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Finals > Emergencies > Flashcards

Emergencies Flashcards

1
Q

Narrow Complex Tachycardia - with Adverse signs

A

O2, Iv access, 12-lead ecg

Expert help
Sedation
Up to 3 synchronised DC shocks
Correct any electrolyte disturbances
Amiodarone 300mg IV over 20 min, 900mg over 24 h via central line
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2
Q

Narrow Complex Tachycardia - No adverse signs - regular rhythm

A

O2,

IV access, 12 lead

Vagal manoeuvres (think about digoxin toxicity, ischaemia, carotid bruit)

If fail, give Adenosine 6mg bolus IV, then 12 mg if necessary.

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3
Q

Narrow Complex Tachycardia - No adverse signs - regular rhythmSinus rhythm not achieved by adenosine/verapamil

A

Possible Atrial Flutter

Seek expert help - possible rate control with beta-blocker

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4
Q

Narrow Complex Tachycardia - No adverse signs - regular rhythmSinus rhythm achieved

A

Probable paroxysmal re-entrant SVT

ASSESS ECG for WPW

if recurrent consider referall

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5
Q

Narrow Complex Tachycardia - No adverse signs - regular rhythm
Irregular

A

Probable AF

Anti-coagulate - warfarin or DOAC

Rate control - Beat blocker eg metoprolol 1-10mg IV

Rhythm control – if definitely under 48 or coagulated over 3 weeks consider DC cardioversion

Can cardiovert with Flecanide 300 mg PO or Amiodarone 300 mg IVI over 20-60 min

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6
Q

Function of adenosine in Narrow complex tachy

A

Transient AV block

Slows ventricles to show underlying atrial rhythm

can cardiovert junctional tachycardia to sinus rhythm

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7
Q

Broad complex tachycardia with adverse signs

A

Sedate
3x synchronised DC shock

Correct electrolyte disturbances

Amiodarone 300mg IV over 20 in, consider repeat shock then 900mg over 24hFurther cardioversion

Consider procainamide or overdrive pacing

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8
Q

Broad complex tachycardia without adverse signs - regular

A

If VT or uncertain rhythm - Amiodarone 300mg IV 20 min, then 900mg over 24 hrIf known SVT or BBB treat as narrow complex tachy (i.e. adenosine)

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9
Q

Broad complex tachycardia with adverse signs - irregular

A

Usually one of :

AF - with BBBP

re-excited AF - amiodarone

Polymorphic VT - Torsade de pointes - Mg 2g IVI

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10
Q

Broad complex tachycardia with adverse signs but cannot stabilise

A

Sedate

Synchronised DC shock

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11
Q

Bradycardia with Adverse signs

A

Atropine 500 mcg IV

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12
Q

Bradycardia with Adverse signs - no response to original therapy

A

repeat atropine every 3-5 mins (max mg)

Transcutaneous pacing

Isoprenaline 5 mcg/min

Adrenaline 2-10mcg/min

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13
Q

Bradycardia with risk of asystole

A

Atropine 500 mcg every 3-5 mins max 3mg

Transcutaneous pacing

Isoprenaline

Adrenaline

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14
Q

Management of Acute STEMI

A

12 lead ECG

O2

IV ACCESS - FBC, U&E, glucose, Lipids, Troponin

I/O - CVS disease, pulse, BP, JVP, murmurs, CI to PCI or fibrinolysis?

Aspirin 300mg

Ticagrelor 180mg (or alt. antiplatelet)

Morphine 10 mg plus anti-emetic like metoclopramide 10mg IV

Reperfusion therap

yBeta blocker if no HF/Asthma/BBB

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15
Q

Management of Acute STEMIwithin 120 min, already had aspirin

A

primary PCI

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16
Q

Management of Acute STEMI>120 min

A

Fibrinolysis - alteplase Ideally <30 min from admission

If not done within 12h or stemi, fonduparinux or enoxaparin

17
Q

Anaphylaxis

A

A-Secure Airway

B-100% oxygen

Remove any known causeC-Raise feet to help restore circulation

Adrenaline IM 0.5mg (0.5mL 1:1000)Repeat every 5 min

Secure IV access

IVI 0.9% saline 500 mL over 15 mins

May need neb Salbutamol, hydrocortisone IV later

18
Q

Tonsillitis

A

Infection of the palatine tonsils

pain, fever, dysphagia and cough

a frequency of more than 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years, and for whom there is no other explanation for the recurrent symptoms), referral to an ear, nose, and throat specialist is advised as this cohort may benefit from tonsillectomy.

