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Gen Med and Surg - C.U > Acute medicine > Flashcards

Acute medicine Flashcards

1
Q

Thermal burns initial first aid

A 
ABCDE 
Within 20mins irrigate the burn 
Prevent hypothermia 
Lay cling film over the burn 
Elevate the area to prevent oedema 
Give pain relief
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2
Q

Chemical burns initial first aid

A

ABCDE
Remove affected clothing
Brush off agent if dry
Irrigate for an hour

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3
Q

Superficial epidermal burns advice

A

Cool bath / shower
Topical emollients
Cold compress
Simple analgesics

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4
Q

When should people with superficial burns seek further help

A

Blister formation - may indicate further dermal injury

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5
Q

What prophylaxis is important with burns

A

tetatnus

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6
Q

Investigations to order in those with burns

A

FBC
U and Es
Carboxyhaem
ABG

CT head/ spine
Wound biopsy culture / histology

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7
Q

outpatient management of cutaneous burns

A

wound cleaning (topical)

topical AB prophylaxis

Tetanus prophylaxis

Opioid analgesic

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8
Q

inpatient care of cutaneous burns

A

burn centre assessment
fluid resuscitation
supportive care
tetatnus immunicsation

Surgery?

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9
Q

Suspected wound infection in a burn, treatment?

A

AB and surgical debridement

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10
Q

4 cardiac rhythmic disturbances leading to cardiac arrest

A

VF
Pulseless VT
Pulseless electrical activity
Asystole

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11
Q

Bed side tests in a cardiac arrest

A 
ABG
Lactate 
FBC 
Toxicology 
Troponin 
Electrolytes and glucose

ECG
CXR

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12
Q

First line management in unwitnessed cardiac arrest

A

CPR

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13
Q

Shockable rhythms

A

pulseless VT and VF

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14
Q

1st line in shockable rhythms

A

CRP + defib + adrenaline 1mg every 3-5 mins

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15
Q

If IV access is not available in a shockable arrest how do you give the adrenaline

A

2mg diluted through an endotracheal tube

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16
Q

1st line in non shockable rhythms

A

CRP + adrenaline 1mg every 3-5 mins

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17
Q

Which anti arrhythmic can be considered in cardiac arrest

A

amiodarone

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18
Q

Return of spontaneous circulation management

A

ABCDE
Aim for SpO2 94-98%
12 lead ECG
treat precipitating cause

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19
Q

How often do you assess the rhythm in a cardiac arrest?

A

every 2 minutes

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20
Q

1st line in hypoglycaemic episode

A

Oral glucose - if alert

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21
Q

2nd line management of hypoglycaemic episode

A

IV glucose 20% in saline - if IV access and drowsy

IM glucagon - no IV access

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22
Q

Causes of hypoglycaemia

A

Insulin
Alcohol
Liver disease
Addisons

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23
Q

Ddx for meningitis

A

Encephalitis
Septicaemia
Subarachnoid

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24
Q

Kernigs sign

A

Pain on passive knee extension when the hip is flexed

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25
Q

1st line investigations in meningits

A 
Blood culture 
FBC
CRP 
UandE 
Calcium 
Magnesium 
Glucose 
Coag profile 
CT head 
LP
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26
Q

1st line antibiotic in meningitis

A

Cefotaxime / ceftriaxone

+ Vanc

> 50 give ampicillin too

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27
Q

Septicaemia means what should NOT be done (in the context of a meningitis hx)

A

LP

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28
Q

2nd line medical management of meningitis

A

Dex

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29
Q

predominant cell type in an LP from a pt with

1) bacterial meningitis
2) viral

A

polymorphs

mononuclear

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30
Q

glucose levels in an LP from a pt with

1) bacterial meningitis
2) viral

A

1) < 1/2 plasma

2) > 1/2 plasma

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31
Q

protein levels in an LP from a pt with

1) bacterial meningitis
2) viral

A

1) >1.5

2) <1

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32
Q

when to suspect encephalitis

A

abnormal behaviour
reduced consciousness
focal neurological signs

PRECEEDED BY INFECTIOUS ILLNESS

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33
Q

Investigations in encephalitis

A

Urine dip
Blood cultures
CT -
LP - send for PCR

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34
Q

Blood tests in suspected poisoning

A 
Glucose
UandEs 
FBC 
LFT
INR 
ABG 
Paracetamol and salicylate levels 
Toxicology
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35
Q

Monitoring in suspected poisoning

A

Vital signs
ECG
Urine output

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36
Q

1st line in patients presenting <4hrs after OD on paracetamol

A

Activated charcoal

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37
Q

When should blood paracetamol level be taken

A

4hr post ingestion

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38
Q

If patient levels above the treatment line and stable and OD <10-12hrs ago give what?

