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EM Flashcards

1
Q

presentation of anaphylaxis

A

airway - swelling, stridor
breathing - SoB, wheeze, accessory muscle use, cyanosis
circulation: tachycardia, hypotensive, pale, clammy
skin: urticaria, erythema, angio oedema, pruritis
GI: N&V, diarrhoea, abdo pain

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2
Q

management of anaphylaxis

A

IM 1:1000 adrenaline
IV fluids
chlorphenamine
hydrocortisone

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3
Q

pathophysiology of anaphylaxis

A

IgE mediated: release of histamine and other proinflammatory mediators from mast cells and basophils
causes vasodilation and capillary leakage resulting in tissue swelling (airway obstruction) and volume depletion (shock)

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4
Q

what are the reversible causes of cardiac arrest

A

hypoxia, hypovolemia, hypo/hyperkalaemia, hypothermia

thrombosis, tension pneumothorax, tamponade, toxins

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5
Q

what are the shockable and non shockable rhythms is cardiac arrest

A

shockable
VF and pulseless VT

non shockable
Pulseless electrical activity and asystole

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6
Q

management of cardiac arrest

A 
CPR 30:2
shock if appropriate
give adrenalin every 5min
give amiodarone after 3 shocks
treat reversible causes
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7
Q

qSOFA

A

GCS < 13
RR >22
SBP < 90 or DBP < 60

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8
Q

SIRS

A

HR > 90
RR > 20
WCC <4 or > 12
temp > 38 or < 36

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9
Q

define sepsis and septic shock

A

sepsis
Life-threatening organ dysfunction due to dis-regulated host response to infection

septic shock
sepsis with refractory hypotension (criteria = sepsis + need for vasopressors to maintain MAP of at least 65 + lactate > 2)

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10
Q

markers of severe asthma attack

A

PEF < 50%
RR > 25
HR > 110
cannot complete sentences

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11
Q

markers of life threatening asthma attack

A

SpO2 < 92
silent chest, cyanosis, poor respiratory effort
arrhythmias or hypotension
exhaustion or altered consciousness

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12
Q

management of acute asthma attack

A

moderate = 4 puffs salbutamol then 2 puffs every 2 mins for 10 min -> reassess -> discharge/repeat salbutamol

severe = salbutamol nebs + oral prednisolone -> reassess ->discharge/repeat

life threatening = ICU input, salbutamol nebs + ipratropium nebs + oral pred/IV hydrocortisone
repeat nebs in 15 mins
consider continuous nebs or IV magnesium sulphate
patient will require admission

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13
Q

management of acute COPD exacerbation

A 
oxygen - aim of 88-92%
salbutamol and ipratropium nebs
oral pred/IV hydrocortisone
antibiotics if pyrexial 
consider aminophylline
consider IV magnesium (if wheeze is main component)
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14
Q

investigations for cardiac chest pain

A 
ECG
HSTnT
routine bloods
Lipid profile
consider: d dimer, chest x ray, glucose, ECHO
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15
Q

what position and artery do each ECG leads correspond to

A

V1 - V4 = anterioseptal/posterior (depression) - LAD/RCA or LCx
V5 - V6 = apical - LCx
I, aVL = lateral - LCx
II, III, aVF = inferior - RCA

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16
Q

pathophysiology of paracetamol overdose

A

paracetamol is metabolised into a toxic substance
normally this is bound to glutathione in the liver to form a non toxic compound which is excreted
however in an overdose the liver’s glutathione stores are depleted meaning the toxic metabolite builds up causing hepatic injury

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17
Q

management of paracetamol overdose

A

if presents within 1 hour of ingestion = activated charcoal
if within 2-8 hours = measure paracetamol levels at 4hrs, NAC if over the normal
with in 8-24 hours = give NAC, measure paracetamol level, discontinue if normal with no evidence of AKI or hepatic injury
> 24 hours = NAC if jaundice, hepatic tenderness, INR > 1.3 or ALT > 2xULN

