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Flashcards in Acute Care Deck (160)
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1

What are the causes of airway obstruction

central nervous system depression
swelling - infection or anaphylaxis
foreign body
bronchospasm

2

What can cause central nervous system depression

head injury
intracerebral bleed
hypercapnia
hypoglycaemia
alcohol
opioids
general anaesthetic

3

What can cause respiratory arrest

decreased respiratory drive (due to CNS depression)
decreased resp effort
lung disorders

4

What is the treatment for ACS

IV morphine + antiemetic
15L oxygen via non-rebreathe mask if sats <94%
sublingual glyceryl nitrate (unless hypotensive)
Aspirin 300mg crushed/chewed

5

How is A assessed

speak to patient
listen to breathing sounds
look at breathing pattern

6

How is airway obstruction treated

15L oxygen via non-rebreathe mask
airway manoeuvres
suction
Guedel/nasopharyngeal

7

How is B assessed

resp rate
o2 sats
pattern of breathing
chest deformity
trachea
chest expansion
percussion
breath sounds - ?rattle, wheeze, stridor
auscultate

8

How is C assessed

hands - ?cool, warm, pale, pink, mottled
CRT
peripheral and central pulses
HR
BP - wide PP = arterial vasodilation, narrow PP = arterial vasoconstriction
auscultate
ECG

9

How is D assessed

AVPU
check drug chart for drugs that cause reduced consciousness
pupils
blood glucose

10

Which cardiac arrest rhythms are shockable?

VF
pulseless VT

11

Which cardiac arrest rhythms are non-shockable?

asystole
PEA

12

describe the treatment of shockable cardiac arrest

CPR
secure airway
break CPR every 2 mins to assess rhythm
give shock 150J first
repeat
after third shock give 300mg amiodarone IV and adrenaline 1mg IV
continue CPR and checks every 2mins
repeat 1mg adrenaline IV at alternate shocks
can give 150mg amiodarone IV after five shocks

13

describe the treatment of non-shockable cardiac arrest

CPR
adrenaline 1mg IV STAT
check rhythm every 2 mins
give 1mg adrenaline IV every other cycle

14

State the reversible causes of cardiac arrest

Hypoxia
Hyperkalaemia, hypokalaemia, hypoglycaemia
Hypovolaemia
Hypothermia

Thrombosis - MI/PE
Tension pneumothorax
Tamponade
Toxins

15

State the steps in management of bradycardia

if signs of adverse features, give atropine 500mcg IV
if unsuccessful, arrange senior help and transvenous pacing

if no adverse features, assess for risk of asystole

if risk of asystole, ger senior help and arrange transvenous pacing

16

What are the adverse features in tachy/bradycardia

shock
heart failure
syncope
MI

17

What are the steps in management of broad complex tachycardia

are there adverse features present?

no
- correct electrolyte abnormalities
- if most likely monomorphic VT give amiodarone 300mg IV over 20 mins
- if polymorphic VT give 2g magnesium sulfate IV over 10mins

yes - call for senior help, sedate and cardiovert. give 300mg amiodarone IV over 20 mins
900mg amiodarone IV via central line over 24h

18

What is the difference between monomorphic and polymorphic VT

mono - caused by structural abnormalities. not likely to convert into VF

poly - caused by electrolyte abnormalities, likely to convert into VF

19

What are the steps in management of narrow complex tachycardia

vagal maneouvres
IV adenosine 6mg, 12mg, 12mg

adverse features?

yes
- sedation and cardioversion
- amiodarone 300mg IV over 20 mins then 900mg amiodarone IV via central line over 24h

no - beta blocker eg. IV metoprolol, amiodarone 300mg IV over 1h or digoxin

20

How is GCS calculated?

Eye Opening
Spontaneous 4
To sound 3
To pressure 2
None 1

Verbal Response
Orientated 5
Confused 4
Words 3
Sounds 2
None 1

Motor Response
Obeys commands 6
Localise to pain 5
Withdraws from pain 4
Flexor response 3 (decorticate)
Extensor response 2 (decerebrate)
None 1

21

What are the common causes of reduced GCS

metabolic:
drugs
sepsis
hypoglycaemia/hyperglycaemia
respiratory acidosis
hypoxia
hypothermia
addisonian crisis
hepatic or uraemic encephalopathy

neurological:
trauma
meningitis/encephalitis
tumour
stroke,
SAH
epilepsy

22

What are the key signs and symptoms of anaphylaxis

Onset within minutes
Airway and breathing
Dyspnoea, respiratory distress, wheeze, stridor
Cyanosis
Circulation
Tachycardia, hypotension
Skin
Urticaria, angioedema

23

Describe the pathophysiology of anaphylaxis

Sensitisation phase:
Immune system encounters allergen and makes immunoglobulin E (IgE) against it
No clinical features occur

Effector phase:
Allergen cross-links IgE on surface of mast cells
widespread degranulation and release of histamine
mediates inflammatory bronchospasm, vasodilatation, increased capillary permeability, and tissue oedema

24

What dose of adrenaline do you give to an adult in anaphylaxis

0.5mg (0.5 ml of 1:1,000) IM

25

What dose of adrenaline do you give to a child 6-12 years in anaphylaxis

300 micrograms (0.3 ml of 1:1,000) IM

26

What dose of adrenaline do you give to a child aged 5 and under in anaphylaxis

150 micrograms (0.15 ml of 1:1,000) IM

27

What drugs apart from adrenaline do you give in anaphylaxis

chlorphenamine 10mg IV
hydrocortisone 200mg IV

can give salbutamol 5mg neb and ipatropium bromide 0.5mg neb if wheeze

28

What blood test can help in the retrospective diagnosis of anaphylaxis

Mast cell tryptase
Take three samples taken as soon as possible, after 1-2 hours and after 24 hours
Useful in making a retrospective diagnosis but the absence of a rise does not exclude anaphylaxis

29

What are the steps in management of anaphylaxis

SENIOR HELP
secure airway
15L oxygen non rebreate mask
adrenaline 0.5mg (0.5ml 1:1000) IM
IV access - 2x wide bore cannulae
500ml 0.9% sodium chloride over 15mins
10mg chlorphenamine and 200mg hydrocortisone IV
nebs if wheeze
referral suing SBAR
admit

30

What is the ongoing management for a patient after anaphylaxis

medicalert bracelet
epipen x2