A & E Flashcards
State 3 blood tests that can be taken in paracetamol overdose?
INR
Paracetamol/Salicylate levels
Liver enzymes (AST/ALT)
Billirubin
Give 3 ways paracetamol overdose can be managed?
Activated charcoal <8hr from ingestion
IV Acetylcysteine anytime
Liver transplant in late presentation
What are the characteristic ECG changes in hyperkalaemia?
Small P waves
Tented T waves
Widened QRS complex
VF
Give 5 causes of hyperkalaemia?
Intake: supplements, massive blood transfusion
Release: haemolysis, trauma
Shift from cells: insulin deficiency, metabolic acidosis
Reduced excretion: Renal failure
Medications: K+ sparing diuretics
State 4 steps in the management of hyperkalaemia?
Calcium gluconate Calcium resonium Insulin + glucose Nebulized salbutamol ?Dialysis
Give 7 differentials for chest pain?
Cardiac: myocardial infarction, angina, pericarditis, aortic dissection
Respiratory: PE, pneumothorax, pneumonia
Musculoskeletal: costochondritis, muscle strain
Gastrointestinal: oesophagitis, GORD, cholecystitis, pancreatitis,
Give 3 modifiable and non modifiable risk factors for acute coronary syndrome?
Non- modifiable:
Age
Gender (high incidence in males)
Family history of IHD
Modifiable: Smoking Hypertension Hyperlipidaemia Diabetes mellitus Obesity Sedentary (lazy) lifestyle.
Name the 4 cardiac enzymes that can be measured in MI?
Creatine kinase
AST
LDH
Cardiac Troponin I & T
State 8 management steps involved in MI
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
Give 3 indications of thrombolysis in MI?
ST elevation
New onset left bundle branch block
Posterior MI
Give 2 examples of fibrinolytics used in thrombolysis?
Streptokinase (once only use)
Alteplase (with heparin)
Rereplase
State 4 medication types used in the long term management of MI?
AABS Aspirin/Clopidogrel ACEi B-Blocker Statin
Give 6 risk factors for developing Pulmonary Embolism?
Immobility:
Recent surgery
Long haul travel
Prolonged bed rest
Increased coagulability:
Pregnancy
Thrombophilia
COCP use
Name 4 investigations you can do in Pulmonary Embolism?
D-dimers CXR CTPA VQ scan Leg USS ECG
How can you manage a Pulmonary Embolism?
Oxygen and analgesia
LMWH (dalteparin)
Oral warfarin
How do you manage a pneumothorax?
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)
Where do you aspirate or insert a chest drain?
Aspirate = 2nd intercostal space mid-clavicular
Chest drain = 4th - 6th intercostal space mid-axillary
How can you manage severe pulmonary oedema?
OMFG Hight flow oxygen Morphine Furosemide GTN spray/Nitrates
Give 6 steps in your immediate management of asthma attack?
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
What is the immediate management of DKA? Not ABCDE
Oxygen therapy IV fluids immediately Insulin (sliding scale) Potassium infusion Nuttrition (NGT)
What is the immediate management of an addisonian crisis? 4 things
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.
Give 5 steps in the management of acute COPD?
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
Give 8 reversible causes of cardiac arrest
4Hs Hypoxia Hypovolaemia Hypothermia Hyperkalaemia
4Ts Tamponade Thromboembolism Tension pneumothorax Toxic metabolites
What medication will you give in anaphylaxis?
0.5mg IM (0.5mL 1 in 1000 Adrenaline)
In VF/Pulseless VT, what is management steps you will take?
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
Which rhythms are non shockable?
PEA and Asystole
