End of Life Care – draft

Last Updated on January 24, 2022 by frcemuserclinical signs that death might be imminent, particularly if there is: Refractory / progressive bradycardia Mandibular movement with respiration Deeply mottled skin / cyanosed peripheries Noisy pharyngeal respiratory secretions (aka the “death rattle”) The Jigsaw The Patient and Their Family- In the centre […]

Myasthenia Gravis

Last Updated on January 28, 2022 by frcemuser Autoantibodies are formed which bind to acetylcholine receptors on skeletal muscle. Anti-acetylcholine antibodies impair transmission at the neuromuscular junction Symptoms and sings: ptosis, diplopia, dysarthria (speech disorder), dysphagia (difficulty swallowing), facial paresis, proximal limb weakness, and shortness of breath Management Acetylcholinesterase inhibitors […]

Guillain-Barré syndrome (GBS)

Last Updated on January 23, 2022 by frcemuser It is an autoimmune response to infections (often Campylobacter infection – around 50% of viral) characterised by ascending paralysis, starting with tingling and numbness of the fingers and toes, with decreased or absent reflexes Diagnosis is largely clinical, however, lumbar puncture can […]

Implantable cardioverter defibrillator (ICD) failure

Last Updated on January 23, 2022 by frcemuserMANAGEMENT If the patient is in cardiac arrest Perform basic life support in accordance with current BLS/ALS guidelines Avoid placing the defibrillator electrode over or within 5cm of the ICD generator site If a shockable rhythm is present (VF or pulseless VT), but […]

Aortic Dissection

Last Updated on January 23, 2022 by frcemuserRisk factors hypertension smoking pre-existing aortic diseases or aortic valve disease, family history of aortic diseases intravenous drugs (eg, cocaine and amfetamines) Inherited risks include Marfan’s syndrome, Ehlers-Danlos syndrome Classification The Stanford Classification in common use classifies the dissections into type A and […]

NSTEMI/UA – Management

Last Updated on January 23, 2022 by frcemuserTreatment NSTEMI/UA Initial Drug Treatment Antiplatelet: Offer a 300-mg loading dose of aspirin unless contraindicated Antithrombin: Offer fondaparinux unless high bleeding risk or immediate angiography . unfractionated heparin , if PCI Within 24 hours ,significant bleeding risk , significant renal impairment (265 micromoles/litre) […]

STEMI – Management

Last Updated on January 23, 2022 by frcemuserSTEMI: Treatment Oxygen ( only of sat less than 94%, 88% for COPD), sublingual GTN, opiate analgesia Antiplatelet therapy Offer as soon as possible – Aspirin 300mg PO, unless there is a contraindication to it Do not offer routine GPIs or fibrinolytic drugs […]

Acute heart failure – Treatment

Last Updated on January 23, 2022 by frcemuserPharmacological treatment intravenous diuretic therapy – either a bolus or infusion strategy. For people already taking a diuretic, consider a higher dose of diuretic than that on which the person was admitted unless there are serious concerns with patient adherence to diuretic therapy […]

Peri-arrest arrhythmias – Tachycardias – Unstable

Last Updated on January 19, 2022 by frcemuser Features unstable patient shock – appreciated as hypotension (e.g. systolic blood pressure < 90 mmHg) syncope severe heart failure – manifested by pulmonary oedema (failure of the left ventricle) and/or raised jugular venous pressure (failure of the right ventricle) myocardial ischaemia – […]

Cardiac arrest- ALS- 2021

Last Updated on January 23, 2022 by frcemuser start CPR immediately, and defibrillate rapidly (<3 minutes) when appropriate. Place pads – Antero-lateral (lateral – Mid-axillary line) pad position. In patients with an implantable device Place the pad > 8 cm away from the device, or use an alternative pad position […]