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72 Cards in this Set
- Front
- Back
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What is Parkland formula for burns?
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4 x wt (kg) x % BSA (full number, not decimal)
give first 1/2 in the first 8 hours |
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What is Charcot's triad? What is it used for?
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Fever
Jaundice RUQ pain ascending cholangitis |
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What part of the ear does gentamycin affect in causing deafness?
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cochlear hair cells
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What is Grey-Turner's sign and what is going on with this sign?
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bruising in both flanks, sign of retroperitoneal hemorrhage
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Common causes of respiratory acidosis?
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ventilatory failure and type II resp failure (COPD)
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Common causes of respiratory alkalosis?
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Type I resp failure
Over ventilation (mechanical or hyperventilation) living at high altitudes |
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Causes of metabolic acidosis?
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TOO MUCH ACID
1) Shock or cardiac arrest (build of lactate and H+) 2) DKA 3) Chronic renal failure NOT ENOUGH BICARBONATE 1) loss from gut 2) renal tubular acidosis |
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Causes of metabolic alkalosis?
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1) Loss of acid
- from stomach (nasogastric suction, high intestinal obstruction) 2) Excess administration of alkali) 3) over administration of bicarbonate |
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What are the reversible causes of cardiorespiratory arrest?
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4 Hs and 4 Ts
Hypoxemia Hypovolemia Hypo/Hyperkalemia Hypo/Hyperthermia Tamponade Tension pneumothorax Toxins/poisons/drugs Thromboembolism |
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What are the different kinds of shock
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Hypovolemic
Cardiogenic Obstructive Septic Spinal Anaphylactic (septic, anaphylactic and spinal shock are kinds of redistributive shock) |
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What are the causes of hypovolemic shock?
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Haemorrhage
Dehydration Diarrhea/vomiting Burns 3rd space loss |
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Mechanism of anaphylactic shock?
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Foreign protein/antigen causes release of histamine causing widespread vasodilation leading to hypotension and increased capillary permeability.
Also, oedema of airway obstructs ventilation |
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Mechanism of obstructive shock?
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Flow of blood is obstructed, impeding circulation and resulting in circulatory arrest.
Causes Tamponade Tension pneumothorax (inc intrathoracic pressure preventing venous return to heart) Massive PE Aordtic stenosis (obstructing ventricular |
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What is Kussmaul's sign and what does it indicate?
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Rise in JVP with inspiration.
Indicates limited RV filling. Causes: Cardiac tamponade RV infarction RHF Cardiac tumour Tricuspid stenosis |
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What are the metabolic response to trauma/major surgery/severe infection?
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Initially, hypermetabolism until glycogen stores are depleted and gluconeogenesis ceases.
1) glucagon and catecholamine release stimulates gluconeogenesis 2) Hepatic conversion of glycoggen to glucose 3) Insulin resistance caused by catecholamines, cortisol, and down reg of insulin receptor expression 4) Hypertriglyceridemia due to increase in FFA synthesis 5) Protein breakdown for energy from AAs: glutamine taken from muscles to fuel leucocytes and enterocytes, and for formation of glutathione (free radical scavenger) 6) Hepatic protein synthesis increased to produce acute phase reactants |
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What are the complications of the catabolic state caused by trauma/major surgery/severe infection?
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Protein breakdown assoc w wasting and weakness of skeletal and resp muscle. increases need for mechanical ventilation and delays mobilisation. may slow tissue repair, wound healing and immune function
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When do you give tetanus immunoglobulin?
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if uncertain vaccination history or <3 tetanus toxoid vaccine doses and not a clean, minor wound
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What is the protocol for tetanus prophylaxis?
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Give tetanus toxoid vaccine if >5 years since last dose and not a clean, minor wound
Give tetanus Ig if uncertain vaccination history and not a clean, minor wound |
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How do you score the GCS eye response?
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1. no eye opening
2. eye opens to pain 3. eye opens to speech 4. eye opens spontaneously |
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How do you score the GCS verbal response?
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1. No verbal response
2. Incomprehensible - moaning 3. Inappropriate - random, no convo 4. Confused 5. Oriented |
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How do you score the GCS motor response?
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1. No motor response
2. Extension to pain (decerebrate) 3. Flexion to pain (decorticate) 4. Flexion/withdrawal to pain 5. Localizes to pain 6. Obeys commands |
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What is the mean arterial pressure formula?
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CO x TPR
2/3 diastolic pressure + 1/3 systolic pressure |
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5 most common causes of life threatening altered LOC
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1) SAH
2) Cardiac (MI, tamponade, arrhythmia, structural/valuvular abnormalities 3) Metabolic: Hypoglycaemia, adrenal crisis 4) Drup OD/alcohol intox 5) Status epilepticus |
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What clinical signs differentiate a structural from metabolic cause of coma?
