A & E Flashcards
What preparations should be made for an admission of a major trauma case?
Inform trauma team
Prepare resuc room
Prepare fluids and O -ve blood
Who forms the trauma team?
Anaesthetist
Surgeons
Orthopaedics
What is a fast scan?
rapid bedside USS assessement
What BP should you aim for in trauma patients?
Aim for 90 systolic (permissive hypotensive resuscitation) - helps blood to clot
When might you not want to follow permissive hypotensive resuscitation and bring the BP up more?
hx HTN/ cardiac disease
hx cerebrovascular disease, carotid artery stenosis, poor renal function
Define shock
Medical emergency in which organs and tissues are not receiving adequate perfusion of blood
What is MAP equation?
Diastolic + (Systolic-diastolic)/3
What is the minimum MAP needed to perfuse your organs?
70
How are CO, BP and SVR linked?
BP= CO X SVR
What sats do you aim for in COPD?
88-92%
What are the criteria for anaphylaxis?
1) Sudden onset, rapid progression of sx
2) Life threatening airway/breathing/circulation problem
3) Skin/mucosal changes
What test can be used post-anaphylaxis to confirm dx?
Tryptase (1-6h post anaphylaxis)
What is the dose of adrenaline for anaphylactic shock?
0.5mg IM
What drugs do you give following adrenaline in anaphylactic shock?
Chlorphenamine IV and hydrocortisone IV
What dose of adrenaline is used in cardiac arrest?
1mg IV (between second and third shock)
What drug is used to tx a patient in VT who is not displaying adverse features?
Amiodarone
What drugs are used to control AF in primary care?
beta blocker
CCB (diltiazem, verapamil)
Which three things make up cushings triad?
1) Altered respirations (decreased)
2) Widening pulse pressure (systolic htn)
3) Bradycardia
What is cushings reflex?
Physiological response to raised ICP
What is first line tx for angina control?
Beta blocker and/or CCB
and aspirin
ECG findings in PE
Tachycardia
RBBB
R axis deviation
S1Q3T3
Tx for hypothermia
Warm fluids/ O2
Bladder/peritoneal lavage
Bear hugger device
What value is a marker of carbon monoxide poisoning?
Carboxyhaemoglobin
Which cardiac enzymes can be measured as markers of ACS?
Troponin T
CKMD
(AST, CK)
What drug can be given IV as part of the major blood loss protocol?
Transexamic acid (if less than 3h from injury)
What are the criteria for PCI in STEMI?
Present within 12h of sx onset
and
PCI available within 2h of first medical contact
What drugs do you give initially in STEMI?
Aspirin 300mg Ticagrelor Morphine GTN spray O2
What score can be used to risk assess pts with NSTEMI?
GRACE score
Mx for severe pulmonary oedema
O2
Diamorphine IV
Furosemide IV
GTN spray (unless BP less than 90)
What is the most common cause of broad complex tachycardia?
VT
What should you do in unstable VT?
DC cardioversion (X3) Then amiodarone followed by more shocks
How do you manage torsades de points if caused by congenital long QT?
Beta blockers
How to tx torsades de pointes caused by acquired long QT?
Stop predisposing drugs
Correct hypokalaemia
Give magnesium sulphate
What can precipitate AF?
Hyperthyroidism
Alcohol
How do you manage SVT?
Vagal manoeuvres
Adenosine
How do you treat a bradycardic pt with adverse signs?
Atropine IV
What factors would make you consider a bradycardic patient at risk of asystole?
Recent asystole
Mobitz II AV block
Complete heart block with broad QRS
How would you treat a bradycardic patient deemed at risk of asystole or is unstable and hasn’t responded to initial atropine?
Repeat atropine
Transcutaneous pacing
Consider adrenaline
Seek expert help to arrange transvenous pacing
Which Ix are essential in asthma?
PEF ABG CXR FBC U&E
What are the markers of severe asthma?
Unable to complete sentences
RR>25
PR>110
PEF 33-50% predicted
What are the markers of life-threatening asthma?
PEF < 33% predicted Silent chest Hypotension Exhaustion Normal/high PaCO2 on ABG
What tx would you initially instigate in severe asthma?
Salbutamol nebs
Ipratropium nebs (Atrovent)
Hydrocortisone IV
What treatment could be considered if asthma is responding poorly to nebs and steroids?
IV MgSO4
IV salbutamol
What are target o2 sats in copd?
88-92%
What is important to do later when starting COPD pts on O2?
ABG within 1 hour
What signs indicate a PTX?
Reduced expansion
Hyperesonance
Decreased breath sounds
Which ix is essential in PTX and when would you not do it?
CXR
Don’t do it if suspect tension PTX as need urgent tx
What ix do you need to do if suspect PCP?
