SJCT

airway, breathing, circulation compromise and skin changes

airway - not able to talk; collapsed airway - intubation; head tilt and chin lift
breathing - dyspnoea, wheezing, coughing, cyanosis
circulation - tachycardia, hypotension, LOC, collapse
skin changes - urticaria, itching, angiooedema (tongue, eyes, throat, lips), flushing

ABCDE approach; lie patient on their back with legs up if hypotensive, IM Adrenaline 1:1000; 500mcg/0.5mg x2 if first dose doesn't work, given in anterolateral aspect of middle thigh

high flow oxygen, 500-1000mL 0.9% sodium chloride/Hartmann's solution IV, nebulised salbutamol if wheezing, corticosteroids as supportive treatment

NSAIDs due to causing further sodium retention

I SEAL

I - insulin excess
S - sulfonylurea/sepsis
E - exercise, endocrine insuffiency: addison's disease, hypopituitarism, neoplasm, insulinoma
A - alcohol excess
L - liverenail failure

<3mmol/L

conscious - short acting carbohydratelucose tablet and long acting carbohydrate
unconscious - 100mg IV glucagon 10% 10-20 minutes or IM glucagon IM (no IV access; difficulty if there is liver failure, has to pass through the liver) and IVI 5% dextrose and long acting carbohydrate

hypovolemic shock, PE, post-thrombotic syndrome

100-120bpm, 5-6cm depth at 30:2
drugs given:
- shockable rhythm (VF, pulseless VT) - adrenaline 1mg IV/IO and amiodarone 300mg IV/IO after 3rd shock
- unshockable rhythm (PEA, asystole) - adrenaline 1mg IV/IO after each shock

wait 2 minutes before shocking again

always search for reversible causes of cardiac arrest
4Ts - tension pneumothorax, thrombus, cardiac tamponade, toxins
4Hs - hypovolemia, hyper/hypokalemia or other metabolic disturbances, hypovolemia, hypoxia and hypothermia

DKA - 14-33 mmol/L

steroids, missed insulin, infection, stress, dehydration, surgery

blood ketones (urinalysis); only in DKA

yes, but no confusion and rapid recovery

Klebsiella, Pseudonomas, E. Coli

Donning - hand hygiene, mask, visor, apron, gloves
Doffing - gloves, hand hygiene, mask, visor, apron, hand hygiene

ABCDE, analgesia; opioids and UFH followed by revascularisation; bypass/angiography

on the plantar side of the foot, often painless

charcot joint - joint deformity causing warmth, swelling, erythema and pain around the joint
abscess
gangrene - leads to amputation
cellulitis - IV antibiotics
osteomyelitis - x-ray to rule out

group A - LABA
group B - LABA and LAMA
group C - LABA, LAMA +/- ICS

confusion
uremia >7
respiratory rate >30
BP systolic <90, diastolic <60

>65 y/o

hyperchloremic metabolic acidosis due to large amounts of chlorine in this fluid compared to the plasma fluid

IV terlipressin and antibiotic, band ligation (definitive treatment)

UGIB - endoscopy, if unstable first recusitate the patient, then if nothing found, colonoscopy
LGIB - CT angiography if unstable, colonoscopy if stable

CT angiography

anti-mitochondrial antibodies

acute - painful (suprapubic pain)
chronic - painless

senior help, McRobert manouvre (hyperflexed knees), patient on all 4s, if unsuccesful episiotomy and Zanelli manouvre

ABCDE, IV glucose, lactulose, rifamixin

hypotension; dropped BP

shockable rhythms; cpr, adrenaline 1mg and amiodarone 300mg after 3rd shock
unshockable rhythms; adrenaline 1mg every 3 mins and cpr

ABCDE - attach 12 lead ECG
MONA
IV morphine 2.5-5mg
15% oxygen
GTN
300mg LD asprin orally

IV terlipressin and broad spectrum antibiotics

inferior MI, RCA

AVRT, AVNRT