Untitled Deck Flashcards
When do you control hypertension in the first 24 hours after an acute ischaemic stroke according to NICE?
NICE advises against actively managing hypertension during this period, except in the following situations:
• To facilitate thrombolysis–target BP< 185/110.
• In cases of pre-eclampsia, aortic dissection, or hypertensive encephalopathy/nephropathy/cardiac failure.
What percentage TBSA burn would meet the criteria for referral to a burns centre on area alone?
> 40% Total Body Surface Area (TBSA)
Where is propofol predominantly metabolised?
Hepatic metabolism, primarily via glucuronidation and sulfation pathways.
What is the dose of IV magnesium in the management of acute asthma, and how does it work as a bronchodilator?
Dose: 1.2–2 g IV over 20 minutes.
Mechanism as a bronchodilator:
1. Calcium blocker in bronchial smooth muscle
2. ↓ Ach release at the NMJ
3. ↑ Sensitivity of β-receptors to catecholamines
What is the Parkland formula for IV fluid replacement after a burn?
Volume of IV fluids = 4 mL/kg/%TBSA over 24 hours.
Half of total is given in the first 8 hours after the injury.
This formula takes into account pre-hospital fluid administration. Therefore, any pre-hospital fluid is subtracted from total. When calculating TBSA, erythematous regions are omitted unless there is additional blistering or underlying evidence of a partial-thickness burn.
What did the PROPPR trial (2015) demonstrate for blood product administration in a 1:1:1 ratio compared to a 1:1:2 ratio?
No difference in all-cause 24-hour or 90-day mortality.
Post-hoc analysis found a significant reduction in death by exsanguination within the first 24 hours and a higher rate of achieving haemostasis in the 1:1:1 group compared to the 1:1:2 group.
What are the 12 physiological variables of the APACHE II score?
CNS, CVS, RESP, RENAL, MICRO/HAEM, GCS, MAP, HR, RR, PaO2, Arterial pH, Na+, K+, Creatinine, Temperature, WCC, Hct.
The worst of these variables within the first 24 hours of critical care admission is used. Effects of age and chronic health are incorporated to give a single score with a maximum of 71. A score of >25 represents a predicted mortality of >50%.
What dose of adrenaline do you give in adult anaphylaxis?
0.5–1 mL of 1:1,000 IM (0.5–1 mg) OR 0.5–1 mL of 1:10,000 IV (50–100 mcg)
What is the difference between intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS)?
IAH: sustained or repeated pathological elevation of IAP ≥ 12 mmHg.
ACS: sustained IAP > 20 mmHg + new organ dysfunction/failure +/− abdominal perfusion pressure (APP) < 60 mmHg.
How do you measure intra-abdominal pressure (IAP)?
IAP is measured:
• Direct: puncture of the abdominal cavity
• Indirect: via a urinary catheter in the bladder or a balloon-tipped catheter inserted into the stomach. Correlates well with direct measurements but can be inaccurate when there are adhesions, pelvic fractures, and abdominal packs.
Where in adults does the trachea start and divide anatomically?
Starts at C6, extends to T4 where it bifurcates. It is approximately 10–12 cm long.
The right main bronchus separates at a 25° angle and the left main bronchus separates at a 45° angle.
