EMERGENCIES Flashcards

1
Q

Headaches.

First and worse headache

Thunder clap headache

A

SUBARACHNOID HAEMORRHAGE

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2
Q

Headaches.

Unilateral headache and eye pain

A

cluster headache

glaucoma

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3
Q

Unilateral headache and ipsilateral (same sided) symptoms

A

migraine

tumour

vascular

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4
Q

Headaches.

Cough initiates headache

A

Raised ICP

Venous thrombosis

Benign intracranial hypertension

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5
Q

Headache worse in the mornings.

Worse on bending forwards

A

Raised ICP.

Venous thrombosis.

Benign intracranial hypertension

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6
Q

Persisting headache +/- scalp tenderness in over 50s

A

Giant cell arteritis

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7
Q

Headache with neck stiffness or fever

A

Meningitis

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8
Q

Two very important additional things to ask in a headache history

A

Any recent travel (malaria)

Pregnancy possibility (pre-eclampsia)

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9
Q

Stony dullness to percussion may indicate

A

Pleural effusion

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10
Q

Key investigations to remember in a patient with acute breathlessness

A

Baseline observations –> sats, HR, Temp, peak flow

ABGs if sats are below 94% –> concerns over acidosis, drugs or sepsis

ECG (signs of PE, Left ventricular hypertrophy, MI)

CXR –> rule out any other pathology

Baseline bloods –> glucose, FBC, u&e’s and consider drug screen

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11
Q

Life threatening differential diagnoses for acute chest pain

A

Acute MI

Angina / acute coronary syndrome

Aortic dissection

Tension pneumothorax

Pulmonary embolism

Oesophageal rupture

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12
Q

What do you give in benzo overdose

A

Flumazenil

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13
Q

Dose of adrenaline given in anaphylaxis management

A

0.5mg (0.5mls of 1:1000)

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14
Q

Mimics of anaphylaxis involve

A

Carcinoid syndrome

Pheochromocytoma

Hereditary angioedema

Systemic mastocytosis

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15
Q

Management of STEMI

A

300mg loading dose ASPIRIN ASAP

Angiography with primary PCI
- if within 12 hours of symptoms & PC can be done within 120 minutes

Fibrinolysis
- if within 12 hours of symptoms and PCI not possible in 120 minutes
- give antithrombin at same time
- ECG 60-90 mins post fibrinolysis

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16
Q

NSTEMI / unstable angina: early management

A

300mg LOADING dose of ASPIRIN asap unless contraindicated

Initial antithrombin therapy –> fondaparinux unless high bleeding risk or immediate angiography

GRACE SCORE –> 6 month mortality
<3% LOW RISK
- conservative management
- offer ticagrelor with aspirin unless high bleeding risk

> 3% HIGH risk
- offer immediate angiography with follow on PCI if indicated within 72 hours.

17
Q

Cardiac rehabilitation and secondary prevention

A
  1. Physical activity
  2. Lifestyle advice: driving, flying and sex
    —-> ETOH < 14 units weekly
    —-> 20-30 mins physical activity daily to breathlessness
    —-> smoking cessation
    —-> weight management
    —-> Mediterranean diet (bread, fruit, veg, fish)
  3. Stress management
  4. Health education

DRUG TREATMENT
1. ACEi
2. Dual antiplatelet (aspirin + another) for 12 months
3. Beta blocker (if BB contraindicated then diltiazem or verapamil)
4. STATIN