A+E Flashcards
Where is a Jefferson #?
C1#
Hangman #?
C2 axis # - hyperextension injures brainstem
which part of the spine is a flexion teardrop #?
What causes this #?
C spine
caused by extreme hyperextension of neck
what type of fracture can be caused by axial loading of the head?
Burst fracture
when to CT head: indications for <1hr
GCS < 13 on initial assessment
· GCS < 15 at 2 hours after injury on assessment in ED
· Suspected open or depressed skull fracture
· Any sign of basal skull fracture
· Post-traumatic seizure
· Focal neurological deficit
· >1 episode of vomiting since the head injury
indications for CT<8hours:
Age > 65 years
· Hx bleeding or clotting disorder
· Dangerous mechanism of injury (RTC or fall > than 1 metre/5 stairs)
· >30mins retrograde amnesia of events immediately before the head injury
what shape bleed in CT of subdural haematoma?
crescentic shape - concave
crosses suture lines
what shape in extradural haemorrhage on CT?
what can these head injuries lead to?
biconvex shape
can cause mass effect and herniation
what haemorrhages are classically walk talk then die head injuries?
extradural
what is air in cranium called?
pneumocephalus
when to CT in trauma? (whole body)
polytrauma:- haemodynamic instability mechanism of injury - >1 body part findings on FAST scan obvious severe injury
anaphylaxis management:
IM adrenaline 500mcg
IV Hydrocortisone 200mg
IV chloramphenamine 10mg
1L Hartmanns
Livedo Reticularis or “mottling” is caused by ?
reduced blood flow and oxygenation to the skin
(normal in kids)
in elderly -> sepsis/DIC
PEA mx?
‘non-shockable’ rhythm – the treatment for this is CPR and adrenaline every 3-5 mins
The Rule of Nines is one of the easiest ways to determine the percentage of skin affected by burns:
palm is 1% of the total body surface area
front of face and neck is 4.5%, the front of the chest is 9% and the whole left arm is 9%.
Burns to his face and neck. Shallow breathing, a RR 45 and is making stridor like noises. Sats 95% on air. On closer inspection he has soot in his mouth and nose. Which two of interventions are appropriate?
senior anaesthetic review with view to early intubation
high flow o2 15L non-rebreath
Indications for referral to a regional burns unit?
> 10% TBSA
burns over major joints
pregnant patient
chemical or electrical burns
emergency first aid advice for burns (eg arm boiling water)?
20 mins under cold water
wrap in cling film after
4yo burn on arm. analgesia?
PO paracetamol, ibuprofen
The burn is described as painful and sensitive to touch. It is erythematous and wet with blistered areas. How would you describe the depth of the burn?
partial thickness
how should burn with blisters be managed after initial first aid?
deroof blisters
dress with non-adherent dressing
review in clinic 48h
Some patients with COPD will retain CO₂. why>
Increased VQ mismatch
The Haldane effect - deoxygenated haemoglobin binds to CO₂ with greater affinity than oxygenated haemoglobin
Active bleeding point visualised on the nasal septum in the right nostril. The bleeding has not stopped despite firm pressure for 15 minutes. Which one is the next appropriate management?
Silver nitrate cauterisation
if silver nitrate hasn’t controlled the epistaxis - what mx next?
rapid rhino into each nostril
24h
At the end of the 21 hour NAC infusion, you must re-check the INR, plasma creatinine, venous pH or plasma bicarbonate and ALT. If all blood results meet the following criteria:
INR is 1.3 or less AND
ALT is less than two times the upper limit of normal AND
ALT is not more than double the admission measurement
TCA OD: antidote?
Na bicarbonate
