ARDS- Definition
- Type 1 respiratory failure
- Non-cardiogenic (i.e. PAWP <16 mm Hg)
- Diagnosis: Berlin criteria
- Lung injury of acute onset, within 1 week of an apparent clinical insult and with progression of respiratory symptoms
- Bilateral opacities on chest imaging not explained by other pulmonary pathology
- Respiratory failure not explained by heart failure or volume overload
- Decreased arterial PaO2/FiO2 ratio:
- Mild ≤ 39.9 kPa
- Moderate < 26.6. kPa
- Severe < 13.3 kPa
- Causes
- Primary pulmonary (SARS, barotrauma)
- SIRS (e.g. Pancreatitis)
PCA prescription- Morphine PCA, IV
- 50 mg in 50 ml 0.9 % NaCl
- 1 mg bolus; 5 minute lockout
- No background
Notes- Marjolin's ulcer
- Aggressive ulcerating SCC presenting in an area of previously traumatized, chronically inflamed, or scarred skin
- e.g. At a long-standing venous ulcer
- Gallbladder polyps
- > 1 cm with / co-occurring gallstones in people over 50 => Risk of development to adenocarcinoma
- CXR in pancreatitis
- ARDS
- Alelectasis (due to pain; risk of pneumonias)
- Perforation (alternative cause of raised amylase / late complication)
- Antibiotics (meropenem, imipenem) are sometimes used in pancreatitis for prophylaxis, but not much evidence base
- Evidence of end-organ dysfunction in SIRS
- Poor or altered cerebral function
- Hypoxemia (PaO2 less than 10 kPa)
- Elevated plasma lactate
- Oliguria (< 0.5 ml/kg body weight.h)
- Hypotension
- Raised bilirubin
- DIC
- Infection + 2 criteria + organ dysfunction = Severe sepsis
- Infection + 2 criteria + lactate >4 or SBP <90 or MAP <70 after 30 ml/kg fluid bolus = Septic shock
- Conditions associated with berry aneurysms (cf 85% of SAHs):
- Adult polycystic kidney disease, Ehlers-Danlos syndrome coarctation of the aorta
- Acute anterior uveitis occurs in as many as 30% of patients at some time during the course of ankylosing spondylitis (esp. with HLA-B27 allele)
- HBeAg: Secreted version of HBcAg; Marker of active replication and infectivity
- Hyperactivity and short stature are associated with Perthes disease
- Low platelet count and raised transaminase level is typical of dengue fever
- Hypercalcaemia, renal failure, high total protein = myeloma
- Conn's syndrome is the likely diagnosis - a renin:aldosterone ratio would be an appropriate first-line investigation
- Bilateral INO
- Young: MS
- Old: Stroke
- Cluster headache prophylaxis: Verapamil
- Osteochondritis dissecans: Pain after exercise, Intermittent swelling and locking
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