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Phase 3a - Arun&Erin > Acute medicine > Flashcards

Acute medicine Flashcards

1
Q

What are the types of injuryies seen in major trauma (4)

A

Blunt force - falling off motorcycle

Penetrative - e.g gunshot/knife

Sports injuries - open fractures/ splenic/ renal injuries

Blast injuries (explosive force)

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2
Q

Types of blast injury (4)

A

Primary - blast disrupts gas filled structures

Secondary - impact airborne debris

Tertiary - transmission of body e.g thrown against wall

Quaternary - all other forces e.g injured by fire

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3
Q

What does the ATMIST handover for emergency medicine stand for?

A

A - age
T - time
M - mechanism
I - injuries found/suspected
S - vital signs
T - treatment

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4
Q

How to manage Catastrophic haemorrhage

A
  • Clear any clots obscuring bleeding source
  • Direct pressure
  • More direct pressure
  • Indirect pressure (proximal source of bleeding)
  • Torniquet
  • Haemostatic agents (i.e. ceelox)
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5
Q

When is intubation absolutely indicated?

A
  • Inability to maintain and protect own airway regardless of conscious level
  • Inability to maintain adequate oxygenation with less invasive manouvres
  • Inability to maintain normocapnia
  • Deteriorating consciousness level
  • Significant facial injuries
  • Seizures
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6
Q

Timeframe for securing an airway

A

45 minutes

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7
Q

When is intubation relatively indicated?

A
  • Haemorrhagic shock - presence of evolving metabolic acidosis
  • agitated patient
  • multiple painful injuries
  • transfer to another area of hospital
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8
Q

When is a person high risk for C spine injury?

At least one of the following…

A
  • Age 65 or older
  • Dangerous mechanism of injury
  • Paraesthesia in upper or lower limbs
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9
Q

When is a person low risk for C spine injury?

At least one of the following…

A
  • Involved in minor rear-end motor vehicle collision
  • Comfortable in sitting position
  • Ambulatory at any time since injury
  • No midline cervical spine tenderness
  • Delayed onset of neck pain
  • Unable to actively rotate their neck 45 degrees to left and right
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10
Q

Signs of tension pneumothorax

A
  • Diminished breath sounds
  • Hyperesonance
  • Distended neck veins
  • Deviated trachea
  • Hypoxia
  • Tachycardia
  • Hypotension
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11
Q

Airway and c spine management (4)

A

-Immobilise the C-Spine*
-Provide oxygen
-Assess airway - Look, listen, feel
-Proceed to RSI if indicated

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12
Q

Open pneumothorax

A
  • Wound to chest wall communicating with pleural cavity
  • More than 2/3 aperture of trachea
  • Air moves down pressure gradient into pleural space
  • Wound seals on expiration
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13
Q

Tx for tension pneumothorax

A

Thoracostomy followed by large bore chest drain (if chest wall is too thick)

Needle thoracocentesis - 2nd IC space mid clavicular line

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14
Q

What is a massive haemothorax

A

Defined as over 1500ml blood in the lung space

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15
Q

Massive haemothorax what do you do if there is >1500ml blood or >200ml/hr

A

consideration urgent thoracotomy

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16
Q

What is the triad of cardiac tamponade?

A

Beck’s triad
* Hypotension
* Diminished heart sounds
* Distended neck veins

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17
Q

What is flail chest

A

Fracture of 2 or more ribs in 2 or more places causing ventilators failure

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18
Q

Treatment of flail chest

A

Intubation to help ventilation

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19
Q

What is the treatment of cardiac tamponade?

A

Pericardiocentesis

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20
Q

Secondary survey injuries - (ones that wont kill you immediately)

A

Simple pneumothorax
Aortic injuries
Diaphragmatic injuries
Fractured ribs
Lung contusion
Cardiac contusion

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21
Q

Signs of a bleeding patient

A
  • Sweaty/diaphroetic
  • Anxious/confused
  • Pallor/periopherally cold
  • Tachycardia
  • Tachypnoea
  • > CRT
  • Narrow pulse pressure
  • Hypotension
  • Bradycardia
  • Arrest
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22
Q

Places you can bleed to death from: (‘Blood on the floor and 4 more’)

A
  • External haemorrhage
  • Chest
  • Abdomen
  • Pelvis
  • Long bones
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23
Q

Indications for emergency laparotomy

A
  • Peritonism
  • Radiological evidence of free air
  • GI haemorrhage
  • Persistent/resistant haemodynamic instability
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24
Q

What are the long bones in the body?

