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Year 6 > Emergencies > Flashcards

Emergencies Flashcards

1
Q

Anteroseptal MI leads and artery?

A

V1-4, LAD

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2
Q

Antereolateral MI leads and artery?

A

V4-6, 1, AvL, LAD or left circumflex artery

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3
Q

Inferior MI leads and artery?

A

II, III, AvF

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4
Q

Lateral MI leads?

A

I, AvL, V5-6

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5
Q

Lateral MI artery involvement?

A

Left circumflex artery

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6
Q

Posterior MI ECG changes?

A

Tall R waves V1-2

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7
Q

What are the reversible heart attack causes?

A

Hypoxia, hypothermia, hypovolaemia, hypokalaemia
tension pneumothorax, thrombosis, tamponade, toxins

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8
Q
  • Inferior MI mx arrythmia?
A

medical management (atropine; fatigue of AV nodal cells can be reversed)

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9
Q
  • Anterior MI mx arrythmia?
A

temporary TC pacing  permanent pacemaker

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10
Q

Dressler’s syndrome

A

(2-6 weeks), pericarditis (<48 hours)
 S/S: fever, pleuritic pain, pericardial effusion, raised ESR
 Mx: NSAIDs

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11
Q
  • Complications of an MI
A

DARTH VADER:

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12
Q

Morphine dose in MI?

A

o Morphine (5-10mg IV; repeat after 5 minutes if needed) + metoclopramide (10mg IV)

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13
Q

Management of acute pulmonary oedema?

A

o (1) Sit them up  high-flow O2 (if SpO2 decreased)
o (2) IV diamorphine (3mg) + IV metoclopramide (10mg) [caution in liver failure and COPD]
o (3) IV furosemide (40-80mg) [larger dose in renal failure]
o (4) SL GTN spray x2 [if SBP ≥100mmHg, use IV GTN] Ix: ECG  ABG, BNP  CXR
o (5) Further management:
 Further furosemide [40-80mg]
 Further nitrate infusion [maintain SBP ≥90, if it drops <100, treat as per cardiogenic shock]
 CPAP

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14
Q

Safety borders for needle compression?

A

Base of axilla, 5th ICS, lateral edge of pectoris major, lateral edge of latissimus dorsi

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15
Q

Doses of drugs in asthma acute management?

A

5mg salbutamol
0.5mg ipatropium bromide
40-50mg PO prednisolone for 5 days

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16
Q

What to measure in suspected carbon monoxide poisoning?

A

Carboxyhaemoglobin

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17
Q

Mx of carbon monoxide poisoning

A

o 100% high-flow oxygen via a NRB mask (continuing for a minimum of six hours)  target 100% SpO2
o Hyperbaric oxygen (limited evidence base)

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18
Q

Phaechromocytoma tx?

A

o 1st: short-acting alpha blockade  long-acting alpha blockade phentolamine = phenoxybenzamine
o 2nd: beta blockade
o 3rd (delayed 4-6w)  surgery (4-6 weeks after presentation to allow for full alpha blockade to occur)

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19
Q

Information about poisoning?

A

Toxbase

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20
Q

(haemodialysis indicated in overdoses of which drugs?

A

-Barbiturates
- Lithium
- Alcohol
- Salicylates
- Theophylline
Remember BLAST

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21
Q

Ix for suspected poisoning?

A

o All unconscious patient = glucose, paracetamol, salicylate levels (IN ALL POISONING)
o FBC, U&E, LFTs, INR; ABG; ECG

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22
Q

Mx of poisoning?

A

Activated charcoal > gastric lavage
 Activated charcoal (50g every 4 hours, with water): reduces absorption of drug
* Indications: paracetamol, carbamazepine, dapsone, theophylline, quinine, phenobarbital
* CIs: alcohols, metal salts (lithium, iron), petroleum, corrosives, clofenotane, malathion

 Gastric lavage: rarely used, if used after 30-60 minutes, may make matters worse
o Haemodialysis
o Antidotes (TOXBASE, Poisons Information Service)

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23
Q

o BDZ (i.e. diazepam, Z-drugs) reversing agent?

A

Flumazenil (if iatrogenic)

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24
Q

o Opiate (codeine, methadone, heroin) reversing agent?

A

Naloxone

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25
Q

o Paracetamol reversing agent?

A

N-acetylcysteine

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26
Q

o Aspirin reversing agent?

A

Sodium bicarbonate

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27
Q

o TCA (amytriptyline; w/ long QT/arrhythmia) reversing agent?

A

Sodium bicarbonate

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28
Q

o Beta blockers reversal agent?

A

Atropine (low HR), glucagon (low BP)

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29
Q

o Ethylene glycol (antifreeze) reversal agent?

A

Fomepizole

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30
Q

o Iron reversal agent?

A

Desferrioxamine

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31
Q

o Cyanide reversal agent?

A

100% O2 + sodium nitrite/thiosulphate

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32
Q

o Organophosphates (inactivate AChE) reversal agent?

