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
List common causes of metabolic acidosis in the ED
DKA
Lactic acidosis
Alcohol
Salicylate toxicity
List common causes of metabolic alkalosis in the ED
severe vomiting
loss of potassium
List common causes of respiratory acidosis in the ED
Severe Asthma
Pneumonia
Hypoventilation
List common causes of respiratory alkalosis in the ED
Hyperventilation
Panic attack
Salicylate poisoning
All women presenting with abdominal pain must have which test
PREGNANCY
Do a urine BHcG
Raised ICS makes you vomit - true or false
True
It can do
What is involved in a specific head injury examination
GCS Pupils Ears External signs of head injury Neurological examination Cervical spine
A fixed dilated pupil is a sign of what
3rd nerve palsy
Typically due to raised ICP
What is Cushing’s triad and what is it a sign of
Hypertension
Bradycardia
Irregular breathing (reduced brain stem perfusion)
Late sign of raised ICP
What are the NICE criteria for a CT head within one hour of presenting with head injury
GCS less than 13 on initial assessment in A&E
GCS less than 15 at 2hours after the injury in A&E
Suspected open or depressed skull fracture.
Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
Post-traumatic seizure.
Focal neurological deficit.
More than 1 episode of vomiting.
In trauma what comes before ABCDE in the primary survey
C-spine protection
Major haemorrhage
What bedside test can be done to diagnose PE
ECHO
Shows right heart strain
How would you treat PE in a collapsed patient
Thrombolyse with Alteplase 10mg stat then 90mg over 120mins
How do you treat a extradural bleed
Immediate Burr hole / neurosurgical intervention
How do you treat a depressed skull fracture
Requires referral to neurosurgery for elevation of the bone fragments and wound care
What is the initial management for an asthma attack
Oxygen - high flow 15L, if nebs added give through nasal cannula to boost
Salbutamol neb - 5mg via 5L O2
Ipratropium neb - 0.5mg, alternated or with sal
Steroids - hydrocortisone
May put up a saline bag if getting dry
What investigations would you do if someone was having an asthma attack
A-E
ABG
Bloods
