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Year 6 > Emergencies > Flashcards

Emergencies Flashcards

1
Q

In which leads can you see ST elevation for the following MIs? and which arteries are affected

Anterior
Lateral
Inferior
Posterior

A

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

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2
Q

What are some causes of MIs?

A

Hypoxia, hypothermia, hypovolaemia, hypokalaemia, Toxin, thrombus, tension pneumo, tamponade

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3
Q

What are some complications of MIs?

A

Death
Arrythmias
Rupture
Thrombus
Haemorhhage
Valvular disease
Aneurysm
Dressler - fever, pericardial effusion, pleuritic chest pain
Embolism
Reinfarct

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4
Q

What is the acute management for an MI?

A
  1. DAPT - aspirin 300mg and tricagrelor 180mg
  2. Anticoag - PCI or fibrinolysis

if within 12 hours and can PCI in 2 hours then do it, otherwise, enoxaparin

  1. Morphine 5mg
  2. Beta blocker
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5
Q

What is the long term management of an MI?

A

ACE inhibitor
Beta blocker
Cardiorehab
DAPT
Statin

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6
Q

What are some causes of pulmonary oedema?

A

Cardiovascular –> increased PAWP
ARDS –> normal PAWP
Fluid overload
neurogenic - head injury

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7
Q

What is the acute management of pulmonary oedema

A
  1. Sit up and high flow O2
  2. diamorphine IV (3mg) + metoclopromide 10mg
  3. IV furosemide 40-80mg
  4. GTN spray
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8
Q

What is the long term management of pulmonary oedema?

A

daily weight
repeat CXR
oral furosemide
consider thiazide diuretic
ACEi if EF<40, B blocker if EF<35 spironolactone

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9
Q

What is the ECG sign for cardiac tamponade?

A

electrical alternans of R wave

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10
Q

Give some examples of broad complex arrhythmias

A

Ventricular tachycardia including Torsades de point

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11
Q

Give some examples of narrow complex arrhythmias

A

sinus tach, SVT, AF/flutter,

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12
Q

How do you manage broad and narrow complex arrhythmias?

A

Broad - IV amiodarone 300mg in 20 mins
Narrow - Valsalva + IV adenosine 6mg, 12mg, 12mg

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13
Q

How do you manage torsades de point?

A

congenital - beta blockers
drug indued - magnesium sulfate

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14
Q

which drugs can cause bardycardia?

A

beta blockers
digoxin
amiodarone
verapamil
diltiazem

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15
Q

How do you manage bradycardia?

A

0.5mg IV atropine

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16
Q

What are soem signs of life threatening asthma?

A

Cyanosis
Hypotension
Exhaustion PEFR<33%
Silent chest
Tachycardia

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17
Q

How do you manage acute asthma?

A
  1. high flow o2
  2. salbutamol 5mg and ipratropium -.5mg nebs with 6L/min oxygen
  3. Prednisolone 50mg for 5 days
  4. IV magnesium sulfate
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18
Q

What investigations should be done in acute presentation of COPD?

A

ABG
Chest X ray
Bloods
ECG
sputum culture
blood culture

19
Q

How much should you aim to increase O2 and CO2 by in COPD?

A

increase O2 by more than 8kPa while increasing CO2 by less than 1.5kPa

20
Q

How do you manage acute COPD?

A

24% O2
Salbultamol 5mg and ipratropium 0.5mg nebs
prednisolone 30mg AND hydrocortisone 200mg IV
amoxicillin and co-amox
senior help and aminophyline IV

21
Q

What are the borders of the triangle of safety

A

top - base of axilla
lateral edge of latissimus dorsi and pec major
5th ICS

22
Q

What investigations do you do for suspected PE?

A

Wells score
>4 –> CTPA
if positive DOAC
if negative USS of leg

<4 –> D dimer
if positive CTPA
if negative - consider alternative diagnosis

23
Q

What score is used for low risk PE?

A

pulmonary embolism rule out criteria

24
Q

how do you manage a PE?

A
  1. 10-15 L O2
  2. 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

25
Q

How do you manage ARDS?

A
  1. inotropes through central line
  2. IV broad spectrum Abx and diuretics
  3. O2 60-100%
26
Q

What are some features of ARDS?

A

Acute onset - within a week
bilateral pulmonary infiltrates
dropping PaO2
resp failure not due to heart failure

27
Q

how do you manage an acute GI bleed?

A
  1. resusitation
    give packed RBC
    IF ACTIVE BLEEDING
    - give clotting factors
    - give platelets
  2. risk assess
  3. endoscopy - after resus or within 24 hrs
  4. long term management
28
Q

what scores would you use to risk assess for acute GI bleed?

A

blatchford score - pre endoscopy
rockland score - post endoscopy

29
Q

what can be used prophylaxis for variceal bleeds?

A

propranalol

30
Q

What are the Uk and worldwide leading causes of encephalitis and how do you treat?

A

UK HSV2
Worldwide - arbovirus

IV acyclovir + ceftriaxone (as hard to tell between this an meningitis)

31
Q

how do you treat meningitis

A
  1. Abx - ceftriaxone
  2. dexamethasone
  3. fluid resus
  4. airway support
32
Q

how to manage epilepsy?

A

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

33
Q

What is the criteria for an immediate CT head?

A

GCS <13
traumatic injury
>1 episode vomiting
signs of basal skull fracture
post traumatic seizure
focal neurological deficits

34
Q

what is the criteria for a CT head within 8 hours?

A

LOC or amnesia since injury AND
- age>65
- bleeding/ clotting disorder (also if on current anticoags)
- dangerous mechanism of injury

35
Q

What are some indications for immediate CT spine?

A

GCS<13
patient intubated
parasthesia
focal deficits
>65 years

36
Q

When would you consider ICP monitoring?

A

mandatory for GCS 3-8 and abnormal CT head
advised if GCS 3-8 and normal CT head

37
Q

What are some signs of increased ICP?

A

headache worse on leaning forward
altered gcs
focal neurological deficits
changes in vision
cushings triad - high bp, low pulse, irregular resp rate

38
Q

how do you manage someone with increased icp?

A

urgent neurosurgery referral
sit up at 40 degrees
intubate and hyperventilate - as co2 vasoconstricts
manitol
steroids
fluid restrict

39
Q

how do you manage someone with a head injury?

A

A-E
give oxygen
immobilise neck
stop bleeding
assess GCS
BLOODS - u/e, glucose, bood alcohol, toxicology, clotting
neurological exam
radiographs

40
Q

what are some signs and symptoms of cauda equina syndrome?

A

bilateral sciatica RED FLAG
saddle anaesthesia RED FLAG
urinary/faecal incontinence
lower limb weakness RED FLAG
sexual dysfunction

41
Q

what investigations would you do for suspected cauda equina?

A

lower limb neuro exam
DRE
bladder scan if urinary retention
MRI!

42
Q

how do you treat cauda equina?

A

PO dexamethasone (if metastatic disease, then start while waiting for MRI results)
decompressive laminectomy

43
Q

what are some signs for spinal cord compression?

A

back pain
UMN signs and sensory level - above L1
LMN sign and sensory level - below L1

44
Q

how do you manage spinal cord compression?

A

oral/IV dexamethasone and radiotherapy or surgery (if not frail)

Year 6 (10 decks)

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