True/Falses Flashcards
Metabolic alkalosis
Results from hypo aldosteronism Causes muscle cramping Can result from a large strong ion difference Can result from excess saline admin Causes hyperventilation
FTTFF
VAP
if undertreated is associated with increased mortality
If diagnosed more than 5 days after admission to unlikely to be due to multi resistant organisms
Can be treated with beta lactams vancomycin or aminoglyc
Is better treated with aminoglycosides compared to beta lactamse inhibitors as they have enhanced activity in hypoxia and acidosis
In immunosuppressed pts is associated with herpes simplex
TFTFT
PE
Warfarin is adequate for initial anticoagulant
D dimmer is up
ECG has right axis deviation
Jaundice has been described
Trop is likely to be normal
FTTTF
Brain stem death
Temp must be greater than 35c 3rd CN response must be absent Knee and ankle jerks must be absent Platers must be extensor Serum sodium must be within 5 of normal
TTFFF
Perc Trachy
Can be safely done in the morbidly obese
Has a lower risk of stoma infection compared to surgical
Reduces time of mech ventilation
Serial dilators have a reduced risk of tracheal tear compared to forceps
Is more expensive due to kit cost
TTFFF
In RIFLE, a patient in group I
Oligure is always present Loop discretions improve outcome Volume resus with isotonic bicarb may help Protein restriction is needed Consider HF at exchange of 20-25ml/kg/hr
FFTFT
Sengstaken blakemore
Gastric balloon always inflates before oesophageal
100 mls is needed to inflate the balloon
Traction is applied to proximal end to stop gastric bleed
Associated with oesophageal ulcerrarion and aspiration in 20%
They control bleeds in 90%
TFTTT
Sodium bicarb In barbiturate overdose is indicated to:
Increase renal blood flow Increase tubular reabsorption Increase glomerular filtration Promote barbiturate dissociation in alkaline urine Bind excess barbituate
FFFTF
DKA
Can only occur in type I DM
Ketoamia of greater than 2mmol/L is needed for diagnosis
Blood glucose greater than 11 is needed
Bicarb less than 10 or venous pH less than 7.3 or both is needed
Predominant ketone is 3-beta-hydroxybutyrate
FFTFT
Ketones are greater than 3 not 2
Bicarb is less than 15, not 10
DKA
Blood glucose should be used as marker of resolution
Fixed rate inuslin at 0.1 units/kg/hr
Blood ketones should fall by 0.5/hr
Glucose should fall by 1 mmol/hr
Insulin may be increased by 1 unit/hr until targets reached
FTTFT
glucose can be used but it’s third line
Ketones should fall by 0.5
Glucose should fall by 3 not 1
You can increase by 1 unit per hour if this 3 mmol target isn’t reached
Rib fractures
Mortality can be as high as 33%
Resp failure is commonly due to pain and damage to tissue
A flail occurs when there is paradoxical movement during chest wall during inspiration
4 or more fractures have the highest mortality
Incubated patients with flail, resp failure or prolonged vent should have operative fixation
TTFFT
A Flail moves inward as the chest moves outward. This depends how the question is worded
4 or more has higher mortality but 7 or more is the highest
Fixate if tubed, resp failure, prolonged vent. Non tubed casn be done for deterioating function
Acute liver failure;
O Grady classification is not prognostic
Paracetamol is leading cause of ALF in Europe
NAC should be given to all ALF
Coagulopathy should be urgently corrected
They may be pro thrombotic
FTFFT
o Grady is the kings classification, sub acute, acute and hyper acute. It is of prognostic value
Paracetamol is leading in the UK, but Europe….
