Phase 3B > ACC > Flashcards

ACC Flashcards

(60 cards)

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1
Q

What equipment may be required when preparing for the arrival of a seizing patient?

A 
Airway adjuncts (nasopharyngeal and oropharyngeal airways)
ET tubes
Suction
Oxygen
Cannula bloods and fluid
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2
Q

What is the initial medical treatment of the seizing patient?

A

Buccal midazolam at home
PR 10mg diazepam
IV lorazepam

Maximum of two doses, including pre-hospital treatment

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3
Q

What is the second line treatment of status epilepticus if benzodiazepines fail to control cease seizures?

A

IV phenytoin bolus

Could also use Keppra (levotiracetam)

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4
Q

What should be checked before administering phenytoin?

A

Check the patient is not in respiratory depression

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5
Q

If phenytoin does not work, what is the next step in management?

A

Call anaesthetist for rapid sequence induction with sodium thiopentol

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6
Q

Give five causes of status epilepticus.

A 
Hypoglycaemia
Meningitis
SAH and brain injury
Eclampsia
Alcohol/drug withdrawal/overdose
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7
Q

What are some complications of status epilepticus?

A 
Aspiration
Hypoxia and brain damage
Death from airway occlusion
Rhabdomyolysis
Metabolic lactic acidosis
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8
Q

What are features of early alcohol withdrawal?

A

Shakiness
Insomnia
Nausea
Tachycardia

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9
Q

What is delirium tremens and how is it treated?

A

Acute confusional state, tremor, and vivid/disturbing abnormal perceptions secondary to alcohol withdrawal

Chlordiazepoxide

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10
Q

How can you assess alcohol dependence?

A

AUDIT

CAGE

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11
Q

What are five non-ACS causes of chest pain?

A 
Pericarditis
Aortic dissection
Oesophageal spasm
Pulmonary embolism
Costochondritis
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12
Q

Which troponin is more specific?

A

Troponin I > C

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13
Q

When do troponins peak after myocardial infarction?

A

12-24 hours

Therefore tested 6-12 hours after pain

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14
Q

What is the diagnostic criteria for MI?

A

2/3 of:

Consistent history
Raised enzymes
Abnormal ECG

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15
Q

What other investigations are required in MI?

A

CXR and/or echo
Angiogram
Myoview

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16
Q

How can you tell the difference between anterior ischaemia and posterior infarction (ST depression in anterior leads)?

A

Do posterior leads

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17
Q

What is the subsequent management of an ACS patient?

A

PCI within 90 minutes of diagnosis, if unavailable IV alteplase with heparin

Glycoprotein IIb/IIIa inhibitor (abciximab, tirofiban, eptifibatide)

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18
Q

What is the most important test to do for the unconscious patient?

A

Blood glucose

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19
Q

Which methods can be used for applying painful stimuli?

A

Sternal rub
Supraorbital pressure
Trapezius squeeze

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20
Q

What are 6 causes of decreased consciousness?

A 
Hypoglycaemia
Sepsis
Addisonian crisis
Meningitis
Cardiovascular syncope (tamponade, arrhythmias)
PE
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21
Q

What is the treatment of an opiate overdose?

A

IV naloxone 0.4-2mg adult

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22
Q

What is found on examination in opiate overdose?

A

Pinpoint pupils
Decreased respiratory rate
Hypotension
Tachycardia

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23
Q

What does blood in the external auditory canal suggest and what measures should be taken?

A

Fracture of base of the skull

Stabilise C-spine and CT scan

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24
Q

What is the ATMIST mnemonic for trauma?