A

n-acetylcysteine - IV with dextrose after level

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39
Q

Day after paracetamol OD check

A

INR
UandE
LFTs

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40
Q

If unsure when taken paracetamol OD / staggered OD

A

Give n-acetylcysteine without waiting for levels

41
Q

septic shock definition

A

subset of sepsis, coexistance of persistent hypotension. requiring vasopressors to maintain MAP

42
Q

sepsis definition

A

life threatening organ dysfunction due to dysregulated host response to infection

43
Q

Differentials for sepsis

A

SIRS
MI
Acute pancreatitis
PE

44
Q

Maintenance fluid calculation

A

30ml/kg/24hrs

then work out how many ml per hour

45
Q

simple fluid maintenance prescribing

A

1 saline
2 dextrose

each with 20mmol of potassium

46
Q

NSTEMI risk stratification tool

A

GRACE

47
Q

Blood to take in a suspected overdose

A 
Paracetamol 
Salicyltate levels 
Clotting screen 
LFTs 
FBC
UandEs
48
Q

Side effects of NAC

A

Hypoglycaemia
Bronchospasm
Shock
Vomiting

49
Q

What to look for in a patient when assessing airway?

A

Full sentences
Added sounds
Using accessory muscles

50
Q

How much oxygen should be given to patients in an acute situation?

A

15L through non rebreath mask

51
Q

How much should adrenaline be given to an adult in suspected anaphylaxis?

A

1:1000 5ml 500 micrograms

52
Q

How much naloxone should be given to a pt with opioid overdose?

A

400 micrograms IV

53
Q

Criteria for CT scan in head injury?

A

For adults who have sustained a head injury and have any of the following risk factors, perform a CT head scan within 1 hour of the risk factor being identified:

GCS less than 13 on initial assessment in the emergency department.

GCS less than 15 at 2 hours after the injury on assessment in the emergency department.

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.

54
Q

Mneumonic for a quick hx in an emergency situation

A

AMPLE

allergies
medication 
PMH
Lead up to PC 
Eat and drank last?
55
Q

Medications in anaphylaxis

A

Adrenaline - 0.5ml of 1:1000 or 0.5mg IM

Chlorphenamine - 10mg
Hydrocortisone - 200mg

56
Q

Blood to take in an acute situation

A 
FBC
UandE 
LFTs
CRP 
Group and save (consider cross match) 
VBG - glucose and lactate 
Clotting 
Glucose

consider ABG

57
Q

Initial management of a GI bleed

A 
Protect airway
NBM
Two large bore cannulae in AQF
Blood including coag, G&amp;S and cross match 
Catheterise - urine output 
Obs every 15mins o
58
Q

GI bleed fluid management

A

Normal saline fast until blood arrives

Consider FFP for low platelets

Correct coagulopathy

59
Q

Immediate investigation in upper GI bleed

A

OGD

60
Q

If variceal bleed identified on OGD give what

A

Broad spectrum AB and talopressin

61
Q

Impratropium dose in acute asthma

A

500 micrograms

62
Q

Bloods in meninigits

A 
FBC
UandE
LFT
Coag
Group and save
CRP
PCR serology
blood cultures 
EBV
HIV
HSV
63
Q

1st seziure presentation what is likely

A

structural brain abnormality >50%

64
Q

Investigations in status epilepticus

A

bedside - urine dip and culture, observations, ECG

bloods - FBC, U&E, LFT, glucose, lactate, VBG, CRP, Ca2+

Consider - toxicology screen

  • CT
  • EEG
65
Q

Initial management of SE

A

ABCDE

Slow IV bolus of lorazepam 2-4mg

Can give another dose if no response in 10 mins

OR rectal diazepam

66
Q

If no response to lorazepam what could be given next in SE?

