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Year 4 > A&E > Flashcards

A&E Flashcards

1
Q

Causes/types of burns

A

Thermal (cold and heat)
Radiation
Electrical
Chemical

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2
Q

Categories of burns (and describe each)

A

Superficial - painful, no blisters
Partial
-> Superficial - painful, blisters
-> Deep - less painful than superficial but still painful, more red, wet
Full thickness - insensate, waxy/white, dry

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3
Q

Immediate burn management

A 
Remove near clothing/jewellery
Irrigate running fluid 10 minutes
Analgesia
A-E assessment
(look for red flags e.g. singed nasal hairs, circumferential, loss of GCS)
IV access, bloods, fluids
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4
Q

How is the volume of fluid needed to replace burns loss calculated?

A

Parklands formula (guides volume of fluid to be given in 24hrs, the first half volume given in 8hrs)

= %BSA x weight (kg) x 4

%BSA calculated using

  • rule of 9’s
  • palmar area (pts own hand = 1% BSA)
  • lund and browder chart
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5
Q

When/what type of burns should be referred to specialist centres?

A

Circumferential, pregnant, on ears/face/perineum/genitals

If >15% BSA in adults or >10% children

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6
Q

Describe A-E assessment components

A 
C (C-spine and catastrophic bleeding)
Airway
Breathing
Circulation
Disability
Everything else/expose
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7
Q

What are the main sources of haemorrhage in trauma?

A

‘On the floor + 4 more’: (clap)

  • Floor
  • Chest
  • Long bones
  • Abdomen
  • Pelvis
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8
Q

What are the components of AMT4

A

Age
DoB
Place (name of hospital)
Current year

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9
Q

What is the definition of shock and describe 4 types

A

Failure of the circulatory system and a drop in BP
Types:
- hypovolaemic (loss of circulating volume)
- obstructive (tension pneumothorax, cardiac tamponade -> both reduce preload and CO)
-> neurogenic shock (rare, due to sympathetic nerve damage and unopposed PNS drive)
-> cardiogenic (rare, due to myocardial contusions and failure of heart to function normally)

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10
Q

List causes of a reduced conscious level

A 
COMA!
CO2/CO excess
Overdose
Metabolic (BM, K...)
Apoplexy (brain tissue damage e.g. stroke, SAH, abscess)
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11
Q

What is the minimum urine output to monitor patients with catheters?

A

0.5ml/kg/hr (= 30ml/hr)

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12
Q

What are third space fluid losses and name some causes

A

When fluid moves from the intravascular space into the interstitial non-functioning spaces (3rd spaces)
Occurs in bowel obstruction, and in peritonitis

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13
Q

Describe and give examples of crystalloids

A

1) Normal 0.9% saline
2) Hartmann’s (most physiological, contains HCO3 and lactate)
3) Dextrose = 5% glucose, used for maintenance NOT resus as rapidly equibrilates through all body compartments equaly
4) Ringer’s lactate (similar to Hartmann’s)

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14
Q

Describe and give examples of colloids

A

1) Natural -> albumin and blood

2) Synthetic -> gelofusion

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15
Q

Describe the maintenance daily quantities of water, sodium, potassium, chloride and glucose for a patient who does not have any more than insensible losses

A 
Water = 30ml/kg/day
Na/K/Cl = 1mmol/kg/day
Glucose = 50-100g/day
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16
Q

What is the most common transfusion ratio of

  • packed red cells
  • FFP
  • platelets
A

4:2:1

Packed red cells = O2
FFP = all protein and clotting factors
Platelets = platelets

17
Q

What is tranexamic acid, how does it work?

A

Useful in trauma
Anti-fibrinolytic
Binds to lysine binding sites on plasminogen to stop it being converted into plasmin, and without plasmin it means that fibrin clot cannot be broken down, therefore helps to stop bleeding

18
Q

What ED investigations may you want to carry out in a falls patient?

A
  • ECG
  • BM
  • BP (lying and standing)

also:

  • CK if long lie
  • CT head
  • troponin
  • urinalysis and CXR if sepsis?
  • full bloods
19
Q

List 5 causes of a raised JVP

A

PQRST!

  • pulmonary HTN, PE, pericardial effusion, pulmonary stenosis
  • quantity (fluid overload)
  • R-HF
  • SVC obstruction
  • Tamponade (cardiac)/TR
20
Q

What is the significance of a sustained rise in JVP following the hepatojugular reflex?

A
  • R sided HF
21
Q

What is Corrigan’s sign?

A

Visible carotid pulsation (AR)

22
Q

What is de Musset’s sign?

A

Head bobbing in time with pulse (AR)

23
Q

What is the antedote for paracetamol overdose?

A

NAC

24
Q

What is the antedote for CO overdose?

A

High flow oxygen/hyperbaric O2 therapy

25
Q

How would a B-blocker overdose present? And what is the antedote?

A

Present with bradycardia, hypotension, heart failure and syncope

Treat with atropine (if bradycardic) or possibly glucagon

26
Q

How would a salicylate overdose present? And what is the antedote?

A

Initially hyperventilation and respiratory alkalosis, sweating, N&V, then later a metabolic acidosis (as the affects of the acid take place)

Treatment:

  • general (ABC, charcoal)
  • urinary alkalinization with intravenous sodium bicarbonate -> enhances elimination of aspirin in the urine
  • haemodialysis
27
Q

How would a TCA overdose present and what is the antedote?

A

Just think - TCA’s have HAM side effects

  • anti-histamine e.g. sedative
  • anti-adrenergic e.g. postural hypotension, dilated pupils, blurred vision
  • anti-muscarinic e.g. dry mouth, dry, urinary retention, tachycardia

On ECG = sinus tachy, wide QRS, prolonged QTc

Treatment: IV sodium bicarbonate

28
Q

What is the treatment for opioid overdose?

A

Naloxone

29
Q

How would a ca+ channel blocker overdose prevent and what is the antedote?

A

Presents with CV depression: bradycardia, heart block, hypotension

Treatment - calcium gluconate!

30
Q

List differentials for LOC

A

PASS-OUT

  • pressure (hypotension, postural or vasovagal)
  • arrhythmia
  • seizure
  • sugar (low)
  • output reduced (cardiac e.g. HF, tamponade, resp e.g. PE, CO poisoning)
  • Unusual e.g. panic attack, hyperventilation
  • Transient e.g. stroke/TIA
31
Q

Describe the treatment of anaphylaxis

A 
A-E (with 15L O2)
IM adrenaline (0.5ml of 1:1000) -> repeat every 5 mins
Fluids
IV chloramphenamine (10mg)
IV hydrocortisone (200mg)

Year 4 (28 decks)

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