Good morning and welcome to your Friday dose of Your Daily Meds.
Bonus Review: How is H+ produced in the stomach and secreted into the gastric lumen?
Answer: So CO2 reacts with water under the influence of carbonic anhydrase. This produces the H+, which is then actively transported into the gastric lumen by H+K+-ATPase. The HCO3- in the reaction passes across the basolateral membrane in exchange for Cl- via an antiport.
Question:
With regard to episodes of delirium, which of the following is not a feature of extrinsic and environmental management?
* Well-lit room or patient cubicle
* Remove seeing glasses to reduce risk of injury
* Room or patient cubicle near nursing station
* Family member present
* Frequent orientation with calendars and clocks
Have a think.
Scroll for the chat.
Quick Investigation:
Consider the following ECG:
What is the correct rate, rhythm, axis and interpretation, respectively?
* Ventricular rate 40/min; atrial fibrillation; left axis deviation; rapid ventricular response
* Ventricular rate 60/min; atrial flutter; normal axis; 3:1 block
* Ventricular rate 40/min; sinus rhythm; normal axis; complete heart block
* Ventricular rate 40/min; sinus rhythm; normal axis; left bundle branch block
* Ventricular rate 60/min; atrial fibrillation; right axis deviation; ischaemic changes
Have a think.
Do some counting.
More scroll for more chat.
The Environment:
The principles of extrinsic or environmental management of delirium include:
* Quiet, well-lit rooms or cubicles, near windows to orient to time of day
* Optimise hearing and vision
* Room or cubicle near nursing station for closer observation and increased cares if agitated
* Family members present for reassurance and re-orientation
* Frequent orientation with clocks, calendars and reminders
So removing the patients’ seeing glasses is least likely to be an effective method of environmental, non-pharmacological management of delirium.
It would probably just make them more crazy…
Squiggly Lines:
This ECG shows sinus rhythm with complete heart block and ventricular escape rhythm.
So sinus rhythm because the sinus node is ticking away regularly giving P waves at a rate of approximately 90/min. But complete heart block because there seems to be no relationship between this sinus rhythm and the ventricular rhythm. So the ventricles will tick along at their own rate (the escape rhythm - which is slower than that of the atrial pacemakers).
Note: there are three characteristics of complete heart block. These are A-V dissociation, atrial rate > ventricular rate, and a regular ventricular rate.
The ventricular rate is approximately 40/min with sinus rhythm - yep. The QRS complexes are wide with left bundle branch block (LBBB) morphology - wide because the depolarisation is coming from the slow lumbering ventricles, not the snappy quick atria. The axis is normal. And there is a prolonged QT at 600ms.
So this person probably looked quite sick…
Bonus: What humoral factors stimulate parietal cell gastric acid production?
Answer in Monday’s dose.
Closing:
Thank you for taking your Meds and we will see you Monday for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!
Luke.
Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks.
Just credit us where credit is due.
