment of tumour lysis
Hydration Electrolyte correction RRT Rasburicase
63
How does allopurinol work
Xanthine oxidase inhibitor preventing uric acid formation
64
What is the definition of base excess
The amount of acid or base required to restore 1l of blood to a pH of 7.4 at body temp and normal pco2
65
What is the standard base excess
Base excess corrected to haemophilic concentration of 50
66
How much energy does 1 g of protein and carb provide
1 g of protein 4kcal
67
How much energy does 1 g of fat provide
9g
68
What is respiratory quotient
The amount of co2 produced / the amount of oxygen consumed
69
What is refeeding syndrome blood changes
Hypo kalaemia Hypo phosphatemia Hypo magnasaemia
70
Drowning subtypes
1 no water inhalation 2 water inhalation but adequate ventilation 3 evidence of inhalation and inadequate ventilation 4 absent ventilation
71
Response to water inhalation
``` Laryngospasm Aspiration of water Poor gas exchange Washout of surfactant Diver reflex- hypotension Brady Catecholamine surge Rise in icp ```
72
Re warming following drowning
2-3 degrees per hour
73
What is inhalational injury
Upper airway thermal injury Chemical irritation to respiratory tract Hypoxia
74
Presentation on bloods of carbon monoxide poisoning
Normal po2 Hbco >5 Sats normal
75
Presentation of cyanide inhalation on bloods
Lactic acidosis | High scvo2
76
Outline cam iCU test
Altered mental status Inattention: saveaheart Rass disorganised thinking: stone float on water are there fish in the sea , raise 2 fingers on one hand
77
What is a raised compartment pressure
30 Diastolic - compartment pressure < 30 also bad
78
How do you measure compartment pressures
Set up needle Attach needle to diaphragm chamber and syringe with 3ml saline Hold at angle use to insert needle and zero Insert 1-3 cm Inject 0.3 ml Measure pressure
79
Define malignant hyperthermia
``` Rare autosomal dominant Decent in ryanodine receptor Chromosome 19 Abnormal RYR1 channel allows excessive calcium release following exposure to a trigger Sustained skeletal muscle contraction ```
80
Management of MH
``` Stop all triggers Dantrolene 1mg/kg every 10mins Hyperventilate with 100% o2 Cool Monitor CK, urine , myoglobin levels ```
81
Define neuroleptic malignant syndrome
Reaction to antipsychotic agents (haloperidol and procholperazine) Dopamine antagonism 1 week of instigation Altered mental status, autonomic changes and extrapyramidal signs
82
Define seretonin syndrome
Interaction between 2 serotonin enhancing drugs L- dopa, lsd, mdma, ssri, maoi Altered mental state, autonomic dysfunction and neuromuscular excitability
83
Treatment for seretonin syndrome
``` Stop offending drugs Cool Benzodiazepines or propranolol Dantrolene Cyproheptadine ```
84
Causes of eye problems on itu
Disease- facial oedema, decrease GCS, neurological injury Treatment- proning, cpap, sedation, paralysis
85
The main eye disease on itu
Direct cornea injury Exposure keratopathy Chemists (conjunctival swelling) Microbial conjunctivitis and keratitis
86
Outline the degrees of lid lag
Grade 0 - completely closed Grade 1 conjunctival exposure but not cornea Grade 2 any cornea exposure
87
Treatments required for the different grades of lid lag
Grade 1 lubrication Grade 2 tape and lubricate
88
Explain the use of flurosceine dye in eye disease
Drops in the eye Use a blue light Epithelial defects glow yellow
89
What is exposure keratopathy
Dryness of the cornea due to incomplete lid closure allowing excessive tear evaporation and produces a red eye
90
Risk factors for chemosis of the eye
``` Compromised venous return Positive pressure ventilation Tight et tape Peripheral oedema Prone Sirs ```
91
Common bacteria causing microbial eye Infections
Psa Acinetobacter Staph epidermis
92
What are the 4 H and 4 Ts
Thrombosis Tamponade tension pneumothorax Toxins Hypovolamia Hypoxia Hyper kalaemia Hypothermia
93
What is dress syndrome
Drug reaction with eosinophilia and systemic symptoms Rash, lymphadenopathy low plts, high eosinophils in response to exposure to medications
94
Which drugs cause dress
2-6 weeks following exposure to ``` Anticonvulsant: carbamaizipne, phenytoin Antibiotics: amox, taz, vanc Anti inflammatory: diclofenac ibuprofen Allopurinol Omeprazole All TB drugs ```
95
Pathophysiology of dress
Type 4 hypersensitivity reaction | Cytotoxic T feels initiators autoimmune reaction
96
What does sample stand for in a secondary survey
``` Signs and symptoms Allergies Medications Past medical history Last oral intake Events leading up to injury ```
97
Class of haemorrhage
Class 1: 15% Class 2 : 15-30% Increase in hr / decrease pulse pressure Class 3: 31-40% Increase HR / low BP/ low uop/ low GCS Class 4: >40%
98
What size is a c d e cylinder
C 170 D 340 E 680
99
Parkland and modified parkland
Parkland is 4mls/ kg/ TBSA | Modified 1.5 per 8 hour 1.5 per 16 hour

Icm (16 decks)

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