A&E Flashcards
Causes/types of burns
Thermal (cold and heat)
Radiation
Electrical
Chemical
Categories of burns (and describe each)
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
Immediate burn management
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
How is the volume of fluid needed to replace burns loss calculated?
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
When/what type of burns should be referred to specialist centres?
Circumferential, pregnant, on ears/face/perineum/genitals
If >15% BSA in adults or >10% children
Describe A-E assessment components
C (C-spine and catastrophic bleeding) Airway Breathing Circulation Disability Everything else/expose
What are the main sources of haemorrhage in trauma?
‘On the floor + 4 more’: (clap)
- Floor
- Chest
- Long bones
- Abdomen
- Pelvis
What are the components of AMT4
Age
DoB
Place (name of hospital)
Current year
What is the definition of shock and describe 4 types
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)
List causes of a reduced conscious level
COMA! CO2/CO excess Overdose Metabolic (BM, K...) Apoplexy (brain tissue damage e.g. stroke, SAH, abscess)
What is the minimum urine output to monitor patients with catheters?
0.5ml/kg/hr (= 30ml/hr)
What are third space fluid losses and name some causes
When fluid moves from the intravascular space into the interstitial non-functioning spaces (3rd spaces)
Occurs in bowel obstruction, and in peritonitis
Describe and give examples of crystalloids
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)
Describe and give examples of colloids
1) Natural -> albumin and blood
2) Synthetic -> gelofusion
Describe the maintenance daily quantities of water, sodium, potassium, chloride and glucose for a patient who does not have any more than insensible losses
Water = 30ml/kg/day Na/K/Cl = 1mmol/kg/day Glucose = 50-100g/day
What is the most common transfusion ratio of
- packed red cells
- FFP
- platelets
4:2:1
Packed red cells = O2
FFP = all protein and clotting factors
Platelets = platelets
What is tranexamic acid, how does it work?
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
What ED investigations may you want to carry out in a falls patient?
- ECG
- BM
- BP (lying and standing)
also:
- CK if long lie
- CT head
- troponin
- urinalysis and CXR if sepsis?
- full bloods
List 5 causes of a raised JVP
PQRST!
- pulmonary HTN, PE, pericardial effusion, pulmonary stenosis
- quantity (fluid overload)
- R-HF
- SVC obstruction
- Tamponade (cardiac)/TR
What is the significance of a sustained rise in JVP following the hepatojugular reflex?
- R sided HF
What is Corrigan’s sign?
Visible carotid pulsation (AR)
What is de Musset’s sign?
Head bobbing in time with pulse (AR)
What is the antedote for paracetamol overdose?
NAC
What is the antedote for CO overdose?
High flow oxygen/hyperbaric O2 therapy