NAC, growing evidence but not universal
Do not correct coag, treat the cause
Yes they may be thrombotic
Upper GI bleed
Rockall determines if endoscopy is needed
Glasgow should be used after endoscopy
Restrictive transfusion strategy improves outcomes
Hct is part of Glasgow score
Age is part of Rockall
FFTFT
Rockall is done post endo
Glasgow is a risk stratified before
Yes sprestrict to 70
Hb is Glasgow. Also urea, systolic bp and systemic disease features
Age is Rockall, as is, shock, Comorbid state, diagnosis and evidence of bleeding
Chest pain, vomiting, hr 120, t wave inversion
Oesophageal rupture can by excluded by normal cxr
Ct with contrast is most useful investigation
NSTEMI is a differential
Mortality Rupture is 35%
Mackler triad is vomiting, short of breath and subcut emhysema
FTTFF
Rupture can have a normal x ray
Ct with contrast is useful
MI is a differential
Mortality can be anywhere from 20-70
Mackler is vomiting, subcut emphysema AND thoracic pain NOT breathlessness
Hypertension
Arterial pressure can be lowered by reducing cardiac output alone
NICE recommends angiotensin blockers in over 55
NICE recommends ca blockers in over 55
ACE is found mainly in the pulmonary vascular use
Aliskiren is a direct angiotensin inhibitor
TFTTF
MAP= CO x PVR there reduced CO would reduce MAP
ACEi to the under 55s, Ca blocker to the overs
ACE Is in the pulmonary vasculature
Alisa Erin is a DIRECT RENIN INHIBITOR
Beta blockers
All purely block beta receptors
B-adrenoreceptors are G.S. type of GPCR
Metoprolol acts by blocking sodium channels
increase insensitive of diabetic patients to hypos
POISE showed beta blocker on days of surgery increases risk of mortality
FTFFT
labetalol alpha They are G.S. Metro pro lol has no effect on Na. propranolol does Risk of hyper Poise increased with of death
Which of these cause raised lactate without tissue hypoxia
G6PD renal failure Leukaemia Biguanides Monoxide poisoning
FTTTT
G6PD deficiency causes raised LDH
Renal failure clears lactate in extreme cases..
Cancer, metformin etc
Dexmeditomidine
Is a GABA agonist Is more selective for a2 than a1 Inhibits norad at the locus coeruleus Has analgesic properties As an infusion reduced the median time to extubation compared to Midas
FTTTT
a2:a1 is 1600:1, 8x more than clonidine
Inhibits norad, but at the locus?
Is an analgesic
MIDEX study, but not proprioception
Consequences of near drowning in warm water
Hypotension Haemolytic Cardiac arrest Alveolar oedema Seizures
TTTTF
not sure about hypotension
Anaemia of the critically ill is characterised by
Low ferritin Low red cell folate Low serum iron Low transferrin High reticulocyte
FFTTF
Ferritin increases white transferrin reduces
Folate stays normal
Iron does drop
No change or possibly even a drop in reitculocytes
REM sleep
Occurs every 60 minutes
Associated with MI
normal patterns are abolished for several weeks following surgery
Melatonin restores normal sleep architecture in critical care
Benzos abolish REM
FTFFT
Every 90 minutes Yes through increase myocardial o2 demand REM is abolished 2-5 days after surgery Melatonin does not restore sleep Benzos do abolish
Drainage of ascites
FFP should be given if coagulopathic
Go below the umbilicus
PMN leukocyte count more then 100 is diagnostic of SBP
Paarecentesis is complicated by haemoperitoneum in greater than 5%
Hyponatramiea may result from large volume
FTFFT
No need to reverse coag
White cell greater than 250
Bleeding is very rare