A 
Age
Timing (incident and arrival)
Mechanism
Injuries
Signs
Treatment
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25
Which team members are in the trauma team?
Anaesthetist Radiologist General surgery Trauma and orthopaedics
26
What additional equipment is required in a trauma call?
Pelvic binder, collar and block, trauma mattress
27
What is a good indicator of blood volume and whether the pelvic fractures are stable or not?
Blood pressure
28
What causes tachycardia in traumas?
``` Shock Collapsed lung Bleeding from fractures Pain Anxiety ```
29
What is a FAST scan?
Looks for free fluid around abdominal organs and cardiac tamponade
30
What is the pathophysiology of a tension pneumothorax?
Injury to lung, inhalation causes indrawing to lungs. On exhalation, the injury (valve) closes so air cannot escape.
31
How does a tension pneumothorax cause cardiac arrest?
Pressure on the mediastinum and vena cava reduces cardiac output and preload resulting in hypotension and tachycardia
32
What are signs of tension pneumothorax?
Reduced breath sounds, tracheal deviation, apex beat deviation, resp distress, cyanosis
33
What is the treatment of tension pneumothorax?
Needle decompression large bore cannula 2nd IC space, mid clavicular line, above the rib to avoid neurovascular bundle Followed by chest drain in 5th IC space mid clavicular line
34
What is ARDS?
Non-cardiogenic pulmonary oedema leads to respiratory failure
35
What are the signs of ARDS?
Cyanosis Bilateral fine inspiratory crackles Peripheral vasodilation
36
What is the treatment of ARDS?
CPAP, unless mechanical ventilation is required
37
What is permissive hypotensive resuscitation?
Intentional lowering of blood pressure during fluid resuscitation until definitive surgical control of bleeding occurs
38
What is contained in a massive transfusion pack?
Platelets, FFP, clotting factors
39
What type of hypersensitivity reaction is anaphylaxis?
Type 1 Rapid release of stored histamine
40
Give five symptoms of anaphylaxis from different body systems.
``` Hypotension Bronchospasm (wheeze) Laryngeal oedema (stridor) Vomiting Urticarial rash ```
41
What is the treatment of an acute allergic reaction?
PO/IV chlorphenamine Fluids Oxygen
42
What is the treatment of anaphylaxis?
IM adrenaline 500mcg Hydrocortisone IV or PO Prednisolone Can be repeated after 5 minutes IV adrenaline after two attempts
43
How long does it take for paracetamol to reach plasma concentration after ingestion?
One hour
44
When does hepatic toxicity of paracetamol overdose occur?
24-72h
45
What is the pathophysiology of paracetamol overdose?
Metabolism of paracetamol results in toxic metabolite NAPQI. NAPQI is inactivated by glutathione. When glutathione stores are depleted to <30%, NAPQI leads to necrosis of the liver and kidney tubules
46
When is blood taken in paracetamol overdose?
4 hours post overdose - indicates whether liver damage will occur
47
Which patients are at higher risk of liver damage?
Malnutrition HIV positive Alcohol or other liver disease
48
Which patients should receive N-acetyl cysteine?
Timed plasma paracetamol level plotted above the graph Any doubt about timing of ingestion or a staggered overdose
49
What is NAC?
Glutathione analogue
50
Name three side effects of a spinal anaesthetic.
Hypotension Low pressure headache (better when lay down) High spinal block (limb/respiratory weakness)
51
Which airway adjunct reduces the risk of aspiration of stomach contents into the lungs?
Tracheal tube
52
For a short operation in a diabetic patient, what should be done about their medications?
Omit sulfonylureas Continue metformin Usually depends on their blood glucose whether they will need a sliding scale
53
What are the indications for a sliding scale in surgery for diabetics? What are the fluids of choice for the insulin infusion?
On insulin BM>12mmol/L <14 run in 10% dextrose; BM>14 run in saline
54
What is a risk of emergency surgery from an anaesthetic point of view?
Increased aspiration risk
55
In DKA, what rate of insulin is required after fluid resuscitation?
Fixed rate, as background level of insulin is required to suppress ketosis 0.1IU/kg/hr
56
Which coagulation pathways are represented by PT and APTT?
PT: extrinsic --> warfarin APTT: intrinsic --> heparins and NOACs
57
What are five differentials for hypoglycaemia?
``` Addison's disease Undiagnosed T1DM Paracetamol overdose Alcohol consumption Pituitary failure Insulinoma ```
58
What are the normal agents for rapid sequence induction (non fitting patient)?
Suxamethonium/rocuronium With propofol
59
What is the treatment of DIC?
Cryoprecipitate
60
What are the indications for dialysis?
``` Acidosis Electrolytes e.g. hyperkalaemia Intoxication Overload Uraemia ```
Phase 3B
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