A
  • Humerus
  • Femur
  • Tibia
  • Metacarpals
  • Fibula
  • Radius

Bold ones = clinically important (vascular so can bleed more from these)

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25
Q

Blood product administration in trauma: what do you give?

A
  • Blood for blood
  • Clotting factor
  • Tranexamic acid
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26
Q

What is a pelvic binder

A

Aim to reduce and stabilise pelvic fractures and stop bleeding e.g sheet and cable ties

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27
Q

Triangle of death in acute medicine

A

Coagulopathy
Acidosis
Hypothermia

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28
Q

Indications for blood product administration in trauma

A
  • Systolic blood pressure < 90
  • HR > 130mmHg
  • Reduced consciousness level
  • Obvious massive ongoing blood loss
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29
Q

Indications for blood product administration in trauma (4)

A

Systolic blood pressure <90*
HR >130mmhg
Reduced conscious level
Obvious massive ongoing blood loss

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30
Q

How to stop bleeding in trauma

A

Pelvic binder
Splint long bone fractures
Permissive hypotension
Tranexamic Acid 1g 10min then 1g infusion
Emergent damage control surgery
Interventional radiology
Limit crystalloid

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31
Q

Categories of head injuries

A

Primary injury:
* the incident

Secondary injury:
* hypoxic injury
* hypoperfusion
* hypoglycaemia

32
Q

Assessment of neurology in primary survey injury (4)

A

-AVPU
-Pupillary size and response
-Motor score of GCS most predictive outcome
-Sensory level if able

33
Q

What is Cushing’s triad?

ICP rise

A
  • Hypertension
  • Bradycardia
  • Irregular breathing
34
Q

How to manage head injury

A
  • Prevent secondary brain injury
  • Secure airway (GCS < 8 or need to control ventilation)
  • Maintain normal ICP/Glucose/O2/CO2
35
Q

What is done in an Exposure of A-E

A

-Look for limb threatening injuries
-Ensure patient is kept WARM
-consider bedside test e.g x rays
-pain relief

36
Q

Reversible causes of cardiac arrest (4)

A

HOTT
-hypovolemia
-hypoxia
-tension pneumothorax
-cardiac tamponade

37
Q

What is a FAST scan

A

Focused assessment with sonography in trauma

-where quick assessment of patients condition is necessary/ when CT scan is delayed

38
Q

What is flail chest associations

A

Marker for chest trauma:
Pulmonary contusion/ laceration
Pneumothorax
Haemothorax

39
Q

Complications of pelvic fracture

A

-retroperitoneal haemorrhage
-bladder/uretheral rupture
-perforation

40
Q

What are the 3 types of pelvic fracture?

A
  • AP compression - ‘open book’ fracture
  • Vertical shear - unilateral pubic rami fracture
  • Lateral compression
41
Q

What is a pelvic open book fracture

A

Pelvis is opened up due to disruption to the pelvic ring spreading the pubic symphysis and/or fractures pubic rami

42
Q

How does open book pelvic fracture usually occur

A

Anteroposterior compression force

43
Q

What is pelvic vertical shearing injury

A

-vertical, unilateral fractures of the pubic rami
-vertical fracture of the sacral foramina on the same side

44
Q

What is a malgaigne fracture

A

A vertical shear fracture involving one side of the pelvic ring

-usually caused by high energy vertical shear force e.g motor vehicle accident

45
Q

What is bucket handle fracture

A

A pelvic ring injury characterized by fractures or disruptions on opposite sides of the pelvis.

-usually caused by lateral compression force such as side impact motor vehicle collision

46
Q

What is a Jefferson fracture

A

Fracture to C1 (atlas)
-a burst fracture due to C1 ring is disrupted in multiple places

47
Q

Cause of Jefferson fracture

A

Axial compression
-e.g diving head first into shallow water

48
Q

What is hangmans fracture

A

The fracture involves the pedicles of C2 and often results in anterior displacement of the body and peg of C2.

-caused by hyperextension and axial loading

49
Q

What is a flexion teardrop fracture

A

-Fracture of the cervical spine caused by sudden pull of the anterior longitudinal ligament on the anterior.
inferior aspect of the vertebral body

-due to extreme hyperextension of the neck

50
Q

What is a Burst fracture

A

Axial loading most often due to motor vehicle accidents - cause severe compression.

