14.03.26 Placement notes

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