ABCDE Flashcards
In all emergencies, what should be considered to be the primary cause of shock (until proven otherwise)?
Hypovolaemia
If a patient has cool peripheries and tachycardia, what should you give them?
i.v. fluid
Circulation:
How do you measure Capillary refill time?
What is the target CRT?
If the CRT is prolonged, what does this indicate?
Squeeze a digit for 5s, at heart level.
Let go and time how long it takes for the skin to return to the colour of the surrounding skin - should take < 2s.
It indicates poor peripheral circulation.
Circulation:
What does a low diastolic pressure suggest about the arteries?
Name 2 types of distributive shock that can have this effect.
Suggests arterial dilation.
Anaphylaxis or Sepsis
What is the normal range for pulse pressure?
What does a narrow pulse pressure suggest about the arteries.
Give two types of shock that can have this effect.
35-45 mmHg.
It suggests arterial vasoconstriction which can be caused by Hpovolaemia (severe burns, haemorrhage) or Cardiogenic shock (MI, heart failure).
What 4 steps are involved in the immediate treatment of Acute Coronary Syndrome?
How are they given?
- 300mg Aspirin given orally (chewed or crushed) ASAP
- GTN spray or tablet given sublingually
- Oxygen - only if their SpO2 is below 94% breathing air alone
- Morphine titrated i.v. (- to prevent sedation and respiratory depression)
What drugs are given in the later treatment of Acute Coronary Syndrome?
(They are split into 4 groups)
ACEi/ARB
Beta blocker
Aspirin (75mg) and Clopidogrel (for 1st 12 months post ACS)
Statin (high dose)
What is Cheyne-Strokes respiration?
CHORPS stand for 5 causes of Cheyne-Strokes respiration. Name all 5.
Cyclical form: Increase in breathing, followed by a decrease in breathing, followed by breathing cessation (apnoea)
CO poisoning Hyponatraemia Opioid toxicity RICP Pulmonary oedema Stroke
Kussmaul’s respiration is a type of hyperventilation.
What condition is it associated with?
(Deep, sighing respiration)
Diabetic ketoacidosis.
Disability:
You are in A and E, a patient comes in with pin point pupils.
What is your 1st differential?
Opioid overdose
Disability:
You are in A and E, a patient comes in with dilated pupils.
Name 4 possible differentials
Tricyclic antidepressant overdose SSRIs (antidepressants) Ketamine Alcohol Cannabis Amphetamines (used for ADHD, Obesity and Narcolepsy)
Disability:
If you see a pregnant woman seizing, what do you give them?
Magnesium sulphate
Breathing:
What are 6 signs seen in a tension pneumothorax?
- Difficulty breathing
- Hypotension
- Tracheal deviation to opposite side of affected lung
- Absent breath sounds on affected side
- Hyper-resonance on percussion of affected chest side
- DISTENDED NECK VEINS
Breathing:
If a child comes in with stridor and you can do a handover/transfer them quickly, what do you give them?
If you can’t do a rapid transfer/handover, what do you give them?
Rapid: Nebulised Adrenaline
Slow: IM Adrenaline
Circulation:
If a child has low blood pressure, what is this an emergency sign of?
Severe shock
(The shock is in the SEVERE state because children in shock have a normal blood pressure for a long amount of time and the blood pressure only rapidly deteriorates when in the severe stage)
Use a word to describe oesophageal reflux pain
Burning
Give a description of the pain in aortic dissection
Tearing sensation
Paediatric Circulation:
In diabetic ketoacidosis of a child what is the amount of the initial crystalloid bolus?
What route?
Why is it this value?
10ml/kg. Intraosseous. To prevent cerebral oedema.
Paediatric Disability:
How do you treat hypoglycaemia?
Give 2ml/kg 10% glucose IV or IO (intraosseous) then give a glucose infusion (to prevent recurrence)
How do you measure the temperature of a:
1) Less than 4 week old (1)
2) 4 week - 5 year old (3)
1) electronic thermometer in the axilla
2) electronic thermometer in the axilla, chemical dot thermometer in the axilla or infra-red tympanic thermometer
What is the other name for Kawasaki disease?
- this disease is rare and mainly affects children under the age of 5*
- there is no known cause and it is not contagious*
Give 7 features that are likely to be present with this disease.
Mucocutaneous lymph node syndrome
- cervical lymphadenopathy
- erythema and cracking of lips
- erythema of oral and pharyngeal mucosa
- strawberry tongue
- polymorphous rash
- erythema and oedema of hand and feet
- bilateral conjunctival infection with no exudate formation
Discuss the treatments for Kawasaki disease (3).
need IMMEDIATE hospital admission
Aspirin: high dose - anti inflammatory, anti pyretic and pain relief. Once symptoms have gone may still need 6-8 weeks low dose Aspirin: anti-platelet to prevent clot formations.
IVIG: should see improvement within 36 hours of it being given. If not, give another dose.
Corticosteroid: if second dose of IVIG is ineffective or if there is high chance of the disease causing heart problems. (Infants <1 typically get heart problems as a result of the disease so may go straight to steroid treatment).
In anaphylaxis, itching of the palate and/or external acoustic meatus can be a sign on?
Airway blockage
Discuss how you would administer an IV fluid challenge in an:
A) Adult
B) Adult with cardiac failure
C) Child
Adult: 500mL of warmed crystalloid (Hartmann’s or 0.9% saline) over 5-10 minutes
Adult with cardiac failure: 250mL of warmed crystalloid (Hartmann’s or 0.9% saline) over 5-10 minutes
Child: 20mL/kg
What antihistamine do you give in anaphylactic shock?
Chlorphenamine
Circulation:
Give 3 signs of pericardial tamponade
Muffled heart sounds
Distended neck veins
Hypotension
Disability:
If a non-pregnant patient is seizing, what drug should you give them?
Iv Benzodiazepine
Disability:
When examining the patients pupils with a light, if they are unequal what does this indicate?
And what should you do?
Indicates RICP
Lift their head 30 degrees off the bed (only do this if no ?neck/spinal cord trauma) + emergency referral to surgery
Hospital:
What are the 2 treatment options for Bell’s palsy that has a presentation within 72 hours
- Oral 25mg Prednisolone bd x 10 days
2. Oral 60mg Prednisolone once daily for 7 days then decrease dose by 10mg each day (after the 7th day)