Bronchoalveolar lavage
Outline CURB score?
Confusion Urea > 7 RR >= 30 BP< 90/60 Age>=65
What are you target sats in asthma?
94-98
In a patient displaying signs of meningism, what drug is given alongside abx?
IV dexamethasone
Which virus is most likely to cause encephalitis?
HSV-1
How to manage raised ICP?
1) Raise head of bed 40 degrees
2) If intubated - hyperventilate to decrease pCO2 which decreases ICP
3) Mannitol
4) Consider steroids and fluid restriction
Triad of features px in DKA?
Acidaemia
Hyperglycaemia
Ketonaemia
How should you manage DKA?
1) Fluids - 1L NaCl over 1 hour (bolus if systolic <90)
2) Insulin (0.1U/kg/hr)
3) Check potassium and glucose
What is the risk of overhydration in DKA?
Cerebral oedema
What are the ECG signs of hypokalaemia?
PR prolonged
ST depression
Flattened T wave
Prominent U wave after T
What are the signs of hyperkalaemia on ECG?
Tall tented T waves
Small P waves
Wide QRS
VF
What are the three features of HHS?
Hypovolaemia
Marked hyperglycaemia
High osmolality
How should you treat HHS?
Rehydrate slowly over 48hrs with 0.9% saline
Give prophylactic LMWH
What is the first line tx for thyrotoxic storm?
Beta blockers
What bloods are essential to take in Addisons crisis?
Cortisol
ACTH
U & Es
What is the initial tx for Addisonian crisis?
Hydrocortisone IV stat Fluid bolus (repeat if necessary)
Outline the mx for phaeochromocytoma
1) alpha blocker (e.g. phentolamine)
2) long acting alpha blocker and beta blocker given once BP controlled
Antidote for BDZ poisoning
Flumazenil
Antidote for beta blocker poisoning
Glucagon + glucose or
atropine
How does digoxin posioning px?
yellow-green visual halos
What is antidote for digoxin poisoning?
Digifab
What is antidote for iron poisoning?
Desferrioxamine
How do you determine whether a paracetamol poisoning pt needs referral for liver transplant?
Kings college criteria
What abnormalities on an ABG does aspirin poisoning cause?
Resp alkalosis followed by metabolic acidosis
What chart is used to determine the surface area of burns?
Lund and Bowder
Outline the rule of 9s regarding burns
Arm 9% Front trunk 18% Back trunk 18% Leg 18% Head and neck 9%
What is the threshold for referring a burns victim to a specialist centre?
> 25% partial thickness burns
How do you initially manage a burns patient?
Manage airway IV fluids IV morphine Simple saline gauze Ensure tetanus immunity
What sign on ECG indicates hypothermia?
J wave
In what instance would you warm a hypothermia pt rapidly?
If cardiac arrest/instability
What is the BLS ratio of compressions to breaths in resuscitation?
30:2
What are the reversible causes of cardiac arrest?
Hypoxia, hypovolaemia, hyper/hypokalaemia, hypothermia
Tension PTX, tamponade, toxins, thromboembolism
What is the name for ACS with no ST elevation and no troponin rise?
Unstable angina
Where is the ST elevation in a posterior STEMI?
V7-9
Define NSTEMI
Trop positive ACS without evidence of ST elevation
What ECG changes may be seen in NSTEMI?
ST depression
T wave inversion
What is the most common cause of IE?
S.viridans
What criteria are used to dx IE?
Duke criteria
Which type of aortic dissection requires surgical repair?
Type A (ascending aorta)
What is a life threatening DDx of renal colic?
AAA
What are the comps of pericarditis?
Effusion
Tamponade
Myocarditis
DDx for upper GI bleed
PUD Gastroduodenal erosions Oesophagitis VARICES Mallory-Weiss tear Upper GI malignancy
What score is used to risk stratify patients with an upper GI bleed?
Rockall score
Mx for upper GI bleed
1) Protect airway and keep NBM
2) Insert two large bore cannulae and take bloods
3) Give IV fluids
4) Consider blood transfusion if Hb<7
5) Correct clotting abnormalities (e.g. vit K, FFP, platelets)
6) If varices - TERLIPRESSIN IV and broad spectrum abx
7) Catheterize
8) Notify surgeons for ENDOSCOPY
What drugs do you give if varices bleed?
IV terlipressin and broad spectrum abx
What drug is used as primary prophylaxis of varices in liver disease?
Beta blocker or endoscopic banding
Define status epilepticus
Generalized seizure lasting longer than 5 mins
When should you take troponin levels?
As soon as take bloods and at 6 hours
What is a Thomas splint?
Used to stabilise and prevent bleeding from a femoral fracture
What’s a normal urine output?
1ml/kg/hr (less than 0.5 is concerning)