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Structural:
1) extraoccular movements, and motor signs are usually asymmetric. 2) Pupils unequal/non-reactive 3) Focal or lateralising abnormalities present Metabolic 1) extraoccular movements and motor findings absent or symmetrical 2) equal and reactive pupils (=upper brainstem intact) 3) caloric unresponsiveness (=lower brainstem NOT intact) |
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Non-structural cause of fixed constricted pupils?
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cholinergic agents e.g. organophosphates
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Non-structural cause of fixed dilated pupils
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hypothermia, barbiturates, antipsychotics
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Non-structural causes of fixed dilated pupils?
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Anoxia
Anticholinergics (atropine, TCAs) Methanol (rare) Cocaine Opioid withdrawal amphetamines hallucinogens |
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Signs of PE on CXR
Signs of PE on ECG |
westermarks sign: abrupt tapering of vessel
Hampton's hump: wedge shaped infiltrate that abutts the pleura RVH, RAD, Most specific sign = S1Q3 inverted T3 |
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5 life threatening causes of chest pain
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MI/ACS
Tamponade Aortic dissection Massive PE Pneumothorax Oesaphageal rupture |
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At what BSL does cognitive function deteriorate?
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<3.0mmol/L
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Signs of neuroglucopenia
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headache, diplopia
cant concentrate, hallucinations confusion, irritability, irrational/violent behaviour focal neuro defici seizure aLOC/coma |
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Mgt of hypoglycaemia
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If pt can take oral - sweet drink/oral glucose
If pt can't take oral: slow push 50mL 50% dextrose (25mL at a time) flush with saline to prevent irritation to vein If no IV access or no 50% dextrose: 1mg glucagon SC or IM SE: vomiting, so monitor to prevent aspiration |
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Intoxicated patient is hypoglycaemic. What management?
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Glucagon WONT WORK
so glucose is best treatment |
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When do you stop insulin infusion for DKA?
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When ketones are cleared (from serum or urine).
NOT when BSL is normal |
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What are the aims of management of DKA?
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Treat the acidosis
Treat the dehydration |
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What are the key elements of DKA managment?
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1) Fluid replacement
2) Insulin infusion 3) Potassium correction 4) Treat underlying cause 5) Monitor ketones regularly. |
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At what level do you put an epidural in for an operation?
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below the level of the incision, not above!
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significance of betablockers in hypoglycaemia?
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can mask adrenergic symptoms
Results in sudden onset of neuroglycopenia |
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How long before regain of consciousness after IV glucose given for hypoglycaemic attack?
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5 min
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How long before regain of consciousness after glucagon IM/SC given for hypoglycaemic attack?
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6 min
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Why doesn't glucagon help in alcohol associated hypoglycaemia?
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Alcohol inhibits hepatic gluconeogenesis. Hence no glucose to be released from liver.
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Managment of sulfonylurea induced hypoglycaemia
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Stop drug
Admit Treat with IV glucose 10% Monitor BSL frequently Investigate underlying causes: e.g. poor renal fucntion |
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Pharmocological managment of convulsive status epilepticus?
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Simultaneous:
Protect airway Maintain oxygenation Terminate seizure: clonazepam 1mg/kg IV OR diazepam 10-20mg/kg IV OR midazolam 5-10gm/kg IM or IV Followed immed by: phenytoin 15-20 mg/kg IV OR phenobarbitone 10-20mg/kg IV sodium valproate 10mg/kg slow IV push EEG to exclude nonconvulsive status epilepticus |
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indications for ICU mgt of epilepsy
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Refractory status epilepticus
infuse: clonazepam, midazolam, propofol or thiopentone |
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Empirical therapy for suspected meningitis?
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Dexamethasone 10mg IV
Ceftriazone 4g or cefotaxime 2g Add vancomyacin if suspect strep pneumoniae or staph (e.g. sinusitis/OM) Add benzyl penicillin if suspect listeria |
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Emergency treatment of acute cardiogenic pulmonary oedema
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LMNOP
Lasix, morphine, nitrates, O2, Position and positive pressure ventilation CPAP at 10cmH2O or BiPAP at 10cm Plus IV glyceryltrinitrate 10mcgIV (if sysBP>100) Morphine for anxiety Digox for AF/tachy (and not already on digox) If not responding Dobutamine or milrinone |
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Drugs that widen QRS?
