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GP- MINE > acute emergencies > Flashcards

acute emergencies Flashcards

1
Q

GORD presentation

A

Retrosternal chest pain radiating to the neck
Worse after food and lying down after meal
Takes NSAIDs for arthritis
Better with antacids
Smoker, excess etoh, pregnant

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2
Q

pericarditis presentation

A

Retrosternal sharp stabbing chest pain radiating to shoulder and neck
Fever
Worse on inspiration and coughing
Relieved by sitting forward
SOB

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3
Q

MI presentation

A

Localised sharp chest pain worse on movement and breathing
Better with NSAIDS
Manual job difficult to do

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4
Q

PE presenation

A

Sudden onset sharp localised chest pain and SOB
Worse on inspiration and coughing
Haemoptysis
Past history recent surgery, smoker, take OCP

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5
Q

presentation of angina

A

Gradual onset central dull chest pain induced by exercise and relived by rest
Past history HTN, smoker, DM, hyperchol, obese

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6
Q

presentation of aortic dissection

A

Sudden onset (always thing AD)
10/10 tearing chest pain radiating to back
Syncope, pallor, clammy
Previous HTN, smoker, connective tissue disorder

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7
Q

presentation of gall stones

A

40 year old female
Dull right lower chest pain radiating to shoulder tip
Started 3 days ago
Approx. 2 hours after meal
Nausea, vomiting and fever
Eats fatty food, excess etoh, obese

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8
Q

investigations for cardiac chest pain

A

Bloods: troponin, fasting lipids, fasting glucose and FBC
Resting and exercise ECG
CXR – HF

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9
Q

investigations for non cardiac chest pain

A

CXR (pneumonia), abdominal US (gallstones), serum amylase (acute pancreatitis)

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10
Q

Risk factors of CHD

A

Smoking
Hypertension
Hyperlipidaemia
DM
Obesity

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11
Q

major causes of non-cardiac pain

A

Gall stones
GORD
PE
MSK
Anxiety and depression

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12
Q

major causes of cardiac pain

A

ACS and angina
Aortic dissection
Pericarditis

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13
Q

blood volume resus in chidlren

and with DKA?

A

If there are signs of circulatory compromise, establish venous or intraosseous access rapidly and give 20ml/kg bolus of 0.9% sodium chloride
In DKA initial bolus is 10ml/kg due to risk of cerebral oedema
Venous access in children can be difficult  fluid resus should not be delayed give intraosseous

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14
Q

choking in children

A

In choking patient who is conscious and seems to be coughing effectively, encourage coughing
If cough becomes ineffective: 5 back blows followed by 5 chest thrusts

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15
Q

ABCDE - disability resus
low concious?
low BG?

A

Consider intubation to stabilise airway in any child with conscious level graded P or U
Treat hypoglycaemia with bolus 2ml/kg 10% glucose IV or IO, followed by glucose infusion to prevent recurrence
In cases of suspected raised intracranial pressure consider mannitol and neuroprotective measures

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16
Q

classic signs of anaphylaxis

aetiology of anaphylaxis

A

flushing, urticaria, angio-oedema

Allergen reacts with specific IgE antibodies on mast cells and basophils (type 1 hypersensitivity reaction), triggering the rapid release of stored histamine and rapid synthesis of newly formed mediators, causing:
Capillary leakage
Mucosal oedema
Shock
Asphyxia
Usually occur over a few minutes or occasionally biphasic (may be delayed. By a few hours)

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17
Q

presentation of anaphylaxis

skin
airway
general

A

Usually history of previous sensitivity to an allergen or recent exposure to a new drug
Skin symptoms
Itching
Urticaria
Erythema
Rhinitis
Conjuncitivits
Angio-oedema
Airway involvement
Early: Itching of the palate or external auditory meatus
Dyspnoea
Laryngeal oedema (strodros)
Wheezing (bronchospasm)
General symptoms
Palpitations
Tachycardia
Nausea
Vomiting
Abdominal pain
Fain
Sense of impending doom

18
Q

Common triggers of anaphylaxis

A

Peanuts
Eggs
Milk
Venom e.g. bee sting
Drugs
Antibitoics
Opioids
NSAIDs
Contrast
Anaesthetic