A

Atropine

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33
Q

o Digoxin reversal agent?

A

Digifab (Digoxin-specific antibody)

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34
Q

Paracetamol overdose treatment

A

 ≤2 hour  activated charcoal  Ix: paracetamol level ≥4 hours after ingestion  NAC if indicated
 ≥2 hour  Ix: paracetamol level ≥4 hours after ingestion  NAC if indicated
 ≥8 hours (+ ingested amount >75mg/kg)  NAC  Ix: paracetamol level
 If ingestion time unknown or staggered overdose (taken over ≥1 hour)  NAC

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35
Q

Transplant crtieria post-paracetamol overdose

A

 Arterial pH <7.3, 24 hours after ingestion; OR
 PT >100s (INR >6.5) AND creatinine >300mol/L AND grade 3 or 4 HE

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36
Q

S/S of salicylate overdose?

A

 Specific  Tinnitus, hyperventilation, vertigo
 Non-specific  vomiting, dehydration, sweating

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37
Q

o Dose-related response to salicylate overdose?

A

150mg/kg (mild); 250mg/kg (moderate); >500mg/kg (severe); >700mg/kg (fatal)

38
Q

Mx of salicylate OD?

A

o ≤1 hour  activated charcoal: further ix:
 Bloods: paracetamol level, salicylate level, glucose, FBC, U&Es, LFTs, INR, clotting, ABG
 Urine: catheterisation
 Acidosis: if >500mg/L salicylate OR severe metabolic acidosis  alkalinisation of urine (IV NaHCO3)
 Dialysis: if >700mg/L salicylate OR AKI, HF, pulmonary/cerebral oedema, seizures, etc

39
Q

Mx of hypopituirary coma?

A

o 1st  Hydrocortisone
o 2nd  T3
o 3rd  prompt surgery (if cause is apoplexy)

40
Q

Addison’s criteria?

A

o Initial management:
 1st  IM hydrocortisone (100mg, STAT)
 2nd  IV fluid bolus (0.9% saline, >90 SBP) ± glucose
o Continuing management:
 IV fluids
 IV/IM hydrocortisone (100mg/8h)  PO dexamethasone after 72 hours (consider fludrocortisone)

41
Q

Hydrocortisone delivery is addison’s criteria?

A

Hydrocortisone = IM  IV  PO

42
Q

Myxoedema coma s/s?

A

 Hypothyroid signs (bradycardia, coma, seizures, psychosis)
 Hypothermia
 Hyporeflexia [LMN sign – less likelihood of head trauma or brain tumour]

43
Q

Mx of myxoedema coma?

A

 IV T3 (5-20mcg/12 hours) – T3 acts faster than T4 (as T4 is just converted into T3 in the body)
 IV hydrocortisone (100mg/8 hours)
 Further as needed: warming blanket, fluids (caution), ABx (if infection suspected)

44
Q

S/s of thyroid storm?

A

hyperthyroidism (fever, agitation, confusion, coma, tachycardia, AF, D&V, goitre, HF)

45
Q

Management of thyrotoxic storm?

A

 1st = Propranolol (60mg, QDS, IV) ± digoxin use diltiazem if beta-blockers contraindicated
 2nd = Carbimazole (inhibits TPO; 15-25mg, QDS, PO)
 3rd = Hydrocortisone (100mg, QDS, IV) OR dexamethasone (2mg, QDS, PO)
 Other  treat precipitant (i.e. infection, ABx), IV fluids, cooling

46
Q

HHS criteria?

A

BM >33.3mmol/L
Hyperosmolar >330mmol/kg
Volume deplete

47
Q

Mx of HSS?

A

LMWH (VTE risk high)
Slow rehydration (over 48hrs)
½ RATE OF FLUIDS OF DKA
Deficit = 8-15L for 70kg adult
Replace K+ when UO increases

48
Q

Criteria for DKA?

A

BM > 11mmol/L
Ketones >3
Acidosis pH <7.3

49
Q

Hypoglycaemia treatment, unconsciousness/no swallow

A

IM glucagon (community, no IV) OR

Glucose 20%, 100mL, IV, over 10 mins

50
Q

Hypoglycaemia >4, conscious

A

Long-acting CHO
(two biscuits, one slice of bread, 200–300 mL of milk)

51
Q

Hypoglycaemia <4, conscious

A

Glucotabs (4-7) * OR
150-200mL fruit juice OR
4 teaspoons sugar dissolved in water

52
Q

When to use glucogel?

A

capable but uncooperative, can swallow

53
Q

Warfarin requires daily INR monitoring until INR stable with:

A

Antibiotics Regular tramadol Fluconazole AND Omeprazole Amiodarone Corticosteroids (high dose)

54
Q

Adenosine dose for narrow complex tachycardia?

A

6mg, go up to 12mg

55
Q

Treat for stable broad complex tachycardia?

A

Amiodarone 300mg IV or 20-60 mins
then 900mg over 24 hours

56
Q

Treatment for meningitis?

