ACC

Question 1

how long should it take for a patient to be seen, treated and admitted or discharged to ED?

Answer 1

4 hours from booking in at ED reception

Question 2

what are the added clinical risks of emergency medicine?

Answer 2

limited or emerging clinical info
absconding patients (with capacity often a factor)
social concerns eg trafficking, safeguarding, homelessness
drug and alcohol misuse
issues related to follow up of patients
challenging patients groups eg frequent attenders, those in police custody, frailty and mental health crisis

Question 3

what is the action of vasopressors?

Answer 3

drugs that work on alpha-receptors to increase the systemic vascular resistance

Question 4

what is the action of inotropes?

Answer 4

drugs that work on beta-blockers to increase the contractility of the heart

Question 5

what are the causes of delirium?

Answer 5

PINCH ME
pain
infection
catheter / constipation
hydration
metabolic / meds
environment

Question 6

what is the first line medical treatment of delirium?

Answer 6

oral lorazepam 0.5mg

Question 7

What is the simplest initial screening tool for delirium?
What is the best screening test for delirium?

Answer 7

1. single question in delirium (SQID)
2. AMT4

Question 8

what is the DSM V criteria for delirium?

Answer 8

A - disturbance in attention and awareness eg orientation and environment
B - an acute change that tends to fluctuate
C - additional disturbance in cognition eg memory, language, visuospatial
D - disturbances are not better explained by pre-existing neurocognitive disorder
E - evidence it is caused by a medical condition, substance intoxication/withdrawal or meds side effect

Question 9

what are the RFs for delirium?

Answer 9

age > 65
hip fracture
known dementia
severe illness

Question 10

What are the criteria for an exacerbation of COPD?

Answer 10

need 2/3:
1. increased SOB
2. increased sputum production
3. increased purulence of sputum

Question 11

How do you assess the severity of COPD from history?

Answer 11

usual exercise tolerance or functional status
weight loss (with no other cause)
use of long term oxygen therapy
previous need for non-invasive ventilation
number of admission for COPD and number of courses of antibiotics or steroids for COPD in last 12 months

Question 12

What should you give to any patient at risk of peri-arrest?

Answer 12

15L oxygen non-rebreathe mask

Question 13

What airway management should you give a patient at risk of hypercapnic respiratory failure?

Answer 13

target sats 88-92%
most start at 24% venturi mask then titrate up

Question 14

For a patient with COPD who has an acute respiratory acidosis due to their exacerbation, what are their oxygen stats targets and what do you start them on?

Answer 14

target sats 88-92
initiate bronchodilator therapy for 30 mins, prior to starting non-invasive ventilation

Question 15

For an acute exacerbation of COPD, what are the initial medications to treat?

Answer 15

salbutamol 2.5mg QDS and PRN
ipratropium 0.5mg QDS
prednisolone 30mg od or hydrocortisone 100mg QDS
antibiotics if infection

Question 16

what are the bloods indicative of AKI?

Answer 16

(raised potassium)
raised urea
raised creatinine
reduced eGFR

Question 17

what is the criteria for the different grades of AKI?

Answer 17

grade 1: a rise of >26.4 umol/L or 150-200% of creatinine baseline; urine output <0.5ml/kg/h for >6 hours
grade 2: a rise of 200-300% of creatinine baseline; urine output <0.5ml/kg/h for >12 hours
grade 3: an increase of >300%; or serum creatinine >354 uumol/L with an acute rise of at least of 44 uumol/L; urine output <0.3ml/kg/h for >24 hours or anuria for 12 hours

Question 18

Mr Stevens weighs 80kg. He has produced 45 mls of urine per hour for the last 2 hours. His creatinine has risen to 188 from a baseline of 99. What grade of AKI does he have?

Answer 18

grade 1

Question 19

What is the earliest clinical marker of a developing AKI?

Answer 19

urine output

Question 20

Which medications are most likely to cause an AKI?

Answer 20

Ramipril
Also metformin

Question 21

what is the immediate treatment of AKI with hyperkalaemia?

Answer 21

30mls calcium gluconate, 50mls 50% dextrose and 10 units actrapid

Question 22

what are the ECG signs of hyperkalaemia?

Answer 22

flatened p waves
broad bizarre QRS
sloping ST
tented T waves
sine wave ECG
any arrhythmia

Question 23

what is the emergency management of hyperkalaemia?

Answer 23

calcium gluconate IV 30mls 10% bolus
salbutamol 5mg neb
insulin dextrose 10 units actrapid in 50ml 50% dextrose IV over 20 mins
haemofiltration / dialysis if not responding to the above

Question 24

Mr Jones weighs 70kg. His creatinine has risen from 79 to 398. He has produced only 10mls of urine in the last 3 hours. What grade of AKI does he have?

Answer 24

grade 3