19
Q

emergency treatment of anaphylaxis

A

Rapid assessment: A-E
Give high flow oxygen
Lay patient flat and raise legs
Adrenaline IM in anterolateral aspect of the middle third of thigh
Adult 500mg IM
Child IM
>12 500mg
6-12- 300 mg
<6 years 150mg
Should be repeated after 5 mins if no clinical improvement
IV fluid challenge- warmed crystalloid solution e.g. Hartmanns or saline to raise BP
Antihistamine e.g. Chlorphenamine
Steroid e.g. Hydrocortisone
Continuing resp deterioration  bronchodilators e.g. salbutamol
Monitor
Pulse oximetry
ECG

20
Q

investigation for anaphylaxis

A

after treatment

Serum mast-cell tryptase - clarify diagnosis - demonstrates mast-cell degranulation

21
Q

what is:
acute, subacute and chronic breathlessness?

A

Acute breathlessness — when it develops over minutes.
Subacute breathlessness — when it develops over hours or days.
Chronic breathlessness — when it develops over weeks or months.

22
Q

cardiac causes of breathlessness

A

Silent MI
Cardiac arrhythmia
Acute pulmonary oedema
Chronic heart failure

23
Q

pulmonary causes of breathlessness

A

Asthma
COPD
Pneumonia
PE
Lung cancer
Pleural effusion

24
Q

other common causes of breathlessness

A

Anaemia
Diaphragmatic splinting (ascites, obesity, pregnancy)
Psychogenic breathlessness

25
Q

silent MI:
risk factors?
symptoms?
signs?
investigations?

A

Risk factors — coronary artery disease, smoking, high blood lipid levels, hypertension, obesity, diabetes, family history.
Atypical presentations of myocardial infarction such as isolated breathlessness are more common in the elderly, in women and in people with diabetes, chronic renal disease and dementia.

Symptoms — breathlessness, general malaise, sudden collapse, upper body discomfort, nausea.

Signs — breathless (sometimes), abnormal pulse rate, sweating, reduced peripheral perfusion, hypotension.

Electrocardiogram (ECG) — features suggestive of acute MI include ST depression with T-wave inversion, persistent ST elevation, or new left bundle branch block. Q-waves do not give an indication of the age of an MI as remain permanent following infarction.

26
Q

cardiac arrythmia

risk factors?
symptoms?
signs?
investigations?

A

Risk factors — heart failure, valvular heart disease, ischaemic heart disease.
Symptoms — palpitations, breathlessness, chest pain, syncope (or near syncope).
Signs — bradycardia or tachycardia.
ECG — diagnosis of arrhythmia relies on ECG obtained during the arrhythmia

27
Q

pulmonary oedema

risk factors
symptoms
signs

A

Risk factors — chronic heart failure, ischaemic heart disease, valvular heart disease.
Symptoms — severe breathlessness, orthopnea, coughing (rarely with frothy blood-stained sputum).
Signs — elevated jugular venous pressure, gallop rhythm, inspiratory crackles at lung bases, and (occasionally) wheeze. Peripheral circulation is shut down.

28
Q

cardiac tamponade summary

risk factors?
symptoms?
signs?

A

Risk factors — trauma, autoimmune disease, malignancy, myxoedema, myocardial infarction.
Symptoms — breathlessness, collapse.
Signs — tachycardia, pulsus paroxodus, engorgement of neck veins and face peripheral cyanosis shock.

29
Q

chronic heart failure
risk factors?
symptoms?
signs?

A

Risk factors — trauma, autoimmune disease, malignancy, myxoedema, myocardial infarction.
Symptoms — breathlessness, collapse.
Signs — tachycardia, pulsus paroxodus, engorgement of neck veins and face peripheral cyanosis shock

30
Q

pleural effusion summary

causes?
symptoms?
signs?

A

Causes — heart, liver, or renal failure, pneumonia, pulmonary embolism, cancer (including mesothelioma), tuberculosis, pleural infection (empyema), and autoimmune disease.
Symptoms — progressive breathlessness, pleuritic pain and symptoms of the underlying condition.
Signs — reduced chest wall movements on the affected side, stony dull percussion note, diminished or absent breath sounds, decreased tactile vocal fremitus/vocal resonance and bronchial breathing just above the effusion. There may be signs of the underlying condition.