19
Q

Quinsy

A

Comp of bacterial tonsillitis

deviating the uvula away

Trismus (difficulty fully opening the jaw), unilateral symptoms and a ‘hot potato’ voice

Admission,

IV abx, drainage

20
Q

Epistaxis

A

Anterior or posterior plexus - 90% anterior (Little’s area)

Greater palantine artery in older

21
Q

Epistaxis emergency management

A

A-E
Pinch cartilage, 20 mins

Cuaterise with silver nitrate

Pack nose anterior (rapid rhino) or posterior (foley catheter) depending on where bleed is - tamponades

may require surgical ligation

22
Q

Emergency airway obstruction - causes

A

Cancers
Oropharyngeal

Laryngeal

Base of tongue

Infections
Epiglottitis

Deep neck space infections

Foreign body
Mostly seen in children

23
Q

Emergency airway obstruction - red flags

A 
Stridor/Stertor
Cyanosis
Agitation
Respiratory distress
Wheeze
Decreased breath sounds on auscultation
24
Q

Emergency airway obstruction - management

A

Call for help

Nebulised adrenaline/salbutamol

Intubation

tracheostomy

25
Q

Emergency- epiglottitis

A

supraglottic tissue infection

Haemophilus

Influenza type B infection usually

26
Q

Emergency - epiglottitisKey symptomsManagement

A

3 D’s are the key symptoms:

Drooling
Distressed
Dysphagia

IV abx

Laryngoscopy - lateral neck radiograph

O2,

Steroids - dex, 0.08-0.3 mg/kg/day

27
Q

Asthma exacerbation - grading

A

Moderate - PEF 50-75%

Severe - PEF 33-50%, RR 25, HR 110, inability to complete sentences in one breath

Life-threatening - PEF <33%, SpO2 <92%, PaO2 <8 kPa, Normal PaCO2, Altered GCS, cyanosis, hypotension, arrythmia, silent chest, poor respiratory effort

Near fatal - raised PaCO2 or requirement of mechanical ventilation

28
Q

Asthma exacerbation Management

A 
Sit up
15L O2
Salbutamol neb 5 mg
\+/- ipratropium 500 micrograms
Prednisolone 40mg PO (or hydrocortisone 200 mg IV)

repeat 2.5mg Salbutamol every 10-15 min, reasses PEFR and sats reg

BIPAP in COPD

COnsider aminophyline 0.5-0.7 mg/kg/h

Mg sulfate 2g IV over 20 min

29
Q

Croup symptoms

A

Barking cough

Inspiration stridor

Increased WOB

May have widespread wheeze

30
Q

Croup treatment

A

0.3 mg/kg dex or 1mg/kg Pred

Vomiting? Budesone 2mg

AND nebulised adrenaline 0.5 ml/kg (max 5 ml) repeat every 5 min

31
Q

Stevens-Johnsons syndrome - management

A

Cease medications, IV fluids, NG access

32
Q

Flail chest

A

Multiple rib fractures with > or = 2 rib fractures in more than 2 ribs

33
Q

Diaphragmatic rupture

A

CXR changes include non visible diaphragm, bowel loops in the hemithorax and displacement of the mediastinum. In most cases direct surgical repair is the best option.

34
Q

Syringomyelia

A

Associated with Arnold-Chiari malformation - fluid filled cyst, expands over time

35
Q

Buerger’s disease

A

Young male smoker with symptoms similar to limb ischaemia - inflammatory vasculitis

36
Q

CREST syndrome

A

systemic sclerosis comprising calcinosis, Raynaud’s phenomenon, oesophageal dysmotility, sclerodactyly and telangiectasia. - CCB, Prostaglandins

37
Q

Paediatric Sepsis 6

A

O2, fluids, ABx, IV access, inotrope support, senior clinician early

38
Q

Pneumonia follow up

A

All cases of pneumonia should have a repeat chest X-ray at 6 weeks after clinical resolution

39
Q

Hepatorenal syndrome mx

A

vasopressin analogues, for example terlipressin, have a growing evidence base supporting their use. They work by causing vasoconstriction of the splanchnic circulation
volume expansion with 20% albumin
transjugular intrahepatic portosystemic shunt

Finals (18 decks)

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