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Medicine Finals > Clinical Emergencies > Flashcards

Clinical Emergencies Flashcards

1
Q

What is the chest compression to ventilation ratio in adults?

A

30:2

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2
Q

What is the chest compression to ventilation ratio in children?

A

15:2

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3
Q

What are shockable rhythms?

A

Ventricular fibrillation

Pulseless ventricular tachycardia

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4
Q

How do you manage cardiac arrest with a non-shockable rhythm?

A

Start chest compressions at 30:2

1mg Adrenaline 1:10,000 ASAP

Recheck pulse every 2 mins

Repeat 1mg Adrenaline every other cycle

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5
Q

How do you manage a cardiac arrest with a shockable rhythm?

A

Single shock followed by 2 mins of compressions (UNLESS: Witnessed arrest in a monitored patient, then give 3 shocks)

Check pulse every 2 mins and repeat shock + compressions

1mg Adrenaline 1:10,000 and 300mg Amiodarone after 3rd shock

1mg Adrenaline given every 3-5 mins

Can give 150mg Amiodarone after 5th shock

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6
Q

What are the reversible causes of cardiac arrest?

A

4 H’s and 4 T’s

Hypoxia, hypothermia, hypovolaemia, hypokalaemia/hyperkalaemia/hypoglycaemia/hypocalcaemia

Tension pneumothorax, tamponade, thrombosis, toxins

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7
Q

How do you manage suspected sepsis?

A

SEPSIS 6

3 in - fluids, abx, oxygen

3 out - cultures, lactate, urine output

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8
Q

What are paediatric red flag signs?

A

Pale/mottled skin

Unresponsive/does not wake or stay awake

Continuous cry

Resp: Grunting, tachypnoea >60, chest recessions

Reduced skin turgor

Aged <3 months with a temp of 38 or higher

Non-blanching rash

Bulging fontanelle

Neck stiffness

Status epilepticus

Focal neurological signs

Focal seizures

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9
Q

How does anaphylaxis present?

A 
Symptoms:
SOB
Itching
Abdomina pain
Lightheadedness
Signs:
Urticaria
Angioedema
Wheeze
Hypotension
Tachycardia
Stridor due to laryngeal oedema
Shock
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10
Q

What type of hypersensitivity reaction is anaphylaxis?

A

Type 1 Hypersensitivity reaction

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11
Q

How do you manage anaphylaxis

A

ABCDE

A - secure airway
B - provide O2 if required
C - provide IV bolus
D - lie patient flat to prevent cerebral oedema
E - flushing? angioedema? urticaria?

IM Adrenaline - REPEAT AFTER 5 mins

Antihistamines - Oral Chlorphenamine

IV Hydrocortisone

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12
Q

What are symptoms of hypoglycaemia?

A

Can be split into early ADRENERGIC symptoms and late NEUROGLYCOPENIC symptoms

Adrenergic = sweating, tachycardia, palpitations, pallor, hunger, restlessness

Neuroglycopenic = confusion, slurred speech, drowsiness, numbness of extremities, anxiety, blurred vision

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13
Q

How do you manage hypoglycaemia?

A

Conscious patient = Oral glucose

Unconscious/drowsy/unable to swallow =

If IV access = IV Glucose 10% or 20%

No IV access = IM Glucagon (only once, then switch to IV)

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14
Q

How do you manage DKA?

A

Fluid resus:

Adults = 500ml 0.9% NaCl over 15 mins

Children = 10ml/kg 0.9% NaCl over 15 mins

Insulin at 0.1 units/kg/hr

Check potassium regularly - hypokalaemia may occur due to insulin pushing potassium into cells

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15
Q

How fast should the ketones and glucose fall in DKA?

A

Ketones should fall by 0.5mmol/l per hour

Glucose should fall by 3mmol/l per hour.

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16
Q

Which diabetic drug is most likely to cause DKA?

A

SGLT2 inhibitors

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17
Q

How to manage HHS?

A

1L 0.9% NaCl per hour!!