There is an known hyponatraemic complication
Perc trachy
Improved cosmetic appearance compared to surgery
Increased infection risk compared to surgery
Increased bleeding risk
Early trachy is associated with reduced VAP
Minimum of 4 people are needed
TFFFF
Myxoedemic coma
Hydrocortisone is used in management Associated with hyponatramia Associated with hyperglycaeamia Hypothermia Pericardial effusion
TTFTT
Low cortisol causes a hypo
Perc trachies
Can be safely discharged to any ward
Ward staff can do the first trachy change
Cuff should be inflated when patient is taking fluids
Cuff pressure should be 30
Takes 4 days for perc stoma to be established
FFFFF
deflate the cuff as it interferes with swallowing and compresses oesophageal
Cuff pressure 20-25
Takes 7-10 days
These are part of APACHE II
temperature Magnesium Arterial ph Platelets Glucose
TFTFF
TEMPERATURE MAP RR PH PO2 Na K Creatinine Wcc Hct
Lumbar puncture
Should be done urgently to diagnose SAH
Contrainidcations include plts less than 100
A correctly placed needle will go through dura, arachnoid and pia
WCC in CSF can be due to seizures
Ulrasound reduces the failure rate
FTFTT
should be done 12 hours after symptoms
Decreased nocosomial c diff infections are associated with
Alcohol hand gel Avoiding PPI Minimising Abx use Methotrexate therapy High fat enteral feed solution
FTTFF
Spores aren’t killed by alcohol
PPI use was associated with c diff
Over use of abx is bad for gut flora
Metho is immunosuppressant
High fibre feed leads to generation of short chain fatty acids via fibre fermentation. This acidified the GI tract, reducing colonisation. But no evidence that fat reduces it.
In HIT
Risk of abnormal coag recedes in 7 days of stopping
Non immune HIT, may be mild and rarely associated with plts below 100
Anti coag such as danaparoid can be used safely
Unfractionated heparin can be replaced by LMWH
thrombocytopenia will not happen after stopping heparin
FTTFF
Anitobodies can last 100 days
HIT
LMWH has an increased risk compared to UH Most common in females Most common in medical patients Associated with DIC Warfain is safe in acute phase
FTFTF
UH is 1% risk, LMWH is 0.1
F>M
Cardiac surgery the. Surgery, then medicine, then obstetrics
DIC in 10%
Warfarin reduces production of protein C, which is naturally anti coag, this fuels the fire
Brain stem death
Neuro opinion is essential EEG must be isoelectric for 24 hours Convulsions rule out the diagnosis Spinal reflexes rule out the diagnosis A blood screen for drugs must be made
FFTTF
convulsions so an intact motor path and therefore intact stem
Spinal reflexes do not pass through the stem
You only do bloods in specific circumstances, usually just wait that they worn off
Features of amniotic fluid embolus
Cyanosis Hypofibrinogenaemia Chest pain Hypoventilation Hypertension
TTTFF
type one failure, DIC, they get a pleuritic pain, they HYPERventilate and get reduced preload to left heart.
Pulmonary vascular resistance is reduced by
Hypoxia Hypercapnia Alkalosis Epoprostenol (prostacyclin) Nitric oxide
FFTTT
Side effects of aminodarone
Peripheral neuropathy Hypothyroidism Corneal microdeposit Photosensitisatiom Bigeminal rhythm
TTTTF
Also hyperthyroid, Torsades
After a severe burn
Enteral nutrition should start ASAP
vascular access must never be put through burnt skin
Fluid need is maximal in the first 12 hours
Tissue swelling is max at 24-48
Prophylactic abx are needed
TFTTF
no role for abx, feed early.
