Acute Care General Flashcards
A gurgling noise suggests what is happening in the airway
Obstruction by either secretions or blood
Hoarseness suggests what is happening in the airway
It might be indicative of oedema of the larynx and cords and suggests impending airway obstruction particularly in the burns patient
What are paradoxical breathing movements and what do they suggest
This is when the the patient attempts to breath in past the obstruction - their chest wall is drawn in and the abdomen expands.
Suggests complete airway obstruction
How would you remove a foreign object from the airway
MacGills forceps
NEVER use your fingers
Paradoxical chest wall movements in a specific area are suggestive of what
A flail segment of rib fractures (multiple consecutive ribs each broken in more than one place)
Very painful but also compromises breathing
Which areas can hide significant blood loss in a shocked patient
Chest
Abdomen
Pelvis
Long bones - e.g femur
Which type of fluid is used to resuscitate a shocked patient
Crystalloid IV fluid such as 0.9% Sodium Chloride or Hartmann’s solution
Start with boluses of 250-500ml and reassess
When are blood products used for resus
If blood loss is the suspected cause of the shocked patient
How is tranexamic acid used in major haemorrhage
It prevents clot breakdown and helps stop bleeding
How are splints used in major haemorrhage
Brings ends of bones together - tamponades bleeding
Also reduces pain
What is permissive hypotension
When a patient is sufficiently resuscitated that the vital organs are perfused and maintained but not allowing the blood pressure to become so high that clots are disrupted and bleeding restarts.
Keep BP relatively but safely low
An AVPU score of P or less is roughly equivalent to a GCS of what
Less than 8
This is important as this score suggests they may not be able to protect their own airway
List the eye response scores for GCS
4 Points for Spontaneous eye opening
3 points for opening their eyes to sound or speech
2 points to firm pressure
1 point for no response
List the verbal response scores for GCS
5 points for orientated speech 4 points for confused conversation 3 points for Inappropriate Words 2 for incomprehensible sounds 1 for no verbal response
List the motor response scores for GCS
6 points for Obeying commands
5 points for Localizing a pressure stimulus
4 points for Normal Flexion to pressure stimulus
3 points for Abnormal flexion to pressure stimulus
2 points for extension to pressure stimulus
1 point if they are flaccid and do not respond to any stimulus
At what GCS would you typically intubate
8 or less
How do you treat hypoglycaemia in ABCDE
A bolus of 10% Dextrose
What are the contraindications to peripheral venous cannulation
AV Fistula – are precious and may be damaged
Thrombosed veins
Sites of previous surgery - e.g. mastectomy and lymph node clearance causing poor lymph drainage
Sites of localised infection, inflammation, haematoma (i.e. cellulitis, burns etc.)
Patient refusal
List some complications of cannulation
Infection and Phlebitis Missing the vein and damaging surrounding structures Haematoma formation Arterial puncture Excessive bleeding Extravasation of IV fluids
How often do PVCs need replaced
PVCs needs to be reviewed regularly and consider replacement at 72 hours
Which patients would get a CT chest from the ED
Suspected PE (CTPA)
Aortic dissection
Oesophageal rupture
Major trauma
What are the classic signs of PE on ECG
S1Q3T3
S waves in lead 1
Q waves in lead 3
Inverted T waves in lead 3
How would pericarditis present in ECG
Saddle shaped ST segment
What is the main scoring systems for a PE
Wells Score
PERC - rule out score
PESI - determines management