-leads to bin fragments being displaces into the spinal canal - lead to nerve damage

51
Q

When do you use body CT

A

Common visceral inJuries e.g spleen, liver , kidney

52
Q

Gold standard imaging for trauma

A

CT

53
Q

Indications for a CT in trauma

A

1.Haemodynamic instability
2.Mechanism of injury — more than one system/body part
3.Findings on plain film/FAST scan are inconclusive or suggestive of injury.
4.Obvious severe injury

54
Q

What age counts as an ‘older patient’

A

over 65

55
Q

What is the difference in mechanism of injury between younger and older patients?

A
  • Younger: usually road traffic collisions, blows, shooting/stabbing
  • Older: usually falls (< 2m = falling from standing)
56
Q

What is physiologically different regarding respiratory system in older patients?

A
  • Increased chronic resp illnesses (COPD, emphysema, lung cancer)
  • Lower chest wall compliance (makes ventilation more difficult)
  • Higher rates of kyphosis (reduces space for lung expansion = reduces ventilation)
  • All of above = higher risk of hypoxia & hypercapnia
57
Q

What is physiologically different regarding cardaic system in older patients?

A
  • HTN & orthostatic BP changes
  • Reduced cardiac output
  • Increased vascular resistance (due to ‘stiff’ vessels/ atherosclerosis)
  • Heart failure
58
Q

What is physiologically different regarding neurological system in older patients?

A
  • Dementia - makes Hx taking difficult, pt doesn’t remember falling
  • Brain atrophy = more space for bleeding without mass effect (worsened by alcohol use)
59
Q

How can frailty lead to trauma?

A
  • Fragile skin = significant tearing with even minor mechanisms
  • Brittle bones = osteoporosis
  • Prone to infection = can cause falls
  • Polypharmacy = increased falls risk
  • Reduced mobility = increased risk of rhabdomyolysis, pressure damage & hypothermia
60
Q

What is shock?

A

Circulatory failure
* tissue hypoperfusion
* energy deficit
* accumulation of metabolites

61
Q

What is the pathophysiology of shock?

A

Inadequate perfusion -> cullular hypoxia -> energy deficit -> lactate build up -> metabolic acidosis -> cell memb dysfunction -> intracellular lysosome release -> toxic substances enter circulation -> capillary endothelial damage -> further destruction/dysfunction/cell death

62
Q

Causes of shock?

Think of plumbing: fluid, pump, pipes…

A

Fluid:
* Hypovolaemic
* Haemorrhagic

Pump:
* Cardiogenic - ischaemic, arrhythmia
* Obstructive - tension PTX, PE, tamponade

Pipes:
* Distributive - neurogenic, endocrine
* Septic
* Anyphylactic

63
Q

How do you treat hypovolaemic shock?

A
  • Fluid +++
  • Vasopressor ++
  • Inotrope -
64
Q

How do you treat septic/anaphylactic shock?

A
  • Fluid ++
  • Vasopressor ++
  • Inotrope +/-
65
Q

How do you treat cardiogenic shock?

A
  • Fluid +/-
  • Vasopressor -
  • Inotrope ++
66
Q

What are the 5 Rs of prescribing IV fluids?

A
  • Resuscitation
  • Routine maintenance
  • Replacement
  • Redistribution
  • Reassessment
67
Q

Who is exempt from receiving IV fluid therapy as per the NICE guidelines?

These people require more specialist fluid therapy

A
  • < 16
  • Pregnant
  • pt receiving inotropes
  • Burns
  • Severe liver / renal disease
  • Diabetes
68
Q

What is the distribution of fluid in the body?

A
  • Total body weight - 42L
  • Intracellular fluid (2/3 of TBW) - 28L
  • Extracellular fluid (1/3 of TBW) - 14L
  • Interstitial fluid (2/3 of ECF) - 9L
  • Intravascular fluid (1/3 of ECF) - 5L
69
Q

Definition: Osmolality

A

osmoles per kg of solvent

70
Q

Definition: Osmolarity

A

osmoles per L

71
Q

Definition: Tonicity

A

Ability of a solution to cause water movement

72
Q

What are the 2 types of fluid?

A
  • Crystalloids
  • Colloids
73
Q

Give 3 examples of crystalloids

A
  • 0.9% saline
  • Hartmann’s solution
  • Dextrose (5%,10%)
74
Q

Give some artificial and organic examples of colloids?

A

Artificial:
* Gelofusine
* Hetastarch

Organic:
* Blood
* Albumin solutions

75
Q

What does vomiting lead to?

A
  • Loss of H+ ions and chloride along with fluid
  • Leads to hypochloraemic alkalosis
76
Q
A

Phase 3a - Arun&Erin (16 decks)

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