Replace potassium if below 5.5

Aim for glucose reduction of 5mmol/l per hr

Insulin DOES NOT form part of initial management plan

If glucose has stopped dropping with fluids alone can start insulin at 0.05U/kg/hr.

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18
Q

What are causes of metabolic acidosis? (Normal anion gap and raised anion gap)

A

Normal anion gap = diarrhoea, renal tubular acidosis, Addison’s disease

Raised anion gap = DKA, alcohol, shock, sepsis, hypoxia, renal failure, methanol

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19
Q

In hyperkalaemia, what drug can be used to stabilise the cardiac membrane?

A

IV Calcium gluconate

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20
Q

In Hyperkalaemia, what can be used to quickly reduce serum potassium?

A

IV insulin (+Dextrose)

Nebulised salbutamol

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21
Q

In hyperkalaemia, what other drugs can be used to remove potassium from the body?

A

Calcium resonium

Loop diureics

Dialysis - if AKI and hyperkalaemia is not resolving w/ fluids

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22
Q

What is status epilepticus and how is it managed?

A

A tonic clonic seizure lasting more than 5 mins OR two or more seizures consecutively without full recovery in between

ABCDE

If IV Access: IV Lorazepam 4mg - can repeat once after 10-20 mins

If no IV access: Buccal midazolam or rectal diazepam

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23
Q

What is a thyrotoxic storm and how is it managed?

A

Emergency presentation of hyperthyroidism

Fever, Tachycardia, confusion/agitation, nausea+vomiting, HTN

Management = IV Dexamethasone + IV Propranolol + IV Propylthiouracil + fluid resus

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24
Q

What is myxoedema coma and how is it managed?

A

Emergency presentation of hypothyroidism

Fluid resus + IV Thyroid replacement + IV Hydrocortisone

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25
Q

How does an Adrenal crisis present and how is it managed?

A

Reduced consciousness

Hyperkalaemia

Hyponatraemia

Hypoglycaemia

Hypotension

Management = IV Hydrocortisone + IV fluids + treatment of hypoglycaemia

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26
Q

How do you manage a major postpartum haemorrhage?

A
  1. Oxygen
  2. Uterine massage + bimanual compression
  3. Insert 2 large bore cannulas –> Crossmatch
  4. IV fluids
  5. Assess patient’s obs and fluid status
  6. Assess cause (consider 4 T’s)
  7. IM Oxytocin + Ergometrine
  8. Tranexamic acid
  9. Oxytocin infusion
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27
Q

What is the haemoglobin transfusion threshold?

A

<70

or <80 in ACS

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28
Q

What marker should you test for in anaphylaxis and when should you do it?

A

Serum mast cell tryptase
within 6 hours

Confirms diagnosis of anaphylaxis

29
Q

What is the platelet transfusion threshold?

A

xx

30
Q

How is malignant hypertension managed?

A

IV sodium nitroprusside/IV labetalol

31
Q

What are non-shockable rhythms?

A

Asystole

Pulseless electrical activity

32
Q

What is paediatric basic life support?

A

Give 5 rescue breaths (before starting chest compressions)

Start CPR at 15:2

33
Q

Which pulse do you check in children?

A

Infants under 1 years old = Brachial or femoral

Children over 1 years old = Carotid or femoral

34
Q

What are features of DKA?

A

X

35
Q

What are features of HHS?

A

Severe hyperglycaemia
Hyperosmolality

No ketonaemia or acidosis

36
Q

How to calculate anion gap?

A

(K + Na) - (HCO3 + Cl)

Normal = 10-18

37
Q

What is malignant hypertension and how is it managed?

A

Sudden onset extremely high BP , systolic >180 or diastolic >120

With acute end-organ damage –> Hypertensive retinopathy, AKI, cardiac failure, stroke, aortic dissection

Management = IV sodium nitroprusside / IV Labetalol

38
Q

What are risks of status epilepticus?

A

Neurological - Brian injury
Respiratory - hypoxia, aspiration pneumonia
Cardiovascular - arrhythmias
Other - lactic acidosis, rhabdomyolysis, hypo/hyperglycaemia

39
Q

How does paracetamol overdose present?

