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Specialities > A&E > Flashcards

A&E Flashcards

1
Q

What blood tests do you want in a suspected septic patient? What additional investigations should be done?

A 
FBC 
U&Es 
ABG/ VBG 
LFTs 
Glucose 
Lactate 
Coagulation 
CRP 
\+
Blood cultures

X-rays:

  • CXR
  • US
  • CT

Special tests:
- swabs

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2
Q

If a person has sepsis and indwelling catheter where should blood cultures be taken from?

A

2 sets should be taken.

One Peripherally

One from catheter

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3
Q

During sepsis aggressive fluid resuscitation is given, what is the patient at risk of developing?

A

Non-cardiogenic pulmonary oedema

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4
Q

What drugs can be added in a septic patient to increase the MAP? What drug should myocardial dysfunctional patient receive? and what is last drug choice if the first two are not working?

A

Adrenaline
Dobutamine

Dobutamine recommended for myocardial dysfunction

Hydrocortisone IV can be used as last resort

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5
Q

Why may a patient who has experienced trauma have coagulation defects?

A

Depletion of clotting factors

Fluids
- dilute clotting factors

Hypothermia
- reduces effectiveness of clotting

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6
Q

Why are IV fluids not recommended for a trauma patient?

A

Disrupts the initial clot
- new pressure disrupts clot

Haemodilution

Cooling of patient
- making coagulopathy worse

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7
Q

What things should always be recorded following a head injury?

A

GCS
Pupil size and reactivity
Lateralizing signs
Decorticate/ decelebrate signs

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8
Q

What is Cushing’s triad?

A

Signs of Herniation of the cerebellar tonsils through the foramen magnum.
resulting in brainstem compression.

Rising blood pressure
bradycardia
Intermittent respiration

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9
Q

What are some signs of urethral injury?

A

Blood at penile meatus

Perineal ecchymosis

Scrotal haematoma

High riding prostate

Known pelvic fracture

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10
Q

What are the trimodal causes of death following from major trauma?

A

Immediate:

  • massive blood loss
  • neck fracture
  • intracranial bleed
  • aortic sheering
  • airway obstruction

Early:

  • ATOMFC
  • Airway compromise
  • tension Pneumo
  • Open pneumo
  • Massive haemothorax
  • Flail chest
  • Cardiac tamponade

Late:

  • P.E
  • Sepsis
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11
Q

What history do you want about someone when they come in from the ambulance crew?

A

AMPLE

  • Allergies
  • Medication
  • PMH, Pregnancy?
  • Last meal
  • Events
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12
Q

What can be done to stabilize the C-spine prior to placing the in a collar?

A

Bimanual inline stabilization

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13
Q

Name two other injuries/ complications to consider in burns victims:

A

Inhalation injury

Carbon monoxide poisoning

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14
Q

How is frostbite treated?

A

Rapid heating with moist heat >40 degrees

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15
Q

In a patient with major trauma, a C-spine injury is suspected until proven otherwise, when can the collar be removed?

A

Negative radiological findings
Absent pain from spinal origins
- which can be sensed without distraction of other painful stimuli

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16
Q

What are some signs of C-spine fracture seen on clinical examination?

A

Cervical spine tenderness

Subcutaneous emphysema

Tracheal deviation

Laryngeal fracture

Focal neurology

17
Q

Outline the Ottowa rules for x-raying the ankle:

A

X-ray if:

  • any pain over the lateral aspect of ankle across fibula
  • any pain over the medial aspect of ankle across the tibia
  • Unable to weight bare or walk more than 4 steps in ED
18
Q

What are the ottowa rules for the knee?

A

x-ray if:

  • tender over the patella
  • tender over the fibula
  • unable to flex knee to 90degrees
  • unable to weight bare
  • > 55 years
19
Q

What is the injury called that can occur to the thumb which is due to excessive valgus rotation? what ligament is damaged and what is the complication?

A

Game keeper’s thumb

Ulnar collateral ligament

Stener lesion
- where the adductor pollicis gets caught

20
Q

In a patient that attends A&E due to a fall, what are the essential investigations that should be done?

A

Cardiovascular examination
- lying and standing BP

Full neurological examination

  • vision
  • cerebellar signs

MSK examination

21
Q

What is a finding on ECG which can be indicative of an M.I coming very soon, in which ST elevation will be seen?

A

Depression or elevation of the aVR lead

and/ or

Hyperacute tall T waves

Wellen’s syndrome which see biphasic T wave changes in anterior leads. suggest of critical LAD stenosis

22
Q

What are the cut offs for ST - elevation:

A

> 2mm in V1-3 in males
1.5 in V1-3 in females
**note these would an anterior

> 1mm in any other leads
**note these would be inferior

23
Q

What are the progressive changes seen in the ECG for an M.I

A

Hyperacute T waves

ST elevation

Q waves / and inverted T waves

24
Q

What investigations should be done into aortic dissection:

A

ECG: rule out ACS *may see inferior ST elevation
CXR - widening of mediastinum
D-dimer - very unlikely to be aortic dissection if low

CT Angio of chest/ abdo/ pelvis is definitive

*if patient is unstable a TOE can be done

25
Q

What investigation is worth ordering in someone who has overdosed on benzodiazepines to assess how well they have been oxygenating?

A

ABG or VBG

they tend to develop a type 2 respiratory failure

26
Q

What is the substance that is often in cocaine and how does it affect the patient?

A

Levamisole
- anti-worming agent

Mimics HIV and necrotic skin lesions

27
Q

What are the signs and symptoms of cocaine overdose and how are they managed?

A

Hyperthermia

ACS/ chest pain

Rhabdomyolysis

Seizures

Management:

  • Benzodiazepines (this can help vasospasm as well)
  • GTN + Aspirin
  • Dantrolene - if >40 degrees
  • Cyproheptadine
28
Q

What is the serious ECG pattern seen with digitalis toxicity?

A

Bidirectional Ventricular Tachycardia

29
Q

Where would you see fluid in the abdomen if present during a fast scan?

A

Pouch of Morrison
- between liver and kidney

Between kidney and spleen

Around the bladder

Pouch of Douglas
- especially for gynae

30
Q

What signs may be seen on a lateral elbow x-ray other than direct fracture to the bone which suggest fracture?

A

Sail sign

  • displacement of fat pad.
  • very true posteriorly
31
Q

What are the stages of iron toxicity and what is the treatment?

A

stage 1:

  • N&V
  • Abdominal pain
  • Haematemesis

Stage 2:
- apparent recovery

Stage 3:

  • lethargy
  • seizures
  • shock
  • Coagulation abnormalities

Stage 4:
- liver failure

Stage 5:
- pyloric scarring

Treatment:

  • gastric lavage
  • deferoxamine

**remember children are at high risk of this

32
Q

On a CXR you see many radiopaque pills in the stomach, what is it likely to be?

A

Iron tablets

33
Q

What is the fluid resuscitation dose given for DKA in children and what rate is the insulin infused at?

A

Saline - 10mls/kg

Insulin dose: 0.1units/kg/hour

34
Q

What are the complications of DKA?

A

Cerebral oedema

  • GCS/ behaviour changes
  • give mannitol

ARDS

Hypoglycaemia

Hypokalaemia

Aspiration pneumonia

VTE

35
Q

How many shocks can be given in someone who is hypothermic?

A

3 shocks then no more before they are >30 degrees

36
Q

What are some findings of severe DKA requiring HDU input?

A

pH <7.1

Ketones >6

GCS <12

Cerebral oedema on presentation

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