Emergencies Flashcards
In which leads can you see ST elevation for the following MIs? and which arteries are affected
Anterior
Lateral
Inferior
Posterior
Anterior - V1-4 LAD
Lateral - I, avL, V5-6 Left Lateral
Inferior - II, III, avF Right coronary
Posterior - V1-2 Tall R waves - right coronary OR left lateral
What are some causes of MIs?
Hypoxia, hypothermia, hypovolaemia, hypokalaemia, Toxin, thrombus, tension pneumo, tamponade
What are some complications of MIs?
Death
Arrythmias
Rupture
Thrombus
Haemorhhage
Valvular disease
Aneurysm
Dressler - fever, pericardial effusion, pleuritic chest pain
Embolism
Reinfarct
What is the acute management for an MI?
- DAPT - aspirin 300mg and tricagrelor 180mg
- Anticoag - PCI or fibrinolysis
if within 12 hours and can PCI in 2 hours then do it, otherwise, enoxaparin
- Morphine 5mg
- Beta blocker
What is the long term management of an MI?
ACE inhibitor
Beta blocker
Cardiorehab
DAPT
Statin
What are some causes of pulmonary oedema?
Cardiovascular –> increased PAWP
ARDS –> normal PAWP
Fluid overload
neurogenic - head injury
What is the acute management of pulmonary oedema
- Sit up and high flow O2
- diamorphine IV (3mg) + metoclopromide 10mg
- IV furosemide 40-80mg
- GTN spray
What is the long term management of pulmonary oedema?
daily weight
repeat CXR
oral furosemide
consider thiazide diuretic
ACEi if EF<40, B blocker if EF<35 spironolactone
What is the ECG sign for cardiac tamponade?
electrical alternans of R wave
Give some examples of broad complex arrhythmias
Ventricular tachycardia including Torsades de point
Give some examples of narrow complex arrhythmias
sinus tach, SVT, AF/flutter,
How do you manage broad and narrow complex arrhythmias?
Broad - IV amiodarone 300mg in 20 mins
Narrow - Valsalva + IV adenosine 6mg, 12mg, 12mg
How do you manage torsades de point?
congenital - beta blockers
drug indued - magnesium sulfate
which drugs can cause bardycardia?
beta blockers
digoxin
amiodarone
verapamil
diltiazem
How do you manage bradycardia?
0.5mg IV atropine
What are soem signs of life threatening asthma?
Cyanosis
Hypotension
Exhaustion PEFR<33%
Silent chest
Tachycardia
How do you manage acute asthma?
- high flow o2
- salbutamol 5mg and ipratropium -.5mg nebs with 6L/min oxygen
- Prednisolone 50mg for 5 days
- IV magnesium sulfate
What investigations should be done in acute presentation of COPD?
ABG
Chest X ray
Bloods
ECG
sputum culture
blood culture
How much should you aim to increase O2 and CO2 by in COPD?
increase O2 by more than 8kPa while increasing CO2 by less than 1.5kPa
How do you manage acute COPD?
24% O2
Salbultamol 5mg and ipratropium 0.5mg nebs
prednisolone 30mg AND hydrocortisone 200mg IV
amoxicillin and co-amox
senior help and aminophyline IV
What are the borders of the triangle of safety
top - base of axilla
lateral edge of latissimus dorsi and pec major
5th ICS
What investigations do you do for suspected PE?
Wells score
>4 –> CTPA
if positive DOAC
if negative USS of leg
<4 –> D dimer
if positive CTPA
if negative - consider alternative diagnosis
What score is used for low risk PE?
pulmonary embolism rule out criteria
how do you manage a PE?
- 10-15 L O2
- Morphine + metoclopramide
haemodynamically stable
3. LMWH subcut
4. DOAC for 3 months if provoked, 6 months if unprovoked
- if contraindicated the IVC filter
unstable
unfractionated heparin –> DOAC
How do you manage ARDS?
- inotropes through central line
- IV broad spectrum Abx and diuretics
- O2 60-100%
What are some features of ARDS?
Acute onset - within a week
bilateral pulmonary infiltrates
dropping PaO2
resp failure not due to heart failure
how do you manage an acute GI bleed?
- resusitation
give packed RBC
IF ACTIVE BLEEDING
- give clotting factors
- give platelets - risk assess
- endoscopy - after resus or within 24 hrs
- long term management
what scores would you use to risk assess for acute GI bleed?
blatchford score - pre endoscopy
rockland score - post endoscopy
what can be used prophylaxis for variceal bleeds?
propranalol
What are the Uk and worldwide leading causes of encephalitis and how do you treat?
UK HSV2
Worldwide - arbovirus
IV acyclovir + ceftriaxone (as hard to tell between this an meningitis)
how do you treat meningitis
- Abx - ceftriaxone
- dexamethasone
- fluid resus
- airway support
how to manage epilepsy?
secure airway
suction and O2
buccal lorazepam OR 4mg IV lorazepam
IV lorazepam second dose 10-20 mins later
30 ins - IV infusion pheytoin
60 mins - anaesthetics
What is the criteria for an immediate CT head?
GCS <13
traumatic injury
>1 episode vomiting
signs of basal skull fracture
post traumatic seizure
focal neurological deficits
what is the criteria for a CT head within 8 hours?
LOC or amnesia since injury AND
- age>65
- bleeding/ clotting disorder (also if on current anticoags)
- dangerous mechanism of injury
What are some indications for immediate CT spine?
GCS<13
patient intubated
parasthesia
focal deficits
>65 years
When would you consider ICP monitoring?
mandatory for GCS 3-8 and abnormal CT head
advised if GCS 3-8 and normal CT head
What are some signs of increased ICP?
headache worse on leaning forward
altered gcs
focal neurological deficits
changes in vision
cushings triad - high bp, low pulse, irregular resp rate
how do you manage someone with increased icp?
urgent neurosurgery referral
sit up at 40 degrees
intubate and hyperventilate - as co2 vasoconstricts
manitol
steroids
fluid restrict
how do you manage someone with a head injury?
A-E
give oxygen
immobilise neck
stop bleeding
assess GCS
BLOODS - u/e, glucose, bood alcohol, toxicology, clotting
neurological exam
radiographs
what are some signs and symptoms of cauda equina syndrome?
bilateral sciatica RED FLAG
saddle anaesthesia RED FLAG
urinary/faecal incontinence
lower limb weakness RED FLAG
sexual dysfunction
what investigations would you do for suspected cauda equina?
lower limb neuro exam
DRE
bladder scan if urinary retention
MRI!
how do you treat cauda equina?
PO dexamethasone (if metastatic disease, then start while waiting for MRI results)
decompressive laminectomy
what are some signs for spinal cord compression?
back pain
UMN signs and sensory level - above L1
LMN sign and sensory level - below L1
how do you manage spinal cord compression?
oral/IV dexamethasone and radiotherapy or surgery (if not frail)