A 
Nausea and vomiting
Loin pain/Abdominal pain
Haematuria
Jaundice
Metabolic acidosis
40
Q

How is paracetamol overdose management?

A

Less than 1 hour ago = Activated charcoal
Staggered overdose = NAC
Between 1 and 4 hours ago = Wait til 4 hours
>4 hours = Nomogram

Give NAC if indicated by nomogram

41
Q

How does salicylate overdose present?

A 
TINNITUS
Nausea and vomiting
Abdominal pain
Sweating, fever
Confusion

Bounding pulse
Cardiac arrhythmias

Respiratory alkalosis and then metabolic acidosis!!!

42
Q

How is salicylate overdose managed?

A

IV Bicarbonate

If severe - haemodialysis

43
Q

How does opioid overdose present?

A

Decreased resp drive
Bradycardia
Loss of consciousness

44
Q

How is opioid overdose managed?

A

Naloxone

45
Q

How is benzodiazepine overdose managed?

A

Supportive care
Within 1 hour = Activated charcoal

if severe - Flumazenil

46
Q

How does tricyclic overdose present? What is seen on ECG?

A 
Arrhythmias
Seizures
Metabolic acidosis
Coma
Hypothermia
Hyperreflexia

ECG changes = Sinus tachycardia, Broad QRS, QT prolongation

47
Q

How is tricyclic overdose managed?

A

If within 1 hour = Activated charcoal

If more than 1 hour = IV sodium bicarbonate

48
Q

How dose lithium overdose present?

A 
Coarse tremor
Diarrhoea
Nausea and vomiting
Hyperreflexia
Seizure
Coma
49
Q

How is lithium overdose managed?

A

Supportive care with normal saline

If severe - haemodialysis

50
Q

How is beta blocker overdose managed?

A

If bradycardic - atropine

Note: Sotalol can cause QT prolongation

51
Q

How is ethylene glycol poisoning managed?

A

Fomepizol

Ethanol

52
Q

How is methanol poisoning managed?

A

Fomepizol

53
Q

How is insecticide poisoning managed?

A

Atropine

54
Q

How does lead poisoning present?

A 
Abdominal pain
Peripheral neuropathy
Blue lines on gum margin
Fatigue
Constipation

Blood film= basophilic stippling

55
Q

How is lead poisoning managed?

A 
Chelating agents
dimercaptosuccinic acid (DMSA)
D-penicillamine
EDTA
dimercaprol
56
Q

How does carbon monoxide poisoning present?

A

Cherry red skin
Confusion
Nausea + vomiting
Tachycardia

Sats probe will show 100%

57
Q

How is carbon monoxide poisoning managed?

A

100% oxygen

58
Q

How is cyanide poisoning managed?

A

Hydroxocobalamin

59
Q

How is cocaine poisoning managed?

A

Diazepam

60
Q

How is ecstasy poisoning managed?

A

Diazepam

61
Q

How is alcohol withdrawal managed?

A

Chlordiazepoxide or Diazepam

If seizing / delirium tremens = Lorazepam

62
Q

How is suspected spinal cord compression managed?

A

Whole spine MRI

Dexamethasone

63
Q

What triad is seen in raised ICP?

A

Cushing’s triad
Wide pulse pressure
Bradycardia
Irregular breathing

Other symptoms:
Headache
Vomiting
papilloedema

64
Q

What is normal ICP?

A

7-15

65
Q

How is raised ICP managed?

A

Elevate head to 30 degrees
IV Mannitol
Controlled hyperventilation

66
Q

What are indications for BiPAP (NIV)?

A

COPD

67
Q

What are indications for CPAP?

A

Heart failure

Obstructive sleep apnoea

68
Q

How do you manage someone who is choking?

A

Mild airway obstruction (they are still able to talk) - encourage them to cough

If severe airway obstruction(unable to talk) but conscious-
give up to 5 back-blows
if unsuccessful give up to 5 abdominal thrusts
if unsuccessful continue the above cycle

If unconscious-
call an ambulance
start CPR

Medicine Finals (32 decks)

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