A

If due to ?alcohol - thiamine

blood glucose low - start with 50ml of 20% glucose

Treat acidosis

Treat hypotension

IV infusion of phenytoin

67
Q

Definitive management of SE

A

General anaesthetic

68
Q

shock definition

A

circulatory failure resulting in inadequate organ perfusion

69
Q

MAP =

A

CO X SVR

70
Q

CO =

A

HR X Stroke volume

71
Q

Causes of inadequate CO

A

Hypovolaemia - bleeding / fluid loss

Pump failure - arrythmia, ACS, valve failure

72
Q

Causes of loss of SVR

A

Sepsis
Anaphylsxis
Neurogenic
Endocrine disorder - e.g. addisons

73
Q

Presentation of ecstasy poisoning (MDMA)

A

Agitation, anxiety, confusion and ataxia

CV - tachycardia, hypertension

Hyponatraemia

Hyperthermia

Rhabdomyloysis

74
Q

Treatment of hyperthermia in ecstasy poisoning if supportive therapy doesn’t work?

A

Dantrolene

75
Q

MOA of cocaine

A

Blocks uptake of dopamine, noradrenaline and serotonin

76
Q

CV effects of cocaine

A 
MI 
Tachy and bradycardia 
Hypertension 
QRS widening and QT prolongation 
Aortic dissection
77
Q

Neurological effects of cocaine

A

Seizures
Mydraisis
Hypertonia
Hyperreflexia

78
Q

In patients who have taken cocaine and have abdo pain, consider?

A

Ischaemic colitis

79
Q

Systemic SE of cocaine

A

Hyperthermia
Metabolic acidosis
Rhabdomyolysis

80
Q

1st line in cocaine toxicity

A

Benzodiazipines

81
Q

Features of opioid misuse

A 
Pinpoint pupils 
Drowsiness 
Rhinorrhoea 
Watering eyes 
Yawrning 
Needle track marks
82
Q

Complications of opioid misuse

A

Viral infection
Infective endocarditis
VTE
Overdose - resp depression and death

83
Q

Emergency management of opioid overdose

A

IV or IM naloxone

84
Q

meaning of organ contusion

A

brusing

85
Q

Extradural haematoma is

A

Bleeding between dura and the skull - arterial

86
Q

Majority of extradural haematomas caused by?

A

skull fractures to the temporal bone causing rupture of the middle meningeal artery

87
Q

Presentation of extradural haematoma

A

Quicker onset than subdural

features of raised ICP

May have a lucid interval

88
Q

What is subdural haematoma?

A

bleeding of the outermost layer of the meninges - venous

89
Q

risk factors for a subdural haematoma?

A

Old age
Alcoholism
Anticoagulation

90
Q

presentation of subdural haematoma

A

a little while after a fall, become drowsy etc

slow onset of symptoms

91
Q

Medications to reduce ICP

A

Mannitol and furosemide

92
Q

Minimum of cerebral perfusion pressure in adults

A

70 mmHg

93
Q

Unilateral dilation of one pupil and sluggish light response / fixed indicates?

A

3rd nerve palsy due to tentorial herniation

94
Q

Bilateral dilated pupils + sluggish or fixed pupils indicates?

A

Poor CNS perfusion

or bilateral 3rd nerve palsy

95
Q

Causes of bilaterally constricted pupils?

A

Opiates
Pontine lesions
Metabolic encephalopathy

96
Q

Causes of unilateral constricted pupil?

A

sympathetic pathway disruptiob

97
Q

Acute stroke management

A

Exclude haemorrhagic stroke

Then give 300mg Aspirin and then altepase within 4.5hrs

98
Q

Management of ketoacidosis

P
A
N
I
C
S
A

Potassium - measure hourly
Acidosis - check venous pH and ketone levels
Normal saline - bolus if BP <90 or 1L in 1st hr
Insulin infusion - 0.1 units/kg/hr
Catheter and culture - urine and bloods
Stomach aspiration if drowsy

Gen Med and Surg - C.U (16 decks)

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