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Medicine > A & E > Flashcards

A & E Flashcards

1
Q

State 3 blood tests that can be taken in paracetamol overdose?

A

INR
Paracetamol/Salicylate levels
Liver enzymes (AST/ALT)
Billirubin

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2
Q

Give 3 ways paracetamol overdose can be managed?

A

Activated charcoal <8hr from ingestion
IV Acetylcysteine anytime
Liver transplant in late presentation

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3
Q

What are the characteristic ECG changes in hyperkalaemia?

A

Small P waves
Tented T waves
Widened QRS complex
VF

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4
Q

Give 5 causes of hyperkalaemia?

A

Intake: supplements, massive blood transfusion
Release: haemolysis, trauma
Shift from cells: insulin deficiency, metabolic acidosis
Reduced excretion: Renal failure
Medications: K+ sparing diuretics

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5
Q

State 4 steps in the management of hyperkalaemia?

A 
Calcium gluconate
Calcium resonium
Insulin + glucose
Nebulized salbutamol
?Dialysis
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6
Q

Give 7 differentials for chest pain?

A

Cardiac: myocardial infarction, angina, pericarditis, aortic dissection

Respiratory: PE, pneumothorax, pneumonia

Musculoskeletal: costochondritis, muscle strain

Gastrointestinal: oesophagitis, GORD, cholecystitis, pancreatitis,

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7
Q

Give 3 modifiable and non modifiable risk factors for acute coronary syndrome?

A

Non- modifiable:
Age
Gender (high incidence in males)
Family history of IHD

Modifiable: 
Smoking
Hypertension
Hyperlipidaemia
Diabetes mellitus
Obesity
Sedentary (lazy) lifestyle.
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8
Q

Name the 4 cardiac enzymes that can be measured in MI?

A

Creatine kinase
AST
LDH
Cardiac Troponin I & T

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9
Q

State 8 management steps involved in MI

A 
High flow O2
Aspirin (300mg)
Morphin (5-10mg IV) with Metoclopramide
GTN spray
B-Blocker
Thrombolysis if indicated (PCI or fibrinolytics)
Canulas: FBC, U&E, Lipids, Glucose, Cardiac enzymes
Attach ECG
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10
Q

Give 3 indications of thrombolysis in MI?

A

ST elevation
New onset left bundle branch block
Posterior MI

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11
Q

Give 2 examples of fibrinolytics used in thrombolysis?

A

Streptokinase (once only use)
Alteplase (with heparin)
Rereplase

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12
Q

State 4 medication types used in the long term management of MI?

A 
AABS
Aspirin/Clopidogrel
ACEi
B-Blocker
Statin
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13
Q

Give 6 risk factors for developing Pulmonary Embolism?

A

Immobility:
Recent surgery
Long haul travel
Prolonged bed rest

Increased coagulability:
Pregnancy
Thrombophilia
COCP use

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14
Q

Name 4 investigations you can do in Pulmonary Embolism?

A 
D-dimers
CXR
CTPA
VQ scan
Leg USS
ECG
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15
Q

How can you manage a Pulmonary Embolism?

A

Oxygen and analgesia
LMWH (dalteparin)
Oral warfarin

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16
Q

How do you manage a pneumothorax?

A

Primary
No symptoms and 2cm air rim = aspirate
If aspirate fails = chest drain

Secondary
Aspirate always
>2cm, SOB or >55y/o = Chest drain

Possible surgical (pleurodesis)

17
Q

Where do you aspirate or insert a chest drain?

A

Aspirate = 2nd intercostal space mid-clavicular

Chest drain = 4th - 6th intercostal space mid-axillary

18
Q

How can you manage severe pulmonary oedema?

A 
OMFG
Hight flow oxygen
Morphine
Furosemide
GTN spray/Nitrates
19
Q

Give 6 steps in your immediate management of asthma attack?

A 
Oxygen sat up with non rebreathe mask
Nebulised salbutamol (5mg) & ipratropium bromide
IV hydrocortisone (100mg)
CXR (exclude pneumothorax)
Monitor: Sats, ABGs, PEFR

If no improvement then:
Continue above steps
Magnesium sulphate
ITU involvement

20
Q

What is the immediate management of DKA? Not ABCDE

A 
Oxygen therapy
IV fluids immediately
Insulin (sliding scale)
Potassium infusion
Nuttrition (NGT)
21
Q

What is the immediate management of an addisonian crisis? 4 things

A

Hydrocortisone sodium succinate (100mg, IV stat) if Addisonian crisis is suspected.

IV fluids: plasma expander i.e. colloid (gelofusin) first followed by 0.9%saline

Give antibiotics e.g. cefuroxime

Monitoring: blood glucose since the danger is hypoglycaemia.

22
Q

Give 5 steps in the management of acute COPD?

A

Controlled oxygen therapy (starting with 24%)
Nebulized salbutamol & ipratropium
Steroids (IV hydrocortisone & oral predinasolone)
Abx. if evidence of infection
Physiotherapy (sputum expectoration)

If no response:
IV aminophylline
Nasal intermittent positive pressure ventilation
Intubation
Respiratory stimulant
23
Q

Give 8 reversible causes of cardiac arrest

A 
4Hs
Hypoxia
Hypovolaemia
Hypothermia
Hyperkalaemia
4Ts
Tamponade
Thromboembolism
Tension pneumothorax
Toxic metabolites
24
Q

What medication will you give in anaphylaxis?

A

0.5mg IM (0.5mL 1 in 1000 Adrenaline)

25
Q

In VF/Pulseless VT, what is management steps you will take?

A 
Chest compressions with bag and mask
Shock until sinus rhythm
After 3rd shock add:
IV Adrenaline (1mg 1 in 10,000)
IV Amiodarone (300mg)

Then Adrenaline every 3-5mins

26
Q

Which rhythms are non shockable?

A

PEA and Asystole

Medicine (17 decks)

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