A

Cefotaxime IV
+ ampicillin if immunocompromised or >55 y/o

57
Q

Dose of benzylpenicillin

A

1.2g IM

58
Q

Treatment for acute ischaemic stroke?

A

Aspirin 300mg, oral, once only

59
Q

Treatment for secondary pneumothorax??

A

<2cm = aspirate
>2cm or SOB or >50 y/o = chest drain

60
Q

Treatment for primary pneumothorax?

A

<2cm and no SOB = dishcarge and f/u in 4 weeks
>2cm or symptomatic = aspirate

61
Q

Acute GI bleed tx?

A

ABC + O2
Hx and o/e
2 large bore cannula
Catheter + fluid monitoring
Crystalloid bolus
Cross-match 6 units of blood
Correct clotting abnormalities
Endoscopy
Stop culprit drugs (NSAIDs, aspirin, warfarin, heparin)
Call the surgeons if severe

62
Q

CURB-65 Criteria?

A

Confusion (AMTS<8)
Urea > 7.5mmol
R = respiratory rate >30/min
Blood pressure systolic <90mm hg
> 65 y/o

63
Q

Hypoglycaemia treatment unconscious

A

Glucagon 1mg IM

64
Q

Acute poisoning tx?

A

-ABC
-History
-Cannula and catheter (strict fluid balance)
-supportive measures (fluids and analgsia)
-Correct electrolyte disturbance
-Reduce absorption (charcoal, lavage)
-Increase elimination (N-acetylcysteine etc)
-Psychiatric assessment by liasion pysch

65
Q

Benzodiazepine reversal agent?

A

Flumenazil

66
Q

Drug for DVT/PE?

A

Use enoxaparin (easier to prescribe)

67
Q

Where to find warfarin INR info?

A

Oral anticoagulants – warfarin INR stuff here

68
Q

Good treatment summaries?

A

Medical emergencies in the community
Prescribing in palliative care
Constipation
Fluids and electrolytes
Venous thromboembolism

69
Q

Enzyme inducers?

A

Phenytoin, carbamezapine, rifampicin, alcohol, sulphonylureas,
St John’s wort, smoking, phenobarbital

70
Q

Enzyme inhibitors?

A

Z
Azoles
G
DEVICES
Sodium valproate, isoniazid, macrolides, metronidazole, grapefruit juice, omeprazole, ciprofloxacin, sulphonamides,

71
Q

What not to give with clopidogrel?

A

Omeprazole

72
Q

Patients in a fluid deficit; give fluids at what rate?

A

1L over 4-6 hours

73
Q

Emergency hypoglycaemia fluids?

A

10% glucose
150ml over <15 minutes

74
Q

Emergency hypercalcaemia fluids?

A

0.9% sodium chloride
1000ml over 4 hours

75
Q

Maintenance fluids with no deficits?

A

0.9% sodium chloride + 0.3% potassium chloride
1L over 8-12 hours

76
Q

Fluids in someone with fluid deficit?

A

0.9% sodium chloride + 0.3% potassium chloride
1L over 4-6 hours

77
Q

Common prescription errors?

A

-Levothyroxine is prescribed in mcg
-Methotrexate is given weekly with folic acid
-Wrong indication
-Incorrect dose

78
Q

Which drugs can affect the liver?

A

Statins

79
Q

Drugs to stop in AKI?

A

Diuretics, ACEi, NSAIDs, vancomycin, gentamicin, antifungals, cyclophosphamide, contrast

80
Q

When to give loop diuretics?

A

Earlier in the day

81
Q

What does 1% mean?

A
  • 1 g in 100 mL (or 10 mg in 1 mL) for weight/volume (w/v) calculations; or
  • 1 g in 100 g for weight/weight (w/w) calculations
82
Q

Metabolic alkalosis causes?

A

Vommitting, diuretics and conn’s syndrome

83
Q

Metabolic acidosis causes?

A

DKA, renal failure, methanol/ethanol intoxication

84
Q

Most common cause of leg cellulitis?

A

Streptococcus pyogenes

85
Q

To what regional lymph nodes is ovarian cancer most likely to spread initially?

A

Para-aortic nodes

86
Q

Management of gallstones?

A

Laparoscopic cholecystectomy

87
Q

Treatment for venous ulcers?

A

Compression stockings

88
Q

S/S uveitis?

A

red eye, headache and visual disturbance and is associated with a small pupil.

89
Q

A 65 year old man has sudden pain and redness in his ﾠright eye. He also has a headache and nausea. Visual acuity isﾠ 6/60 ﾠin the right eye. The eye is congested, with a hazy cornea and mid-dilated pupil.

A

Acute glaucoma

90
Q

Ix for probable stroke?

A

Non-contrast CT head is the most rapid investigation to exclude intracranial haemorrhage and allow thrombolysis.

91
Q

DPP4 inhibitor drug names?

A

“gliptins” sitagliptin, saxagliptin, linagliptin, and alogliptin.

92
Q
A

Year 6 (26 decks)

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