Third Year Flashcards
What is the CURB-65 Score?
Used to assess Pneumonia severity:
1 point for each:
Confusion Urea (7 or more) Respiratory rate (30 or more) Blood pressure (less than 90 mmHg Systolic or 60 mmHg Diastolic or less) Aged 65 or over
0-1 Low severity (risk of death < 3%)
2 Moderate severity (risk of death 3-15%)
3-5 High severity (risk of death > 15%)
Do not routinely discharge patients with community‑acquired pneumonia if in the past 24hours they have had 2or more of the following findings:
- temperature higher than37.5°C
- respiratory rate 24breaths per minute or more
- heart rate over 100beats per minute
- systolic blood pressure 90mmHg or less
- oxygen saturation under 90%on room air
- abnormal mental status
inability to eat without assistance.
What 6 parameters make up the NEWS?
Respiration Rate Oxygen Saturations Supplemental Oxygen Temperature Systolic Blood pressure Heart Rate Level of Consciousness
Define Hospital/nosocomial acquired pneumonia
Hospital acquired pneumonia (HAP) is defined as new onset of symptoms along with a compatible x-ray developing more than 48 hoursafterthe patient’s admission to hospital.
An immediate antibiotic prescription and/or further appropriate investigation and management should only be offered to patients (both adults and children) in the following situations:
if the patient is systemically very unwell
if the patient has symptoms and signs suggestive of serious illness and/or complications (particularly pneumonia, mastoiditis, peritonsillar abscess, peritonsillar cellulitis, intraorbital and intracranial complications)
if the patient is at high risk of serious complications because of pre-existing comorbidity. This includes patients with significant heart, lung, renal, liver or neuromuscular disease, immunosuppression, cystic fibrosis, and young children who were born prematurely
if the patient is older than 65 years with acute cough and two or more of the following criteria, or older than 80 years with acute cough and one or more of the following criteria:
hospitalisation in previous year
type 1 or type 2 diabetes
history of congestive heart failure
current use of oral glucocorticoids.
What 4 things should indicate Dialysis is required?
Hyperkalemia
Pulmonary Oedema
Metabolic acidosis
Uraemic encephalopathy (confusion, myoclonic jerks, seizures, coma) or uraemic pericarditis (inflammation of pericardial sac)
If a urine dipstick comes back at Blood ++++ but no bleeding history is indicated, what is the important differential?
Rhabdomyolysis: the myoglobin in the urine cannot be distinguished from haemoglobin so will give a false positive on dipstick
What is required to classify a UTI as ‘recurrent’
Three resolved UTIs in less than 12 months
What are the symptoms of Hyperglycaemia?
- Polyuria
- Polydipsia
- Unexplained weight loss
- Visual blurring
- Genital thrush
- Lethargy
What is diagnostic of Diabetes on a venous capillary sample?
11.1 mmol/L or above for non fasting
7 mmol/L or above for fasting
What are the 9 key care essentials for Diabetes?
- Blood pressure
- Blood glucose
- Eye check
- Foot check
- Cholesterol level
- HbA1c
- GFR/Renal function
- Renal protein e.g. Microalbuminuria
- Weight
- Smoking
What dose of Folic acid should women take who require the higher dose? And what constitutes being high risk?
Some women have an increased risk of having a pregnancy affected by a neural tube defect, and are advised to take a higher dose of 5 milligrams (mg) of folic acid each day until they are 12 weeks pregnant. Women have an increased risk if:
- they or their partner have a neural tube defect
- they have had a previous pregnancy affected by a neural tube defect
- they or their partner have a family history of neural tube defects
- they have Diabetes
Normal ABG Values
pH: 7.35 – 7.45 pO2: 10 – 14kPa pCO2: 4.5 – 6kPa Base excess (BE): -2 – 2 mmol/l Bicarbonate (HCO3): 22 – 26 mmol/l
What is Base excess?
Base excess is the amount of strong base which would need to be added or subtracted from a substance in order to return the pH to normal (7.40).
A value outside of the normal range (-2 to +2 mEq/L) suggests a metabolic cause for the acidosis or alkalosis.
A high base excess (more than +2 mEq/L) indicates a metabolic alkalosis.
A low base excess (less than -2 mEq/L) indicates a metabolic acidosis.
Why is Lactate on an ABG?
Lactate is produced as a by-product of anaerobic respiration.
A raised lactate can be caused by any process which causes tissue to use anaerobic respiration.
Lactate is therefore a good indicator of poor tissue perfusion.
What is Respiratory compensation?
If a metabolic acidosis develops the change is sensed by chemoreceptors centrally in the medulla oblongata and peripherally in the carotid bodies.
The body responds by increasing depth and rate of respiration therefore increasing the excretion of CO2 to try to keep the pH constant.
The classic example of this is ‘Kussmaul breathing’ the deep sighing pattern of respiration seen in severe acidosis including diabetic ketoacidosis.
Here you will see a low pH and a low pCO2 which would be described as a metabolic acidosis with partial respiratory compensation (partial as a normal pH has not been reached).
What is Metabolic compensation?
In response to a respiratory acidosis, for example in CO2 retention secondary to COPD, the kidneys will start to retain more HCO3 in order to correct the pH.
Here you would see a low normal pH with a high CO2 and high bicarbonate.
This process takes place over days.
It is important to ensure that the compensation that you see is appropriate, i.e. as you would expect. If not then you should start to think about mixed acid base disorders.
What is type 1 Respiratory failure?
Type one respiratory failure is diagnosed when there is a PO2 less than 8 and a PCO2 which is low or normal.
T1RF is caused by pathological processes which reduce the ability of the lungs to exchange oxygen, without changing the ability to excrete CO2.
Causes of T1RF include pulmonary embolus, pneumonia, asthma and pulmonary oedema.
What is type 2 Respiratory failure?
T2RF is defined as a PaO2 of less than 8 and a raised PaCO2.
A problem with the lungs.
A problem with the mechanics of respiration.
A problem with the control of respiration.
Pulmonary problems: COPD, Pulmonary Oedema, Pneumonia
Mechanical problems: Chest wall trauma, Muscular dystrophies, Motor neurone disease, Myasthenia Gravis
Central problems: Opiate overdose, acute CNS disease
Causes of tracheal deviation?
Away from lesion:
- Large Pleural effusion
- Tension pneumothorax
Towards lesion:
- Lobar collapse
- Pneumonectomy
- Pulmonar fibrosis
Urea and Electrolyte normal ranges?
Sodium: 135-145 mmol/l Potassium: 3.5 - 5.0 mmol/l Urea: 2-7 mmol/l Creatinine: 55-120 umol/l Bicarbonate: 22-28 mmol/l Chloride: 95-105 mmol/l
Normal ranges of Liver function tests?
Bilirubin 3-17 umol/l Alanine transferase (ALT) 3-40 iu/l Aspartate transaminase (AST) 3-30 iu/l Alkaline phosphatase (ALP) 30-100 umol/l Gamma glutamyl transferase (yGT) 8-60 u/l Total protein 60-80 g/l