31
Q

anaemia symptoms and signs

A

Symptoms — mild anaemia may be asymptomatic or cause mild fatigue. As it progresses, faintness/dizziness, exertional breathlessness, palpitations and chest pain can occur. Rapid blood loss may present with collapse.
Signs — paleness (for example of the conjunctiva or palms). More severe anaemia may lead to tachycardia or cardiac failure.

32
Q

diaphragmatic splinting summary

causes
symptoms
signs

A

(due to ascites, obesity or pregnancy)

Symptoms — chronic breathlessness that develops in association with increasing abdominal size. There are no symptoms to suggest other causes of chronic breathlessness.
Signs — ascites (shifting dullness and fluid thrill) or obesity. There are no clinical features of other causes for chronic breathlessness.

33
Q

patient with unilateral weakness differential

A

stroke
TIA
bells palsy

34
Q

General presentation of stroke and TIA

A

Sudden onset of focal neurological symptoms, which cannot be explained by other conditions e.g. hypoglycaemia
Numbness
Weakness
Slurred speech
Visual disturbance

35
Q

define transient ischaemic attack

A

is a transient (less than 24 hours) neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without evidence of acute infarction.

36
Q

define bells palsy

symptoms of bells palsy include - think facial nerve

A

Bell’s palsy is an acute, unilateral facial nerve weakness or paralysis of rapid onset (less than 72 hours) and unknown cause.

Rapid onset (less than 72 hours).
Facial muscle weakness (almost always unilateral) involving the upper and lower parts of the face. This causes a reduction in movement on the affected side, often with drooping of the eyebrow and corner of the mouth and loss of the nasolabial fold.
Ear and postauricular region pain on the affected side.
Difficulty chewing, dry mouth, and changes in taste.
Incomplete eye closure, dry eye, eye pain, or excessive tearing.
Numbness or tingling of the cheek and/or mouth.
Speech articulation problems, drooling.
Hyperacusis.

37
Q

management of bells palsy

A

The person should be advised to keep the affected eye lubricated by using lubricating eye drops during the day and ointment at night. The eye should be taped closed at bedtime using microporous tape, if the ability to close the eye at night is impaired.
For people presenting within 72 hours of the onset of symptoms, prescription of prednisolone should be considered.
Antiviral treatment alone is not recommended, but it may have a small benefit in combination with a corticosteroid; specialist advice is recommended if this is being considered.

38
Q

management of TIA

A
  • For people who have had a suspected TIA within the last week
    • Offer aspirin 300mg immediately (+PPI for those with GORD)
    • Refer to specialist assessment and investigation team
  • For people who have had a suspected TIA more than a week ago
    • Refer for specialist appointment with 7 days
  • Give people with suspected TIA and their family/carers info for recognising a stroke
39
Q

causes of stroke in the young

A
  • Vasculitis
  • Thrombophilia
  • Subarachnoid haemorrhage
  • Venous sinus thrombosis
  • Carotid artery dissection e.g. via near strangling or fibromuscular dysplasia
40
Q

causes of stroke in the old

A
  • Thrombosis in situ
  • Athero-thromboembolism e.g. from carotid arteries
  • Heart emboli (e.g. atrial fibrillation, infective endocarditis or MI)
  • CNS bleed associated with hypertension, head injury, aneurysm rupture)
  • Sudden blood pressure drop by more than 40 mmHg
  • Vasculitis e.g. giant cell arteritis
  • Venous sinus thrombosis
41
Q

risk factors for stroke

A

HTN

COCP

DM

hyperlipidaemia

previous TIA

preipheral arterial disease

clotting disorder

alchohol

PV

42
Q

management of stroke

A
  • Do not start anticoagulation or antiplatelet treatment in people following stroke until intracerebral haemorrhage has been excluded
  • While awaiting transfer: ABDE and give supplemental oxygen if sats are less than 95%
  • If ischaemic clot (identified by CT) can give tPA if meets guideline
    • Potentially emergency endovascular procedures
    • Other procedures
      • Carotid endarterectomy
      • Angioplasty and stents
  • If haemorrhagic
    • Emergency measures- stop blood thinners
      • Surgical clipping
      • Coiling

GP- MINE (6 decks)

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