Acute Emergencies Flashcards
Seizure- Four elements of management
- Oxygen 10l
- Diazapam 10mg (Midazolam 5/7.5/10mg)
- Don’t ever forget glucose
- Check pulse (vaso-vagal)
Hypoglycaemia
- S&S
- Neuroglycopenia
- Hunger, tremor, headache
2. Neuroglycopenia: I. slurred speech II. agression III. coma IV. fit
Hypoglacemia Mx
- 15-20g glucose
- 4-5tablets
- 1.5-2 tubes 40%
- 150-200ml fruit juice
- 3-4 teaspoons of sugar dissolved - IM Glucagon 1mg (adult)
Glucagon ineffective in malnourishment (anorexia/alcholism)
- IV glucose
- 15-20g as 10-20% solution
- large cannula in large vein - Buccal glucose if non-compliant
- 1.5-2 tubes 40%
Acute Asthma Criteria
Always see the patient!
- Acute severe:
RR > 25
P > 110 - Life-threatening
RR < 8
P <50
Choking management?
- Cough
- Back blows
- Abdo thrusts
- CPR
DDs to consider in Ectopic Pregnancy
DDs:
- UTI
- Ruptured cyst
- GI pain
- Endometriosis pain
Hx to consider Ectopic
- 6-7 week pregnancy
- 1 missed period
- Shoulder-tip pain (phrenic nerve)
- Previous Ectopic, PID, Sterilisation, IUD
Tonsillitis escalating treatment
- Cool drinks
- Para and ibu
- Salt gargle
- ABx - Phenoxymethylpenicillin PO, benzathine benzylpenicillin IM, Amoxicillin/Coamoxiclav PO
- Tonsillectomy
Recurrent episodes
Co-amoxiclav
Two complications of Strep Pyogenes and their management
- Quinsey (peri-tonsillar absess)
i. Aspiration
ii. Incision
iii. Tonsileectomy - Rheumatic HD
i. Benzathine benzylpenicillin IM (or Erythromycin PO)
ii. Furosemide IV/Spironalactone PO (+enalaprilPO)
iii. W/AF -> Amiodarone or Digoxin
Hyponatraemia management
Dilutional: Fluid restriction (1l per day for 10 days)
TIA
- Presentation
TIA
T ransient
- Sudden onset symptoms
- Brief symptoms (minutes)
I schaemic
- AF
- Carotid stenosis
- CHF/HTN
- DM/Hyperlipidaemia
- Cigarette/alchohol
A ttack
- Focal neurological deficit
- Unilateral weakness/paralysis
2 Dysphasia
3 Ataxia/vertigo
4 Amaurosis fugax (one eye)
5 Homonymous hemianopia
6 Diplopia
TIA
- Ix
TIA Ix
Bedside
1. Glucose
Blood
- FBC and platelets
- PT, INR, PTT
- Lipids
- Electrolytes
- ECG
Imaging
7. CT (exclude haemorrhage)
Suspected TIA
- Mx
Suspected TIA Mx
- Anti-platelet
- Aspirin 300mg
- Or clopidogrel 300mg - Refer as high risk
Confirmed TIA
- Followup
Confirmed TIA Followup
- Antiplatelet
- Clopidogrel 75mg OD - High-intensity statin
- Atorvastatin 20-80mg - AF anti-coagulate
- LMWH
- DOAC
Anaphylaxis
- Mx
Anaphylaxis Mx
- ABCDE
- Remove trigger
- Epinephrine
- Adult 500mcg
- Child 300mcg
- Infant 100-150 mcg - High Flow Oxygen
- IV fluids
- Nebulised epinephrine
- Nebulised SABA
- IV Atropine/Glucagon
Croup
- Presentation
Croup S&S
- Laryngo-tracheo-bronchitis
- 6 months - 6 years
- Peaks at 2 - Barky cough ( seal-like)
- Stridor & hoarseness
- Respiratory distress
- Increase with agitation - Viral infection
- Parainfluenza 1 or 3
- Late autumn
Intestinal malrotation
- Presentation
Intestinal malrotation S&S
- Midgut volvulus
- <1 year (90%)
- 1 month (50%) - Bilious vomiting
- 90% - Abdominal pain
- Normal or distended abdo
- Tachycardia (200+)
- HTN
- Later hypotension - Abnormality
- Gastroschisis
- Omphalocele
- Hernia
Intestinal malrotation
- Mx
Intestinal malrotation Mx
- Ischaemic
- Laparotomy - Obstruction
- Laparotomy - Partial or intermittent
- Ladd’s procedure - Questionable
- Elective surgery
Children RR
- Normal Rates
Children RR
30-60 - Neonate
20-40 - Infant
20-30 - Y1-3
15-25 - Y4-10
Children HR
- Normal Rates
Children HR
110-160 - Y<1
95-140 - Y2-5
80-120 - Y5-12
60-100 - Y12+
Child fever
- Red light Sx
Child - Red light Sx
- 2 Hours
- Appears ill
- AVPU - RR>60
- Colour
- Mottled/ashen/blue - Cry
- Weak, high, continuous - Bulging fontanelle
- Reduced turgor
- Non-blanching rash
- Neck stiffness - Neurological signs
- Bile-stained vomit
- Temperature
- 38º Neonate
- 39º 3 mo
Child fever
- Amber light Sx
Child - Amber light Sx
- Pallor
- RR
- 50 <6mo
- 40 >6mo - Drowsiness
- No smile
- Nasal flaring
- Sats <95
- Dry membranes
- CRT >2
- Oliguria
- Swelling/lump
Scarlet fever
- Presentation
Scarlet fever S&S
- Fever & malaise
- Tonsillitis
- Fine punctuate erythema
- Scarlet flushing
- Strawberry tongue
- White turning red d3-4
Scarlet fever
- Mx
Scarlet fever Mx
- IM ABx
- Ben pen
- Penicillin V (phenoxymethyl) - Supportive
- Heart failure ACE
- AF amiodarone
- Joint NSAID
Glandular fever
- Presentation
Glandular fever S&S
- Sore throat
- Malaise, fatigue
- Lymphadenopathy
- Splenomegaly
- Palatal petechiae
- Rash
Glandular fever
- Management
Glandular fever Mx
- No Amoxicillin!!!
- Conservative
- Rest and fluids
- Paracetamol - Salt water
- Prednisolone
- ABx for 2º Infx