In primary adrenocoritcal failure
Blood cortisol is low ACTH is unchanged Potassium is low Sodium is low Glucose is high
TFFTF
No steroid so ACTH raises to stimulate production. No steroid so sodium is lost and k retained. Without steroid glucose drops
Metabolic response to surgery is
Increased utilisation of glucose so reduced fasting BM
Reduced sodium in the urine
Decreased circulating fatty acid
Descreased excretion of potassium in urine
Moderate increase in o2 consumption
FTFFT
Surgery stimulates cortisol, so you hold onto sodium and lose potassium, causes a rise in glucose
Conditions are matched to the antidote
Bretylium, LA toxicity Intralipid, LA toxicity Dantrolene and MH Serotonin syndrome and cyproheptadine Aspirin and NAC
FTTTTF
Ethylene glycol poisoning
Causes a metabolic alkalosis
Co poisoning with ethanol may be protective
Typically causes renal and liver failure
Has a normal osmolar gap
Folinic acid may be used in the treatment
FTFFT
It’s an acidosis, ethanol can be the treatment, renal failure is common, liver is not, the osmolar gap increases
Absolute contraindications to DCD donation
Age more than 75 Recent sepsis Cjd Active harm cancer HIV
FFTTF
age is relative and depends on the organ Sepsis is only absolute if it hasn’t been treated Cjd is absolute As is haem malig HIV disease is, but infection is not
Risks for VAP
NG tube Increased gastric residual volume Gastric acid suppression Previous abx use Muscle relaxants
TFTTT
HIT
Argatroban, danaparoid and fondaparinux can be safely used
Platelets typically fall in the first 3 days after exposure to heparin
Is due to heparin dependent IgM antibodies binding to heparin/platelet factor 4
The warkentin probability scale is used to estimate the probability of HIT
Functional assays such as serotonin release assay, have 95% sense/spec for HIT
TFFTT
occurs later than 3 days
IgG not IgM
Atrial flutter
Type I drugs (flecanide, lidocaine, propafenone) can be used
Digoxin can be used
Sotalol can be used in recurrence
AV block rarely occurs
Atrial rate is usually 300
FTTFT
some such as 1a flecanide will not work
Dig has been described
Elderly patients
Over 80s have an APACHE of at least 6
Mortality for emergency laparotomy in older patients over 70 is 30%
Mortality for NOF is 10% at one month
Elderly patients are less responsive to catechilamines
Benzos, cyclising and atropine increase risk of delirium
TFTTT
You get 6 points for being over 75
NELA says mortality is 20
DKA in children
Cerebral oedema has a mortality of 40%
Dry membranes, sunken eyes, reduced skin turgor, and poor cap refill suggests 3% dehydration
Replace the fluid deficit over 48 hours
Shocked child should be given 10mls/kg fluid bolus
A fixed rate insulin infusion should be delayed by one after after fluid
FFTTT
Some say 20% others 60%
It’s about 9% dehydration
Shocked should get 10-20
Replace fluid over 48 hours and delay insulin one hour
AKI
defined as 1.5x creatinine increase in 48 hours
Furosemide may cause acute interstitial nephritis
Protein intake should be reduced
IV NAC should be given with iv fluid to prevent CIN in high risk pts
Use of low dose hyper osmolar contrast reduces the risk of AKI
FTFTF
1.5x in the preceding 7 days, or an absolute rise on 0.3 over 48 hours
NAC is recommended in high risk but evidence poor
It is ISO or HYPO OSMOLAR solutions
High flow oscillator
Increasing the frequency increases the CO2 clearance
Bias flow should be reduced in BPF
mean airway pressure is lower than conventional ventilation
BP may fall on commencement
HFOV is associated with decreased mortality in ARDS
FFFTF
decreasing the frequency aids clearance, the opposite of normal vent
MUST BE HIGHER TO COPE WITH LEAK
Mean airway pressure is higher
Haemodynamic instability occurs
No evidence of mortality outcome OSCAR/OSCILLATE
Child protection
All clinical staff with contact with children young people and parents/careers need to be level 2 safeguarding trained
Learning difficulties are at increased risk
Low birth weight is an increased risk
Neglect is the commonest form of abuse
A SAH is associated with abuse
TTTFF
Climical in level 2
Physical abuse is most common 7%, neglect is 6%
Sub Dural is concerning for abuse not SAH
Statistics
Null hypothesis is that a difference exists
Type I error rejects the null when it was true
Increasing the power reduces risk of type I
Increasing the expected difference will decrease number of participants needed
A cross over study should be assessed by a paired t test
FTFTT
Null, no difference
Type one is declaring a difference exists when there wasn’t one.