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18
Q

investigations for paracetamol overdose

A 
paracetamol levels
LFTs
U&Es - AKI
INR
ABG - lactate acidosis
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19
Q

what is the toxic dose for paracetamol toxicity

A

> 150mg/kg over 24 hours

20
Q

presentation of opioid overdose

A

CNS depression/coma

bradycardia, bradypnoea, hypotension, hypothermia

21
Q

management of opioid overdose

A

A-E
observation
naloxone if RR<8, SpO2<94, type 2 resp. failure

22
Q

presentation of sedative overdose

A

confusion/coma

bradycardia, bradypnoea, hypotension, hypothermia

23
Q

management of sedative overdose

A

A-E
for benzodiazepines = flumazenil if resp. depression
for barbituates = charcoal hemoperfusion or haemodialysis

24
Q

drugs that can cause serotonin syndrome

A 
SSRI
lithium
triptans
MAOI
cocaine
25
Q

presentation of serotonin syndrome

A

tachycardia, tachypnoea, hypertension, hyperthermia

sweating, flushing, tremor, D&V, agitation

26
Q

management of serotonin syndrome

A

benzodiazepines for agitation and muscle relaxation
cyproheptadine is the antidote
IV fluid if rhabdomyolysis

27
Q

drugs that can cause anticholinergic overdose

A

antihistamines
antipsychotics
TCA

28
Q

presentation of anticholinergic overdeose

A 
dry flushed skin
dry mucous membranes
mydriasis
hyperthermia, hypertension, tachycardia, tachypnoea
delirium, hallucinations
29
Q

management of anticholinergic overdose

A

cooling
benzodiazepine if agitated
sodium bicarbonate if QRS prolonged

30
Q

presentation of CO overdose

A

headache, dizziness, confusion
tachycardia, arrhythmias
abdo pain, N&V
SoB

31
Q

management of CO overdose

A

intubation if unconscious
high flow oxygen
cardiac monitoring
consider hyperbaric oxygen

32
Q

presentation of DKA

A

N&V, abdo pain
hyperventilation, ketone breath
polyuria, polydipsia, dehydration
altered conscious level

33
Q

investigations for DKA

A

VBG
glucose
urine ketones

CXR, BC, UC, WCC, CRP
ECG, troponin

34
Q

management of DKA

A

IV sodium chloride
IV insulin
potassium if < 5

if glucose falls below 14mmol/l in first 4 hours start IV glucose 10%
adjust insulin to maintain glucose between 9-14

if cerebral oedema IV mannitol or dexamethasone

35
Q

when would one use the canadian c spine rule

A

for adults (>16) with a neck injury, is stable (SBP>90, RR = 10-24) and has a GCS of 15

36
Q

what are the high risk factors in the Canadian C spine rule

A

age > 65
dangerous mechanism e.g. fall >3 feet, RTA >60mph, axial load to head
numbness/tingling in limbs
significant distracting injury

37
Q

GCS eyes

A 
4 = spontaneously
3 = to verbal command
2 = to pain
1 = none
38
Q

GCS verbal

A 
5 = oriented
4 = confused
3 = inappropriate words
2 = incomprehensible noise
1 = nonw
39
Q

GCS motor

A 
6 = obeys command
5 = localizes to pain
4 = withdraws from pain
3 = flexion to pain
2 = extension to pain
1 = none
40
Q

blood investigations for a patient that has collapsed

A 
Hb - anaemia
WWC/CRP - infection
glucose - hypo
troponin - ACS/ischaemia
Mg - arrhythmias
U&Es - arrhymias
41
Q

management of a massive PE

A 
oxygen
IV fluids
morphine
nor adrenaline
Anticoagulation (enoxaparin/rivaroxaban/Warfarin)
alteplase
42
Q

investigations for a PE

A 
well's (2 or more = CTPA, <2 = d dimer)
d dimer
CTPA 
CXR
baseline bloods
43
Q

alternatives to CTPA

A

ECHO (if haemodynamically unstable)

V/Q scan (renal failure, pregnancy)

44
Q

presentation of a PE

A

pleuritic chest pain, dyspnoea, cough, haemoptysis

tachycardia, tachypnoea, fever, raised JVP

45
Q

symptom/sign progression in paracetamol overdose

A

N&V, lethargy
RUQ tenderness, hepatomegaly
Jaundice, encephalopathy
AKI, Lactic acidosis, coagulopathy, death

finals (13 decks)

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