Acute Emergencies

Question 1

Seizure- Four elements of management

Answer 1

1. Oxygen 10l
2. Diazapam 10mg (Midazolam 5/7.5/10mg)
3. Don’t ever forget glucose
4. Check pulse (vaso-vagal)

Question 2

Hypoglycaemia

1. S&S
2. Neuroglycopenia

Answer 2

1. Hunger, tremor, headache

2. Neuroglycopenia: 
I. slurred speech
II. agression
III. coma
IV. fit

Question 3

Hypoglacemia Mx

Answer 3

1. 15-20g glucose
   - 4-5tablets
   - 1.5-2 tubes 40%
   - 150-200ml fruit juice
   - 3-4 teaspoons of sugar dissolved
2. IM Glucagon 1mg (adult)

Glucagon ineffective in malnourishment (anorexia/alcholism)

3. IV glucose
   - 15-20g as 10-20% solution
   - large cannula in large vein
4. Buccal glucose if non-compliant
   - 1.5-2 tubes 40%

Question 4

Acute Asthma Criteria

Always see the patient!

Answer 4

1. Acute severe:
   RR > 25
   P > 110
2. Life-threatening
   RR < 8
   P <50

Question 5

Choking management?

Answer 5

1. Cough
2. Back blows
3. Abdo thrusts
4. CPR

Question 6

DDs to consider in Ectopic Pregnancy

Answer 6

DDs:

1. UTI
2. Ruptured cyst
3. GI pain
4. Endometriosis pain

Question 7

Hx to consider Ectopic

Answer 7

1. 6-7 week pregnancy
2. 1 missed period
3. Shoulder-tip pain (phrenic nerve)
4. Previous Ectopic, PID, Sterilisation, IUD

Question 8

Tonsillitis escalating treatment

Answer 8

1. Cool drinks
2. Para and ibu
3. Salt gargle
4. ABx - Phenoxymethylpenicillin PO, benzathine benzylpenicillin IM, Amoxicillin/Coamoxiclav PO
5. Tonsillectomy
   Recurrent episodes
   Co-amoxiclav

Question 9

Two complications of Strep Pyogenes and their management

Answer 9

1. Quinsey (peri-tonsillar absess)
   i. Aspiration
   ii. Incision
   iii. Tonsileectomy
2. Rheumatic HD
   i. Benzathine benzylpenicillin IM (or Erythromycin PO)
   ii. Furosemide IV/Spironalactone PO (+enalaprilPO)
   iii. W/AF -> Amiodarone or Digoxin

Question 10

Hyponatraemia management

Answer 10

Dilutional:
Fluid restriction (1l per day for 10 days)

Question 11

TIA

- Presentation

Answer 11

TIA

T ransient

1. Sudden onset symptoms
2. Brief symptoms (minutes)

I schaemic

1. AF
2. Carotid stenosis
3. CHF/HTN
4. DM/Hyperlipidaemia
5. Cigarette/alchohol

A ttack
- Focal neurological deficit

1. Unilateral weakness/paralysis
   2 Dysphasia
   3 Ataxia/vertigo

4 Amaurosis fugax (one eye)
5 Homonymous hemianopia
6 Diplopia

Question 12

TIA

- Ix

Answer 12

TIA Ix

Bedside
1. Glucose

Blood

2. FBC and platelets
3. PT, INR, PTT
4. Lipids
5. Electrolytes
6. ECG

Imaging
7. CT (exclude haemorrhage)

Question 13

Suspected TIA

- Mx

Answer 13

Suspected TIA Mx

1. Anti-platelet
   - Aspirin 300mg
   - Or clopidogrel 300mg
2. Refer as high risk

Question 14

Confirmed TIA

- Followup

Answer 14

Confirmed TIA Followup

1. Antiplatelet
   - Clopidogrel 75mg OD
2. High-intensity statin
   - Atorvastatin 20-80mg
3. AF anti-coagulate
   - LMWH
   - DOAC

Question 15

Anaphylaxis

- Mx

Answer 15

Anaphylaxis Mx

1. ABCDE
2. Remove trigger
3. Epinephrine
   - Adult 500mcg
   - Child 300mcg
   - Infant 100-150 mcg
4. High Flow Oxygen
5. IV fluids
6. Nebulised epinephrine
7. Nebulised SABA
8. IV Atropine/Glucagon

Question 16

Croup

- Presentation

Answer 16

Croup S&S
- Laryngo-tracheo-bronchitis

1. 6 months - 6 years
   - Peaks at 2
2. Barky cough ( seal-like)
3. Stridor & hoarseness
4. Respiratory distress
   - Increase with agitation
5. Viral infection
   - Parainfluenza 1 or 3
   - Late autumn

Question 17

Intestinal malrotation

- Presentation

Answer 17

Intestinal malrotation S&S
- Midgut volvulus

1. <1 year (90%)
   - 1 month (50%)
2. Bilious vomiting
   - 90%
3. Abdominal pain
4. Normal or distended abdo
5. Tachycardia (200+)
   - HTN
   - Later hypotension
6. Abnormality
   - Gastroschisis
   - Omphalocele
   - Hernia

Question 18

Intestinal malrotation

• Mx

Answer 18

Intestinal malrotation Mx

1. Ischaemic
   - Laparotomy
2. Obstruction
   - Laparotomy
3. Partial or intermittent
   - Ladd’s procedure
4. Questionable
   - Elective surgery

Question 19

Children RR

- Normal Rates

Answer 19

Children RR

30-60 - Neonate

20-40 - Infant

20-30 - Y1-3

15-25 - Y4-10

Question 20

Children HR

- Normal Rates

Answer 20

Children HR

110-160 - Y<1

95-140 - Y2-5

80-120 - Y5-12

60-100 - Y12+

Question 21

Child fever

- Red light Sx

Answer 21

Child - Red light Sx
- 2 Hours

1. Appears ill
   - AVPU
2. RR>60
3. Colour
   - Mottled/ashen/blue
4. Cry
   - Weak, high, continuous
5. Bulging fontanelle
6. Reduced turgor
7. Non-blanching rash
   - Neck stiffness
8. Neurological signs
9. Bile-stained vomit
10. Temperature
    - 38º Neonate
    - 39º 3 mo

Question 22

Child fever

- Amber light Sx

Answer 22

Child - Amber light Sx

1. Pallor
2. RR
   - 50 <6mo
   - 40 >6mo
3. Drowsiness
4. No smile
5. Nasal flaring
6. Sats <95
7. Dry membranes
8. CRT >2
9. Oliguria
10. Swelling/lump

Question 23

Scarlet fever

- Presentation

Answer 23

Scarlet fever S&S

1. Fever & malaise
2. Tonsillitis
3. Fine punctuate erythema
4. Scarlet flushing
5. Strawberry tongue
   - White turning red d3-4

Question 24

Scarlet fever

- Mx

Answer 24

Scarlet fever Mx

1. IM ABx
   - Ben pen
   - Penicillin V (phenoxymethyl)
2. Supportive
   - Heart failure ACE
   - AF amiodarone
   - Joint NSAID

Question 25

Glandular fever

- Presentation

Answer 25

Glandular fever S&S

1. Sore throat
2. Malaise, fatigue
3. Lymphadenopathy
4. Splenomegaly
5. Palatal petechiae
6. Rash

Question 26

Glandular fever

- Management

Answer 26

Glandular fever Mx

1. No Amoxicillin!!!
2. Conservative
   - Rest and fluids
   - Paracetamol
3. Salt water
4. Prednisolone
5. ABx for 2º Infx