Emergencies Flashcards
Commonly identified causes of anaphylaxis
Food (e.g. nuts)
Drugs
Venom (e.g. wasp sting)
What should you give in adult anaphylaxis?
500 micrograms adrenaline (0.5ml 1 in 1,000)
What should you give in anaphylaxis of a child age 6-12?
300 micrograms adrenaline (0.3ml 1 in 1,000)
What should you give in anaphylaxis of a child age 6 months to 6 years?
150 micrograms adrenaline (0.15ml 1 in 1,000)
What is the definition of refractory anaphylaxis?
Defined as respiratory and/or cardiovascular problems despite 2 doses of IM adrenaline
When should you refer to secondary care for burns?
- All deep dermal and full-thickness burns
- Superficial dermal burns of more than 3% TBSA in adults or more than 2% TBSA in children
- Superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure
- Any inhalation injury
- Any electrical or chemical burn injury
- Suspicion of non-accidental injury
What are the shockable rhythms?
- Ventricular fibrillation
- Pulseless Ventricular tachycardia
What are the non shockable rhythms?
- Asystole
- Pulseless-electrical activity
When should you give amiodarone in cardiac arrest?
Amiodarone 300mg should be given to patients who ate in VF/Pulseless VT after 3 shocks have been administered
What are the reversible causes of a cardiac arrest?
The ‘Hs’
- Hypoxia
- Hypovolaemia
- Hyperkalaemia, Hypokalaemia, hypoglycaemia, hypocalcaemia, acidaemia
- Hypothermia
The ‘Ts’
- Thrombosis
- Tension pneumothorax
- Tamponade
- Toxins
Mild hyperkalaemia?
5.5-5.9mmol/L
Moderate Hyperkalaemia?
6.0-6.4mmol/L
Severe Hyperkalaemia?
> 6.5mmol/L
What do you use to stabilise the cardiac membrane in Hyperkalaemia?
IV Calcium gluconate
What do you use to short term shift the potassium from ECF to ICF?
- Combined insulin/dextrose infusion
- Nebulised salbutamol
What do you use to remove potassium from the body in hyperkalaemia?
- Calcium resonium (orally or enema)
- Loop diuretics
- Haemodialysis
What is the definition of massive haemorrhage?
This is the loss of one blood volume in a 24 hour period or the loss of 50% of the circulating blood volume in 3 hours.
A blood loss of 150ml/min is also included.
Management for paracetamol overdose?
Management
activated charcoal if ingested < 1 hour ago
N-acetylcysteine (NAC)
liver transplantation
Management for Salicylate overdose?
Management
- Urinary alkalinization with IV bicarbonate
- Haemodialysis
Management for opioid overdose?
Naloxone
Management for cyanide poisoning?
Hydroxocobalamin
What is Sepsis?
Life-threatening organ dysfunction caused by a dysregulated host response to infection
What is the Sepsis Six?
Blood cultures
Urine output monitoring
Fluids
Antibiotics
Lactate
Oxygen
What are the different groups of shock?
- Septic
- Haemorrhagic
- Neurogenic
- Cardiogenic
- Anaphylactic
What does a palpable femoral pulse equate to?
In order to generate a palpable femoral pulse an arterial pressure of >65mmHg is required
When does Neurogenic shock most commonly occur?
Following a spinal cord transection
What is Beck’s triad?
Elevated venous pressure, reduced arterial pressure, reduced heart sounds
Indicates Cardiac tamponade
What the first-line treatment for bradycardia?
Atropine (500mcg IV)
What is the management of Magnesium sulphate?
IV Magnesium Sulphate
Risk factors for Necrotising fasciitis?
- Skin factors: Recent trauma, burns or soft tissue infections
- Diabetes mellitus
- Intravenous drug use
- Immunosuppression
How do you treat Acute COPD?
- Sit-up
- 24% O2 Venturi mask (Aim 88-92%)
- Vary FiO2 and SpO2 target according to ABG
- Neb Salbutamol 5mg/4hr/Ipratropium 0.5mg/6h
- Steroids Hydrocortisone 200mg IV or Prednisolone 40mg PO for 7-14 days
When should you consider escalation in exacerbation of COPD?
Repeat nebulisers and consider aminophylline IV
Consider NIV (BiPAP) if pH <7.35 and/or RR >30
Consider invasive ventilation if pH<7.26
What is the most appropriate perimeter to measure in suspected Carbon monoxide poisoning?
Carboxyhaemoglobin
What features in examination or history are suspicious for smoke inhalation in burns
Burning sensation in the nose / throat
- Productive cough
- Stridor
- Dyspnoea
- Rhonchi
- Wheezing
- Hoarse voice
- Accessory muscle usage
- Tachypnoea
- Cyanosis
- Odynophagia
- Headache
- Delirium
- Hallucinations
- Decreasing consciousness / comatose
- Convulsions / seizures
- Hypertonia
- Facial burns / loss of facial or intranasal hair
- Soot in mouth or sputum
What effect does carbon monoxide have on the oxyhaemoglobin dissociation
curve and how does this cause symptoms of carbon monoxide poisoning?
Carbon monoxide has a greater affinity for haemoglobin than oxygen (so readily
binds to Hb)
Causing the curve to shift to the left
Left shift → increased affinity of haemoglobin for oxygen / so haemoglobin holds onto
oxygen more tightly
Reducing the release of oxygen to tissues, causing hypoxia and the associated
symptoms
(eg inadequate oxygenation to brain because oxygen held tightly to Hb instead →
headaches / confusion / decreased consciousness)
What is the difference between stridor and wheeze?
Stridor occurs when there is obstruction in the upper airway, wheeze occurs when there is obstruction in the lower airway/stridor more likely heard on inspiration and wheeze on expiration
What position should be encouraged in anaphylaxis and why?
Flat with legs raised, to maximise venous return to the heart
What direction does carbon monoxide shift the bohr curve and why?
Carbon monoxide has a high affinity for haemoglobin and myoglobin resulting in a left-shift of the oxygen dissociation curve and tissue hypoxia.
