Emergencies Flashcards
AEDs are not designed for infants under 1y. Should you use it in an event that arrest occurs?
Yes
The recovery position involves all limbs at 90 degrees at the elbow and knee. One hand against the patient’s cheek and the farther leg brought towards you more. When should you flip the patient to the opposite side?
After 30 mins
What is the paediatric and adult dosages of adrenaline?
Adult and child >12 = 0.5ml
Child 6-12 = 0.3ml
Child<6 = 0.15ml
All 1:1000
In other scenarios 1ml of 1:10000 are used
After an anaphylactic attack has subsided with treatment, what is the next course of action?
Prescribe autoinjectors to the patient advising them of the technique and to always carry 2
!!! Admit to A&E regardless
What is the correct technique patients should follow when having an allergic reaction
Lie flat, elevate legs (unless breathless, then they can sit upright). Place orange part on outer mid thigh and click the button. Yes it can go through clothes
What is the protocol for anaphylaxis
ABCDE, call for help, Administer 0.5ml 1:1000 IM
When equipment is available:
IV fluid challenge (500-1L or 20ml/kg)
Chlorphenamine (IM or IV)
Hydrocortisone (IM/IV)
What is Kernig’s sign?
Sign indicating meningism (may also be seen in SAH)
When hips are fully flexed, patient resists passive knee extension.
How do you assess for a stiff neck for meningism?
Check if they can put chin on chest
A patient presents to your clinic with stiff neck, photophobia, nausea, vomiting, and a non-blanching petechial rash. What is your next course of action?
1) Call emergency ambulance for transfer
2) While waiting perform ABCDE and give fluids and oxygen if available
3) Give IV/IM Benzylpenicillin or Cefotaxime
If patient is shocked, lie flat and raise legs above waist
A patient presents to your clinic with stiff neck, photophobia, nausea, vomiting, and a non-blanching petechial rash. You decide to give IM benzylpenicillin but a note says that they previously had a rash to it. Will you still give the dose or switch to cefotaxime?
A rash in not a contraindication only anaphylaxis
Benzylpenicillin is the drug of choice for treating meningococcal disease. When should it be withheld?
Only withheld if there is an anaphylactic reaction previously to it.
No signs of meningococcal disease, only meningitis
What is the difference between meningitis and meningococcal disease?
Meningococcal disease has meningitis + Rash (non-blanching petechial). Other than that is it just more rapid onset and severe.
Meningitis and encephalitis are notifiable diseases. Contact tracing is undertaken by the local public health department. For a single case, only close contacts require prophylactic antibiotics and vaccination. What are these?
Antibiotics: Ciprofloxacin or Rifampicin
Vaccines: Routine childhood vaccination should have been given but in all cases, give the confirmed serotype (typically A and C)
Give 3 long-term effects of meningococcal disease
1) Hearing loss (refer for audiology)
2) Neurological: Fits, hemiparesis
3) Orthopaedic: Bone and joint damage, poor limb growth
4) Psychosocial effectsF
Define cardiogenic shock
Inability of the heart to maintain sufficient bloodflow due to MI, tamponade, arrhythmia
What is the typical presentation of hypovolemic shock
How is it managed in primary care?
Initially tachycardia (>100), pallor, sweating followed by decompensation with sudden bradycardia and hypotension
Lie patient flat, raise legs above waist and call for emergency ambulance
Gain IV access (2x large bore cannulas) and take blood for FBC and crossmatching!!
Start IV fluids 1L over 15 mins
Give 100% oxygen (15L/min unless hypercapnic like in COPD then give 24% oxygen)
Treat underlying cause
Use this for all heavy bleeding in primary care
How does an AAA present?
Hypovolemic shock + Backpain + Pulsatile mass in abdomen
How does a Dissecting Thoracic Aneurysm present
How is it managed in primary care
Sudden tearing chest pain +/- LOC radiating to the back
+ Hypovolemic shock
+ occlusion of the branches of the aorta
a) coronary arteries -> MI
b) Subclavian arteries -> Unequal pulses and BP in both arms
c) Carotid artery -> Hemiplegia
d) Spinal arteries -> Paraplegia
e) Renal arteries -> Acute renal failure
Lie patient flat, raise legs above waist and call for emergency ambulance
Gain IV access (2x large bore cannulas) and take blood for FBC and crossmatching!!
Start IV fluids 1L over 15 mins
Give 100% oxygen (15L/min unless hypercapnic like in COPD then give 24% oxygen)
A patient presents with frank bleeding on toilet paper when wiping. You determine that this is a haemorrhoid (or anal fissure). What is your management plan in primary care.
As this is very benign and not a source of heavy bleeding, no further investigation is needed => treat as haemorrhoid which is rest, ice, soften stool with ispaghula and give analgesia. Only refer when not settled.
A patient presents with bleeding PR. Who will you refer to and when is it indicated for urgent referral?
Refer to lower GI team within 2 weeks IF (basically if it looks bad, use common sense)
Only if abdominal/rectal mass
Unexplained rectal bleeding >50
Unexplained rectal bleed <50 with abdominal pain, change in bowel habit, weight loss or iron deficiency anaemia
A patient presents with Epigastric/RUQ pain + coffeeground vomit. There is no circulatory compromise. What is your next step in management?
Refer urgently to an upper GI team within 2 weeks
A patient presents with haematemesis via coffee-ground vomit. There is no circulatory compromise. What is your next step in management?
Refer routinely to Upper GI team for endoscopy
It would be an urgent referral if abdominal mass, Epigastric/RUQ pain. dysphagia, or aged >55, weight loss
