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FFICM PREP > Treatments > Flashcards

Treatments Flashcards

1
Q

HUS Treatment

A

Supportive CVS /renal
- fluid resuscitation reduces need for RRT
- Treatment e.coli /shigella with ciprofloxacin, avoid anti motility for diarrhoea as increases shiga toxin exposure
- eculizumab as a complement (C5) inhibitor
- Plasma exchange for atypical (non infectious)
-

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2
Q

TTP treatment

A

Plasma exchange with Octaplas for >=2 days after plt recovery
High dose steroids
Rituximab
Low dose aspirin once plt >50
Supportive measures (do not give plts as will worsen thrombus unless life threatening haemorrhage)

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3
Q

How does NAC work in paracetamol OD?

A

Metabolism of toxic metabolite of paracetamol by glutathione in the liver is overwhelmed and glutathione stores depleted. NAC restores glutathione levels and can act as a secondary substrate for toxic metabolite

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4
Q

What is the mechanism of adrenaline?

A

Adrenaline is a catecholamine that is a strong alpha and beta agonist that is a mixed ionotrope, chronotrope and vasopressor.
- Beta 1 receptor action increases contractility and heart rate
- alpha 1 receptor action causes increased vasoconstriction
- beta 2 receptor action causes bronchodilation and vasodilation at certain vascular beds such as the skeletal muscle

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5
Q

Indications for transplant in ILD

A

Age less than 65
Not intubated (increases mortality by 3x)
TLCO <40%

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6
Q

Lipid emulsion dose

A

20% solution
1.5ml/kg bolus
15ml/kg/hr

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7
Q

How do milrinone and glucagon work in beta blocker and calcium channel blocker overdose?

A

Acts via indirect sympathomimetic effects

Increase myocardial cAMP
Positive ionotropy and chronotropy

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8
Q

Anaphylaxis treatment

A

ABCDE
IM adrenaline = 0.5mg adrenaline bolus up to 2x

IV Bolus can be given but infusion titrated to response

Treatment of bronchospasm
- adrenaline Nebs
- salbutamol / aminophylline infusions

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9
Q

DKA

A

ABCDE

+

specific
- fluid resuscitation with saline
- potassium replacement
- ketones treated with FRII (0.1unit/kg/hr)

+ treat underlying cause

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10
Q

Treatment of hyperthyroidism

A

Supportive management
- ABCDE

Specific
- beta blockade (propranolol)
- propylthiouracil / carbimazole
- Steroids (reduces conversion of T4 to T3)
- iodide (inhibits synth and release of T3/4)
- plasmapheresis / plasma exchange / haemodialysis

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11
Q

Treatment of hypothyroidism

A

Mainly supportive
Steroids
Incremental doses of IV thyroid hormone

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12
Q

Anaphylaxis

A

Supportive
- ABCDE
- early intubation, treat bronchospasm, fluid resuscitation and vasopressors / ionotropes

Specific
- remove trigger if possible
- adrenaline prevents mast cell degranulation
- antihistamines and hydrocortisone are second line

Ensure mast cell tryptase sent at 0,1 and 24 hours for confirmation of diagnosis

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13
Q

Warfarin patient emergency bleeding

A

Prothrombin complex concentrate

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14
Q

TCA overdose

A

Low threshold for diagnosis in intoxication with sinus tachycardia (could narrow with bicarbonate and be diagnostic)

General supportive (ABCDE)
- can have seizures (higher risk if QRS > 100)
- severe resp acidosis may need intubation
- often fluid resistant hypotension

Specific treatment
- Sodium bicarbonate (bolus and infusions)
- lidocaine (sodium channel competition)
- lipid emulsion in severe scenarios

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15
Q

Key consideration of paediatric trauma management

A

Non accidental injury

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16
Q

Paediatric resus haemorrhage doses

A

TXA 15mg/kg
RBC / FFP 5ml/kg
Crystalloid 5ml/kg

After 20ml/kg blood products
-> 10ml/kg plts + 0.1ml/kg calcium chloride

Cryoprecipitate 10ml/kg

17
Q

COVID-19

A

ABCDE

  • Steroids
  • IL-6 inhibitor (tocilizumab)
  • Antivirals (remdesivir for high risk, molnupiravir for outpatients)
  • Neutralising monoclonal antibodies and JAK inhibitors are new therapies
18
Q