Increasing power reduced risk of type II error
If the expected difference is large you need less people to prove it
Cross overs use themselves as a control
ECMO
AV uses a pump
CO2 is exchanged more efficiently than o2
AV needs a cardiac index of at least 2.5
SIRS may happen in decanulation
VA is contraindicated in severe aortic regurgitate
FTTTT
AV uses its own arterial pressure
CO2 is many times more diffusion-y than o2
SIRS on decannulation has been reported
The icnarc 2009 model
Physiology score is from 0-10 Source of admission is used Physiology score has 10 parameters Uses Hct Burns are excluded
FTFFT
Scored to 100
12 parameters in 2009 and 15 in 2017
Burns are included
Hct is from the Apache
Traumatic rib fractures
Contusions lead to ventilation perfusion mismatch and therefore type II failure
Increasing age is associated with morbidity and mortality
Opioids should be first line for all fractures
Flail chest is an indication for fixation
FVC is reduced a year later when comparing control to fixation
FTFTF
Its a type I failure
Opioids are not first line
Flail chest should be operated
FVC is increased after fixation compared to control
Statistics
Ordinal data is continuous
R=0 means a no correlation between two sets of paired data
Mode is the central datum when arranged in order
Negatively skewed data has a longer upper tail
Positive skewed data, mode is, less than median less than mean
FTFFT
The lower tail is longest
Positive skew mode is smallest, then median, then mean is furthest right
In ECGs
ST elevation in V5-6, III and aVL Is a lateral MI in chest pain Normal PR interval is 120-200ms P Pulmonale is a bifid p wave Peaked t waves show Hyperlactatemia Hypokalaemia is associated with U waves
FTFTT
lead I not III for lateral
Bifid p waves are mitrale not pulmonale
PR interval is 120-200
Acid base balance
Kidneys excretes most acid
Pancreatic fistula can cause a normal anion gap acidosis
Low albumin lead to retention of sodium bicarbonate
Bartters disease is associated with met acidosis
Uretric diversion causes a raised anion gap acidosis
FTTFF
lungs excrete most acid through CO2
Fistula loses bicarb
Bicarb is maintained in albumin loss
Bartters is an alkalosis due to renal acid loss, they have hypokalemia, and hyperalodostronism
Uretric diversion is acidosis but the gap is normal
Levosimendan
Is an inodilator Is a calcium channel activator Causes vasodilation by opening ATP dependent K channels in vascular smooth muscle Increases coronary blood flow Cleared by kidneys unchanged
TFTTF
DOES IMPROVE CORONARY FLOW WHILST DILATING SYSTEMIC PULMONARY VESSELS
It is an inodilator, but sensitises calcium rather than activating the channel
Promotes K opening
Is handled by the liver
ACS
grace score estimates 3/12 mortality risk
Grace score should be used in patients with NSTEMI
Primary PCI is recommended for all STEMI within 6 hours of chest pain
Uncocniousness after cardiac arrest due to stemi is a contraindication to PCI
If pci cannot be done within 180 minutes of the time fibrinolytic could be given then they should get fibrinolytic
FTFFF
6 month mortality
Can be used in NSTEMI
Within 12 hours of chest pain
Within 120 minutes of fibrinolytic
Cardiovascular system in sepsis
AF is commonest tachyarrhythmia in sepsis
Loss of HRV in respiration is early sign
Pulmonary hypertension is a significant cause of right heart failure
Excess NO is produced by cNOS
Diastolic dysfunction occurs in less than.a quarter of patients with severe septic shock
TTTFF
it’s iNOS not cNOS
Diastolic dysfunction is in more than a quarter 37%, not less
Crucial illness with haem malignancy
Survival is based by the underlying haem cancer
NIV should not be used outside Crit care
A large ICNARC study found in hospital mortality for icu to be 60%
It is recommended that patients appropriate for further life extending treatment should be considered for an unrestricted trial of icu
