EM Flashcards
presentation of anaphylaxis
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
management of anaphylaxis
IM 1:1000 adrenaline
IV fluids
chlorphenamine
hydrocortisone
pathophysiology of anaphylaxis
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)
what are the reversible causes of cardiac arrest
hypoxia, hypovolemia, hypo/hyperkalaemia, hypothermia
thrombosis, tension pneumothorax, tamponade, toxins
what are the shockable and non shockable rhythms is cardiac arrest
shockable
VF and pulseless VT
non shockable
Pulseless electrical activity and asystole
management of cardiac arrest
CPR 30:2 shock if appropriate give adrenalin every 5min give amiodarone after 3 shocks treat reversible causes
qSOFA
GCS < 13
RR >22
SBP < 90 or DBP < 60
SIRS
HR > 90
RR > 20
WCC <4 or > 12
temp > 38 or < 36
define sepsis and septic shock
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)
markers of severe asthma attack
PEF < 50%
RR > 25
HR > 110
cannot complete sentences
markers of life threatening asthma attack
SpO2 < 92
silent chest, cyanosis, poor respiratory effort
arrhythmias or hypotension
exhaustion or altered consciousness
management of acute asthma attack
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
management of acute COPD exacerbation
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)
investigations for cardiac chest pain
ECG HSTnT routine bloods Lipid profile consider: d dimer, chest x ray, glucose, ECHO
what position and artery do each ECG leads correspond to
V1 - V4 = anterioseptal/posterior (depression) - LAD/RCA or LCx
V5 - V6 = apical - LCx
I, aVL = lateral - LCx
II, III, aVF = inferior - RCA
pathophysiology of paracetamol overdose
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
management of paracetamol overdose
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
investigations for paracetamol overdose
paracetamol levels LFTs U&Es - AKI INR ABG - lactate acidosis
what is the toxic dose for paracetamol toxicity
> 150mg/kg over 24 hours
presentation of opioid overdose
CNS depression/coma
bradycardia, bradypnoea, hypotension, hypothermia
management of opioid overdose
A-E
observation
naloxone if RR<8, SpO2<94, type 2 resp. failure
presentation of sedative overdose
confusion/coma
bradycardia, bradypnoea, hypotension, hypothermia
management of sedative overdose
A-E
for benzodiazepines = flumazenil if resp. depression
for barbituates = charcoal hemoperfusion or haemodialysis
drugs that can cause serotonin syndrome
SSRI lithium triptans MAOI cocaine
presentation of serotonin syndrome
tachycardia, tachypnoea, hypertension, hyperthermia
sweating, flushing, tremor, D&V, agitation
management of serotonin syndrome
benzodiazepines for agitation and muscle relaxation
cyproheptadine is the antidote
IV fluid if rhabdomyolysis
drugs that can cause anticholinergic overdose
antihistamines
antipsychotics
TCA
presentation of anticholinergic overdeose
dry flushed skin dry mucous membranes mydriasis hyperthermia, hypertension, tachycardia, tachypnoea delirium, hallucinations
management of anticholinergic overdose
cooling
benzodiazepine if agitated
sodium bicarbonate if QRS prolonged
presentation of CO overdose
headache, dizziness, confusion
tachycardia, arrhythmias
abdo pain, N&V
SoB
management of CO overdose
intubation if unconscious
high flow oxygen
cardiac monitoring
consider hyperbaric oxygen
presentation of DKA
N&V, abdo pain
hyperventilation, ketone breath
polyuria, polydipsia, dehydration
altered conscious level
investigations for DKA
VBG
glucose
urine ketones
CXR, BC, UC, WCC, CRP
ECG, troponin
management of DKA
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
when would one use the canadian c spine rule
for adults (>16) with a neck injury, is stable (SBP>90, RR = 10-24) and has a GCS of 15
what are the high risk factors in the Canadian C spine rule
age > 65
dangerous mechanism e.g. fall >3 feet, RTA >60mph, axial load to head
numbness/tingling in limbs
significant distracting injury
GCS eyes
4 = spontaneously 3 = to verbal command 2 = to pain 1 = none
GCS verbal
5 = oriented 4 = confused 3 = inappropriate words 2 = incomprehensible noise 1 = nonw
GCS motor
6 = obeys command 5 = localizes to pain 4 = withdraws from pain 3 = flexion to pain 2 = extension to pain 1 = none
blood investigations for a patient that has collapsed
Hb - anaemia WWC/CRP - infection glucose - hypo troponin - ACS/ischaemia Mg - arrhythmias U&Es - arrhymias
management of a massive PE
oxygen IV fluids morphine nor adrenaline Anticoagulation (enoxaparin/rivaroxaban/Warfarin) alteplase
investigations for a PE
well's (2 or more = CTPA, <2 = d dimer) d dimer CTPA CXR baseline bloods
alternatives to CTPA
ECHO (if haemodynamically unstable)
V/Q scan (renal failure, pregnancy)
presentation of a PE
pleuritic chest pain, dyspnoea, cough, haemoptysis
tachycardia, tachypnoea, fever, raised JVP
symptom/sign progression in paracetamol overdose
N&V, lethargy
RUQ tenderness, hepatomegaly
Jaundice, encephalopathy
AKI, Lactic acidosis, coagulopathy, death
