Tips Flashcards
SAMPLE
Signs and symptoms Allergies Meds- esp beta blockers, anticoag etc PMH Last oral intake, or LMP in women Events leading to illness or injury
Important histiry Qs in general
Travel hx
Contact with illness
Preganacy and periods
On examination
Always check calves for DVT
Polyfusor phosphates
Fluids cont Na, K, and phosphate
For hypoP eg DNV
aortic dissection
Px- CP tearing to back, low BP
Ix- CT angio
Ottawa rules ankle XR if
Any pain in malleolar zone AND
Bone tenderness at post edge or tip of lat malleolus OR
Medial malleolus OR
Inability to weight bear both immediately and in ED for 4 steps
Ottawa rules foot XR if
Pain in midfoot zone AND
Bone tenderness at base 5th MT OR
Navicular OR
Cant weight bear as for ankle
Massive PE defin
SBP under 90, or reduced by 40 for over 15 min.
Persis bradyc under 40
Pulselessness
Requiring ionotropic support not due to another cause eg sepsis etc.
PE mx
Wells over 4- immed CTPA and LMWH hep
Wells under 4- do D dimer then the above if pos
LMWH for at least 5d til INR over 2
Then start warfarin or NOAC within 24hr and contin for at east 3/12
Also A to E, O2 and fluids if req
massive PE notes
Hypot or imminent cardiac arrest
Signs of RH strain on CT or echo
Consider Tlysis with IV alteplase
Indics for irradiated blood
Bone marrow transplant recip Autograft recipient Hodgkins Due for bone marrow harvest next 7d Certain Imm supp drugs Due to receive certain other blood products Red cell exch in infants Suspected or known immune defic Intra uterine transfus
indic for CMV neg blood
Haem dis likely to get SC transplants Intrauterine transfusions Neonates up to 28d Planned during preg Certain chemo pts
transfusion obs
Before, at 20min, 1hr, and completion of each unit
Temp
BP
HR
RR
Transfusion reaction signs
Fever, chills, rigors, flushing Tachyc Changed BP Collapse Urticaria Bone, muscle, chest pain SOB NV General malaise Resp distress
Transfusion reac immed mx
STOP the transfus and call help
Maint IV access, slow fluids
Monit temp, HR, RR, sats, BP
Check pt and product details
transfusion reacs and mx
MILD FEVER means Febrile reaction- paracetamol. Restart slower with more obs.
URTICARIA means Mild allergic reac- chlorphenamine. Slow and more obs.
ABO incompat- saline, inform transfus dept, catheter and UO, furosemide if low UO, return bag and giving set, tx DIC
Severe allergic (bronchospasm, angioedema, abdo pain, hypot)- return bag and set, chloerphen, O2, neb salb, adren IM and rep, IV adren if v bad
Haemolytic reac or bact contam- return bag and set, take cultures clotting etc, urinalysis, monit UO, broad abx, O2, fluids
Acute LVF (dysp, hypot) means Fluid overload- O2, furosemide. Measure gas and CVP.
TRALI not LVF- CXR, high O2, tx ARDS, ventil if req
VT
Is regular
QRS concordance in chest leads Marked LAD AV dissoc Fusion or capture beats RSR and pos QRS in V1 Mx- amiodarone 300mg, synch DC shock fails
PT mx
Primary-
SOB OR over 2cm rim then aspirate
If unsucc then retry once, then chest drain
Secondary-
SOB AND over 50yo AND over 2cm then drain immed
If not then asp first and admit for 24hr
If due to trauma or mech ventil- chest drain immed
GI bleed mx
A to E NBM IV fluids Blood for grade 3 or 4 shock Catheter and monitor UO Urgent endosc Sclerohterapy maybe Terlipressin maybe Omeprazole if ulcer
Meningitis mx
Bloods, swabs, LP us after CT if no RICP, CXR Fluids Cefotaxime Maybe dex ICU if shock
Status epil mx
Over 30 min or repeated without recov btw
O2, suction, intub if req Recovery posit Take bloods, ecg Slow IV bolus lorazepam 4mg to large V. Repeat in 10 min. Maybe thiamine, glucose Fluids if low BP Phenytoin infusion if contins GA if refractory
Head inj ix
Obs incl pupils Eye movem and visual fields Fundoscopy Anterograde amnesia RICP signs
indics for CT head
GCS under 13 at all, or under 15 after 2hr
Focal neurol
Skull frac suspected
Siezure
Vomit more than once
LOC AND- over 65, or coagulop, or dangerous mech, or manesia over 30 min
Head inj ventilate if
GCS under 8
PO2 under 9 in air
Spont hyperventil
Resp irreg
admit head injury if
Diffuclt to assess eg intox, child, post ictal
Severe headache, vom, frac
More than brief LOC
Head injury mx
A to E Ocygen if req, C spine, airway Tx seizure Assess GCS and amnesia Ix- UE, gluc, FBC, tox, ABG, clotting Neuro exam Brief hx- mech, tox, lucid, fits, LOC, vom, memory Check for signs of frac skull or neck CT if indic
RICP mx
Elevate head Fluid restrict Hyperventilate Mannitol Tx cause
Ionotropes and vasopressors
Ionot incr contractility eg dobutamine, adren, noraderen
Vasopressors vasoconstrict eg phenylephrine, vasopressin, dopamine, adren, noradren