In septic patients, in dwelling catheters should only be removed if there is a positive culture from the line
FTTTF
It’s determined by the severity of acute illness
Mortality is 43.1
Indwelling catheters should be removed and replaced
Chemotherapy
Bleomycin are at lifelong risk of belomycin induced lung injury
Short periods of high concentration oxygen are safe in patients previously exposed to bleomycin
Anthracyclines such as doxorubicin can cause life threatening cardiac function
Patients with chemo in childhood have 8-9 fold increased risk of mortality to cardiovascular disease in later life
Cyclophosphamide is associated with renal and hepatic dysfunction
TFTTT
even short periods of oxygen can cause rapidly progressive fibrosis
Haemorrhaging cystitis and diffuse HC destruction
The unanticipated difficult airway
A 4th attempt at direct laryngoscopy by a more experienced colleague is permitted
If intubation fails, plan B is bag mask ventilation
Cricoid pressure should be applied during insertion of a subglottic airway
Scalpel cricothyroidotomy is the front of neck technique of choice
Further neuromuscular block should not be administered if front of neck is needed
TFFTF
plan b is an LMA
Take the cricoid off during LMA
You need paralysis to do front of neck
Smoke inhalation
It is associated with a two fold increase in mortality after a burn
In an RSI, sux should be avoided
ET tunes should be cut to an appropriate length to minimise dead space
Early bronch is associated with improved outcomes
Cyanide poisoning should be suspected if the fire involved synthetics such as plastics
FFFTT
3.6x fold increase
Sux CAN be used in the first 24 hours
Do not cut a tube, facial swelling
Regarding encephalitis
In the uk, 60% of viral cases are due to herpes simplex, varicella zoster, and enteroviruses
Time to antiviral treatment is the single most important modifiable risk factor
All patients presenting with encephalitis or meningitis should be tested for HIV
Clinical examination is not as accurate as CT for predicting risk of brain herniation following an LP
MR will demonstrate changes in a minority of cases of herpes enceph
FTTFF
90%
Clin exam is at least as accurate as CT
Lesions on MRI are found in 90% of cases
Vasopressin
Levels demonstrate a biphasic response in septic shock
Has been shown to reduce mortality in septic shock comapared to norad
Vasoactive effects are on V2 receptor
Is an endogenous octapeptide
Has been used at a dose of 40 international units in cardiac arrest
TFFFT
Levels are elevated for 6 hours then suppressed
the VAAST trial compared one to the other, and there was no mortality difference (this is different from adding it in on top of norad in refractory shock)
Its the V1 receptor
Its a nonapeptide
Apparently used in an arrest?!
The enhanced recovery of elective surgical patients
NG tubes should not be routinely used
Thoracic epidurals are recommended in laparoscopic procedures
Multimodal analgesia with the smallest dose of opioid is recommended
Early mobilisation is emphasised
Patients should be well hydrated post op by iv fluid
TFTTF
Maybe an epidural for open procedures
Disconitnue iv fluids ASAP
Dexmeitomidine
Is twice as selective for a2 receptors than clonidine
Associated with less delirium compared to propofol
Produces a state of sleep compared to REM
Withdrawal after prolonged use can cause a hypertensive crisis
Context sensitive half time after 8 hours in 20 minutes
FFFTF
8 times more selective
Less delirium compared to midaz (MIDEX study)
Sleep is non-REM
Half time is 250 minutes
Ventricular arrhythmias
Ventricular ectopics are always benign
VT is defined as rate > 150 bpm
Sustained VT is when its longer than 60 seconds
Polymorphic VT is associated with long QT
VF can occur without loss of cardiac output
FFFTF
Ectopics can be associated with sudden death when there is LVH
Rate >100 not 150
Sustained is longer than 30 seconds
VF has to occur with loss of cardiac output