VAP bundle

A

Head up 30 degrees
Oral chlorhexidine
Daily sedation holds
VTE
Ulcer prophylaxis
Subglottic suction

19
Q

Contraindications for lung transplant

A
  • recent history of malignancy (2 years)
  • poorly controlled significant dysfunction of another organ system
  • uncorrected coronary artery disease
  • unstable acute medical condition
  • uncorrectable bleeding disorder
  • poorly controlled infection or TB infection
  • obesity (>35) or thoracic deformity
  • risk of non complicance due to personal or psychiatric conditions or lack of social support
  • previous thoracic surgery is NOT a contraindication
20
Q

Common indications for lung transplant

A
  • cystic fibrosis
  • ILD (poor prognosis)
  • pulmonary hypertension (ideally pre cor pulmonale)
  • heart lung transplant
  • re-transplantation
  • new progression to early lung adenocarcinoma being transplantable but with full staging CTs, biopsy and a back up recipient if mediastinal LNs found
21
Q

Indications for liver transplant

A

Acute (better prognosis)
- paracetamol toxicity
- hepatotoxic drugs
- acute viral hepatitis
- unknown
- trauma
- budd-chiari syndrome

Chronic liver disease
- PBC, PSC and biliary atresia
- alcoholic liver disease (demonstrated abstinence)
- autoimmune
- chronic viral disease
- malignancy

Metabolic
- Wilson’s disease
- haemachromatosis
- alpha 1 antitrypsin deficiency

22
Q

General transplant contraindications

A

PMHx
- recent history of malignancy
- poorly controlled significant dysfunction of another organ system
- uncorrectable bleeding disorder
- risk of non complicance due to personal or psychiatric conditions or lack of social support
- obesity

Acute
- unstable acute medical condition
- poorly controlled infection or TB infection

23
Q

Management of Infective endocarditis

A

ABCDE resuscitation

MDT management with cardiology, CTS micro
- guide investigation and diagnostic confirmation

Antibiotics related to culture ideally
- consider stopping antibiotics if stable and culture negative
Empiric :
- vanc and gent for native valves
- vanc, rifampicin and gent for prosthetic

Investigate and treat embolic phenomenon

Surgery
- intracardiac prosthetic involvement
- acute MV/AV regurgitation
- uncontrolled infection
- high risk of systemic emboli
- vegetations >10mm with emboli
- vegetations >10mm with severe valve dysfunction
- isolated large >15mm vegetations

24
Q

IE prophylaxis

A

Only for most high risk (NICE 2016)
- acquired valvular heart disease
- HOCM
- previous endocarditis
- previous valve replacement
- congenital heart disease

Only for High risk dental procedures e.g. extraction or subgingival instrumentation

25
Q

Transplant graft rejection

A

Plamapheresis
High dose steroids
IVIG
Antiproliferative agents

Minimised by optimum HLA matching
- ischaemia and reperfusion upregulate graft HLA-antigen expression

26
Q

Transplant immunosuppression

A

Induction agent
- basiliximab (targets activated T cells via IL-2 receptor)
- often associated with high dose steroids

Maintenance
- calcinurin inhibitor (cyclosporin or tacrolimus) can cause nephrotixicity
- MMF and azathioprine

Side effects
- immunosuppression
- cell lysis and cytokine release
- haemodynamic instability
- infection
- malignancy

NB if the graft fails, immunosuppression is often discontinued.

Prophylaxis
- PCP
- CMV
- vaccinations

27
Q

Anticoagulation for non occlusive MI

A

Fondaparinux 2.5mg (VTE prophylaxis dose) showed improved mortality (OASIS trial)

In NICE guidelines

But can increase thrombotic events if going for PCI so not for STEMI/occlusive MI patients

28
Q

Methaemoglobinaemia

A

Remove offending agent
Methylene blue if >20% or symptomatic
- reduces haemoglobin back to Fe2+

Contraindications for methylene blue
- in G6PD deficiency it can precipitate haemolysis

Refractory cases
- exchange transfusion
- hyperbaric oxygen

29
Q

Treatment of hepatic encephalopathy

A

Treat cause

Reduce ammonia production and absorption

Nutritional support

Prevent complications with airway protection etc

30
Q

Chronic hep b treatment

A

Lamivudune

31
Q

Toxic alcohol ingestion

A

Fomepizole - alcohol dehydrogenase blocker which prevents glycolic acid build up and metabolic acidosis

FFICM PREP (10 decks)

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