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Emergency Medicine > Critically ill patient > Flashcards

Critically ill patient Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Purpose of NEWS?

A

Track deterioration and trigger of any needed escalation responses

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2
Q

Parameters monitored on news?

A 
RR
O2 sats
any inspired oxygen
BP
HR
AVPU
Glucose
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3
Q

If they are on inspired oxygen how many more points do they score?

A

2

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4
Q

What parameters change in MI or angina?

A

They dont change till patient starts to decline

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5
Q

Why is RR and O2 not always a good representation of respiratory disease?

A

Doesn’t account for chronic respiratory disease or depth of breath

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6
Q

What RR gets 2 points? 3 points?

A

you want RR to be 12-20
RR 9-11 get 1 point
RR 21-24 gets 2 points
RR 8 and below or 25 and above gets 3 points

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7
Q

What Oxygen saturation gets 2 points? 3 points?

A

want it 96 or above
94-95 get 1 point
92-93 get 2 points
91 or below get 3 points

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8
Q

What temperature do you get 1 point? 2 points? 3 point?

A

Want temperature at 37
If temperature is between 38 and 39 or between 36 and 35 then 1 point
If temperature is 39 or above its 2 points
If temperature is below 35 then its 3 points

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9
Q

On a NEWS chart, what BP gets 1 point? 2 points? 3 points?

A

Blood pressure below 90 systolic is 3 points or above 220 systolic
Blood pressure between 90-100 systolic gets 2 points
Blood pressure between 100-110 systolic gets 1 point

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10
Q

What Heart rate warrants 1 point on NEWS score? 2 points? 3 points?

A

1 point between 90 and 110 and between 40 and 50
2 points between 110 and 130
3 points either over 130 or below 40

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11
Q

What conditions does HR on a NEWS chart not account for?

A

Rhythm problems or bradycardia caused by drugs like beta blockers

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12
Q

What are the main changes seen on a NEWS2 chart?

A

identify those likely to have sepsis
score over 5 needs urgent response
New recording for those with hypercapnic respiratory failure
AVPU changed to ACVPU for confusion, delirium

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13
Q

Why is colour scheme of NEWS2 different

A

Take into account for red green colour blindness

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14
Q

In ABCDE approach what is the A before airways?

A

Approach

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15
Q

What are you initially looking for in the approach to a patient?

A

End of bed inspection, patient cyanosed, breathing, comfortable, on oxygen, clammy, vomiting, do they have venous access, losing blood, UO, catheter, Conscious? speak to them

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16
Q

If a patient is unresponsive on approach what do you do?

A

Feel for a pulse - if none then CPR

17
Q

How do you assess the airways?

A

Look, listen, feel
Look - any see saw movements, accessory muscles
Listen - stridor, wheeze, snore, cough, gurgling
Feel - air flow

18
Q

If a patient has stridor or upper airway obstruction how are they managed? if they have c-spine injury?

A

Call for help
Head tilt chin lift
C-spine injury = jaw thrust

19
Q

After calling for help for airway obstruction what is the next action you take to support the patient?

A

Suction oropharynx to prevent aspiration and laryngospasm, you can then suction nasopharyngeal as long as there is no risk of base of skull fracture

20
Q

After suction to prevent aspiration what is the next stage you take in securing a patient presenting with stridor or upper airway obstruction? How does management change at this stage if they are in cardiac or respiratory arrest?

A

Oropharyngeal airway or LMA mask if they are cardiac or respiratory arrest

21
Q

What sats are you aiming for in someone presenting with respiratory or cardiac arrest? in severe COPD?

A

above 94

COPD aim for 88-92

22
Q

What are you looking for in breathing of ABCDE?

A

Any emergency signs - Acute severe asthma, tension pneumothorax, haemorrhage, pulmonary oedema

23
Q

Why is adequate oxygen saturations not the only essential aspect of respiratory failure to get under control?

A

Need adequate rate and depth of breathing as can still be hypercapnic

24
Q

How do you assess the breathing?

A

look, listen, feel
Look - breathing, tachypnoea, distress signs, cyanosis, accessory muscles, abdominal muscles, depth of breathing, symmetrical chest movement, chest drains, any deformities
Listen - wheeze, silent chest
Feel - respiratory exam, percussion note, central trachea, subcutaneous emphysema

25
Q

How do you initially act to treat a patients breathing in the ABCDE approach?

A

Sit them up 30 degrees
Call for help if the cause is trauma, blocked drains or there is no breathing
Give high flow oxygen to achieve sats of above 94 or between 88-92 in severe COPD

26
Q

How does your breathing management adapt if they have bronchospasm? if they have copd exacerbation? if they have atelectasis/sputum retention?

A

Bronchospasm = bronchodilators
COPD exacerbation = NIV
Atelectasis or sputum retention = physio

27
Q

What tests can you order at B in ABCDE?

A

ABG and CXR

28
Q

If a patient is hypovolaemic what is it important to ascertain before giving big fluid bolus? What can happen? how can you do this from simple assessment? When can you nor do this quick assessment?

A

ensure they are not in cardiac failure
it could cause a flash pulmonary oedema so give a smaller bolus of 250mls for example
Assess by raising legs on pillows and tilting head then reassessing BP, HR and respiratory distress for oedema (do not do in spinal injury or rasied ICP

29
Q

What do you assess in C of ABCDE?

A

CRT, BP, HR, warmth of peripheries
Auscultate - murmurs, tachycardia, arrythmias
Is there any abdominal distension

30
Q

When do you need to act immediately in C of ABCDE?

A

Sepsis
Cardiac tamponade
Haemorrhage

31
Q

If someone presents with sepsis, cardiac tamponade or haemorrhage what is your immediate management aligned with C? what monitoring is done both continuously and standard?

A

IV access large bore cannula
Take bloods for cultures and crossmatch
Give IV bolus of Haartmans or 0.9% saline 250-500mls over 15 mins
recheck BP every 5 minutes for systolic above 100
12 lead ECG - arrhythmia get cardiologist

32
Q

During reassessment of a patients circulation, what are you looking for? What would mean they need to go to ICU?

A

Seeing if their systolic has gone above 100, HR and perfusion if it hasn’t or they are hypotensive - ICU

33
Q

What neurological factors should you take into consideration for D in ABCDE?

A 
Sepsis
Hypoxia
Hypercapnia
CNS infection
Renal failure
Hepatic encephalopathy
Drugs/alcohol
Stroke
Seizures
Intracranial or intracerebral bleed
Hypo or hyperglycaemia
Malignant hypertension
34
Q

What things do you assess for in D of ABCDE?

A 
Glucose
Pupil reflexes
Seizure signs
Ammonia levels if hepatic failure
Any photophobia, neck stiffness
Medications
35
Q

What imaging is performed at D stage?

A

CT head

36
Q

When is naloxone given in opioid overdose? Why is naloxone treatment reassessed after an hour?

A

RR at 8 or below

reassessed as half life is 30-60 minutes which is shorter than the opioids

37
Q

If alcohol is thought to be the cause of the acutely unwell patient, what is given?

A

Pabrinex

Emergency Medicine (5 decks)

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