Ventricular arrhythmias
Treatment of polymorphic VT is 4g Mg over 10 minutes
B-blockers are CI’d in Brugada syndrome
Ca blockers may be used to terminate ventricular arrhythmias of unknown origin
Implantable cardiac defibs are recommended in patients who survived a cardiac arrest caused by VT/VF
Anti-tachycardia pacing can be used to terminate monomorphic VT
FTFTT
Its 2g over 10 minutes
B blockers aggravate ion current imbalances
Ca channel blockers should never be used to terminate a broad complex tachy of unknown origin as it may cause VF
The CXR can usually differentiate between the following
CVC in the SVC or ascending aorta CVC in the SVC or ayzgous vein CVC in the SVC or hemi-azygous vein CVC above or below a pericardial reflection CVC in the SVC or internal mammary vein
TFTTT
The aortic arch is more medial then the SVC
The SVC and azygous are superimposed
The hemi azygous vein is in the left chest
The pericardial reflection is separated by the R main bronchus
The internal mammary is more lateral
The following actions resulting in death, could be considered euthanasia
Stopping MV in a competent adult who consents to stopping
Not transfusing a competent adult Jehovah’s witness
Agreeing with the family of a man with LD who is otherwise well, not to have appendectomy
Giving a man with MND morphine because “he has had enough”
Not admitting a man to ICU with pneumonia and advanced Parkinsons
FFTTF
(my opinion, may be wrong)
1) BJA talks of a case of a paralysed woman who consented to her vent being turned off
2) JW’s can
3) euthanasia or manslaughter? From BJA: Non-voluntary euthanasia describes the killing of a patient who does not have capacity to request or withhold consent
4) sounds straightforward
5) decision to admit to ICU not the same as not treating
Contraindications to heart beating organ donation include:
Heb B Cerebral malignancy in last 12 months Donor not being on the register Continued cranial nerve activity MOF
FTFTF
Active cancer in the last 3 years??
Continued cranial nerve would mean not BSD
Dont need to be on the register
A normal anion gap acidosis is seen in
Rental tubular acidosis Type B lactic acidosis Renal Failure Ketoacidosis Biguanide toxicitiy
TFFFF
RTA is normal acidosis but AKI/CKD is raised
Metformin and any lactic acidosis raises it
Others that are normal
Diarrhoea
Ileostomy
TPN
Ureteric diversion procedures
C diff.
Is an anaerobic gram negative bacillus
Infection is reduced by washing hands with alcohol
Secretes two exotoxins to exert its effects
OTHER TWO QUESTIONS MISSING
FFT
Its Gram positive
Alcohol gel does nothing
It does - Toxin A and Toxin B
A thoracic epidural will pass through the followng
Ligamentum flavum Arachnoid Mater Posterior longitudinal ligament Supraspinous ligament Interspinous ligament
TFFTT
Lig flavum is where the resistance is prior to LOR
Too far!
Sits on the verterbral body
Most superficial ligament
Acute liver failure - the Kings transplant criteria
pH 7.2 Creatinine 200 Bilirubin >300 PT 6.5 Grade 3 enceph
?FTTF
So - if the failure is due to paracetamol, a pH of less than 7.3 is a criteria, but in non paracetamol failure, the pH isnt taken into account.
A creatinine is not part of the non para criteria, but is part of the paracetamol criteria, but the value is greater than 300.
Bili greater than 300 is a criteria in non para but doesnt feautre in para
enceph does not feature in either
Diuretics
Metolozone works on the DCT Bumetanide works on the DCT Furosemide interferes wit K/Na/Cl pump Mannitol exerts its effect through Mg reabsorption in the DCT FIFTH QUESTION MISSING
TFFF?
Bumetanide is a loop
Na/K/Cl co-transporter, not pump…
It works on the PCT and dont think Mg really comes into it
Dilated pupils are caused by
Hypothermia Seizures Tropicamide Sarin ?
TTTF?
Hypothermia causes a fixed dilated pupil
Sarin causes a pinpoint pupil
(Dilated pupils are a mydriasis)
Delirium
Hyperactive nature is >30% cases
F
8-22%
