What bedside tests are done in a confusion screen in elderly
- urine dipstick
- ECG
What blood tests are done in a confusion screen in elderly
- TFTs (hypothyroidism)
- LFTs (liver failure, alcoholism)
- B12, folate
- FBC
- BM
- U n Es (hyponatremia)
- INR (check bleed risk if on warfarin)
- Calcium (hypercalcaemia)
- Digoxin toxicity
What imaging should be done in a confusion screen in elderly
- CXR
- AXR (constipation, bowel obstruction)
- CT head
Target INRs for normal patients pre-surgery
less than 1.4
Target INRs for people with mechanical heart valves
3-4
Common complications from major surgery
- DVT, PE
- Urinary retention due to anaesthetic
- Shock, wound infection, internal bleeding
- Lung complications (due to lack of deep breathing within 48h of surgery)
In which groups of people is measuring eGFR inaccurate?
What should be used to assess kidney function instead?
Inaccurate in frail/ obese people (because eGFR is based off average body weight)
Should look at PLASMA CREATININE instead.
General history questions to ask if you suspect infection
- fever
- weight loss
- change in urinary habits
- palpitations
6 geriatric giants in older patients
- Immobility
- Instability
- Incontinence
- Intellectual impairment
- Iatrogenic eg poly pharmacy
- Pressure sores
Describe grade 1 pressure sores
- Intact skin with non-blanchable erythema
- localised area
- usually over a bony prominence
Describe grade 2 pressure sores
- Partial thickness skn loss
- involves epidermis/ dermis
- May present as intact/ open blister
Describe grade 3 pressure sores
- Full thickness skin loss
- Damage/ necrosis of subcutaneous tissues
- Extends to, but not through underlying fascia, bone, tendon, joint capsule
Describe grade 4 pressure sores
- Full thickness skin loss
- Extensive destruction/ tissue necrosis/ damage to muscle, bone, tendon, joint capsule
- Slough may be present
4 types of urinary incontinence
- stress
- urge
- overflow
- total
What is d-dimer used for, and when is it not as reliable?
To check for presence of PE/DVT
Would also be raised in sepsis so not so reliable.
How much should a breakthrough dose of morphine be
1/6 of total daily morphine dose within 24h
Common side effects of morphine
Myoclonic jerks
Dry mouth
Rash
What lab test to check if patient on statins complains of muscle pain
Creatinine kinase (product of muscle breakdown)
What class of drugs should never be given with ACE inhibitors?
NSAIDs.
Combination is very nephrotoxic.
Symptoms of a dying person
" Get sleepier and sleepier " Breathing slows down: Cheyne-Stokes pattern " Profound weakness " Gaunt appearance " Disorientation (possibly) " Diminished oral intake " Difficulty concentrating " Struggling with oral medication " Weaker pulses, low BP " Audible respiratory secretions " Skin gets colder from periphery inwards " Eventually all signs of cardiorespiratory function cease and the corneal reflex is lost
Clopidogrel and warfarin are not usually given in combination.
In which group of patients is this an exception?
Patients who have had a stent
4 features of metabolic syndrome
- Obesity
- High cholesterol
- Hypertension
- Diabetes mellitus
Normal target INR range
2-3
4 drugs given to palliative patients
- Anti-emetic
- Analgesia eg morphine
- Mood stabiliser eg midazolam
- Anti-secretion eg hyoscine