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Antidepressants
tricyclic antidepressants venlafaxine Cardiovascular drugs flecainide propranolol quinidine Local anaesthetics bupivacaine ropivacaine Others bupropion chloroquine cocaine hydroxychloroquine quinine (sorry for massive list!) |
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Cardiac drugs that prolong QT?
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amiodarone
procainamide quinidine sotalol propranolol |
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Investigations in drug overdose?
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ECG (QRS or QT lengthening)
Drug screen Drug concentrations (avail for PCT, common anticonvulsants, aspirin, digoxin, lithium, methotrexate, patoassium, theophylline, toxic alcohols (methanole, ethylene glycol, ethanol) |
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Stages of EtOH withdrawal
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re. time since last drink:
8hrs - mild withdrawal 1-2d - hallucinations 8hrs-2d - seizures 3-5d - delerium tremens |
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Opthalmoplegia + ataxia + delerium = ?
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Wernicke's encephalopathy d/t Thiamine (B1) deficiency
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Indications for laparotomy at presentation
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1. hemo instability w/ evidence of intrabdo bleeding (+ FAST or DPL)
2. peritoneal signs 3. chest xray showing diaphragmatic tear |
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Indications for laparotomy after diagnostic testing
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1. active extravasation from major abdo vessel or hematoma adjacent to major vessel
2. solid organ injury w active extravasation 3. pancreatic injury 4. hollow viscus injury 5. intraperitoneal bladder rupture |
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Indications for laparotomy during hospital observation
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1. solid organ injury dev hemoinstability or requiring >2 units of packed cells
2. peritonitis 3. persistent urinary leakage or hematuria from fragmented kidney 4. clinical deterioration with no other explanation |
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If hemodynamically stable, which organs in abdominal trauma can be managed non-operatively?
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liver, spleen, renal if no extravasation
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If hemodynamically stable, which organs in abdominal trauma should be managed via laparotomy?
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pancreas, hollow viscus, if kidney fragmented
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Which rhythms are shockable?
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VT, VF
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What is a crystalloid fluid?
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IV infusion fluid composed of crystalline substances such as sodium chloride, potassium chloride or glucose, eg Hartmann's
distributes within ECF |
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What is a colloid fluid?
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IV fluid formed by a colloidal suspension of large molecules in a water or saline based medium
distributes in the intravascular volume and maintains plasma oncotic pressure always isotonic |
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T/F Crystalloids are just as effective as colloids in restoring intravascular fluids
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True
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T/F Severe intravascular fluid deficits can be more rapidly corrected using colloid solutions
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True
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What is distributive shock? Examples...?
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low afterload from excessive or inappropriate vasodilation
anaphylaxis sepsis drug toxicity - vasodilating antiHT meds, nitrates |
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What is neurogenic shock? Examples...?
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loss of sympathetic function causing a distributive shock
spinal cord trauma, epidural |
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Signs of spinal/neurogenic shock
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hypotension without tachycardia or peripheral vasoconstriction (warm skin)
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Signs of obstructive shock (JVP, CO, vascular resistance)
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increased JVP
insufficient CO increased systemic vascular resistance |
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Signs of cardiogenic shock (JVP, CO, vascular resistance)
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increased JVP
decreasedCO increased systemic vascular resistance |
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Signs of septic shock (JVP, CO, vascular resistance, temp, HR)
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decreased JVP
increased CO decreased vascular resistance fever increased HR wide pulse pressure |
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What kind of shock can pancreatitis cause?
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Hypovolaemic shock
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Patient suffering from hypovolemic shock. What fluid replacement do you give?
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1-2L warmed NS/hartman’s
20mL/kg for child |
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What are the steps of initial management for fluid replacement and transfusion in major trauma?
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1) IV access
2) Blood samples: crossmatch, FBC, EUC, clotting studies 3) Fluid resuss STAT 4) Stop bleeding 5) Correct hypothermia and acidosis 6) Exclude other sources of shock 7) Monitor circulation (HR, BP, JVP, peripheral perfusion, basal lung crackles and urine output) See eTG Emergency, Major Trauma for details. |
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A patient requires more than 5U of red cells. What management principles?
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Implement principals for massive transfusion:
1) Prevent dilutional coagulopathy: Platelets, FFP, +/- cryoprecipitate 2) Close monitoring of coags including fibrinogen 3) Give cryoprecipitate if fibrinogen is low 4) For every 5U of blood repeat non-redcell components 5) For 1L of packed red cells, give 3L crystalloid 6) Consult haemotologist re. use of recombinant Factor VIIa |
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Indications for mechanical ventilation
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significant impedance to ventilation by the flail segment,
large pulmonary contusion, an uncooperative patient (e.g., owing to head injury), general anesthesia for another indication, more than five ribs fractured, the development of respiratory failure |
