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
