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Acute Care > Emergencies > Flashcards

Emergencies Flashcards

1
Q

What do you look for in ‘A’ of ABC assessment?

A

Airway safe?
Obstruction? stridor?
Aspiration risk if conscious level below 8 GCS

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2
Q

What do you look for in B of ABC?

A

Breathing:
Resp rate
Depth of respiration
Pattern of respiration/work of breathing
Oxygenation
CO2 elimination (hypercapnic-> bounding pulse)
Not breathing? Call 2222, use bag and mask

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3
Q

Categories of causes of swallow/airway dysfunction

A

Neuro vs direct

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4
Q

Name 7 neuro causes of swallow dysfunction

A
  • Coma
  • Anaesthesia
  • MND
  • MS
  • Brainstem stroke/haemorrhage
  • Congenital/genetic
  • Muscular weakness/poor cough
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5
Q

Name 4 direct causes of swallow/airway dysfunction

A
  • Injury, radiotherapy
  • Malignancy
  • Burns
  • Infection
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6
Q

What is bad about a Guedel airway?

A

If person has gag reflex they may vomit
When it is too large it can close the glottis
Improper sizing can cause bleeding in the airway

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7
Q

How do you size a Guedel?

A

Size it by measuring mouth to angle of mandible

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8
Q

What is type 1 respiratory failure?

A

Type I (hypoxaemic) resp failure
PaO2< 60 mm Hg with a normal or low PaCO2
VQ mismatch (eg alveoli collapse/fluid filled)
eg pulmonary oedema, pneumonia

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9
Q

What is type 2 respiratory failure?

A

Hypercapnic
Ventilation failure
PaCO2>50mm Hg
eg drug overdose, neuromuscular disease, chest wall abnormalities

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10
Q

What are the 3 types of rhythm the defib will recognise?

A

Shockable (VF/pulseless VT)
Return of spontaneous circulation
Non shockable (PEA/asystole)

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11
Q

What rhythms are shockable?

A

VF

Pulseless VT

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12
Q

What rhythms are non shockable?

A

Asystole

PEA (pulseless electrical activity)

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13
Q

If shockable rhythm, what happens in CPR?

A

1 shock
CPR for 2 mins
Assess rhythm again

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14
Q

What happens when spontaneous circulation returns after CPR?

A 
Use ABCDE approach
Aim for SpO2 94-98%
Aim for normal PaCO2
12 lead ECG
Treat cause
Temperature management
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15
Q

Reversible causes of cardiac arrest

A 
4H's 4T's
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia
Thrombosis (coronary/pulmonary)
Tension pneumothorax
Tamponade
Toxins
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16
Q

Is anything injected in CPR?

A

Adrenaline every 3-5mins
Amiodarone after 3 shocks
or if non shockable adrenaline every other cycle

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17
Q

Describe a good chest compression

A

30:2
100-120bpm
5-6cm depth or 1/3 depth of chest

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18
Q

6 emergency causes of chest pain

Symptoms that differentiate cause

A
  • STEMI (CV risk factors, Hx, STEMI will respond to cath lab treatment, 0 r and 3 hr troponin)
  • Aortic dissection (BP dropping, pallor, shock, sudden, radiates to back- CT aortogram
  • Pneumonia/pleuritis
  • Pulmonary embolism (d-dimer to rule out if low risk,
  • Pericarditis (echo to look for tamponade)
  • Mediastinal tumour (weight loss/cough)
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19
Q

6 emergency causes of headache

Symptoms that differentiate cause

A
  • SAH (sudden onset, worst headache ever within a second of onset, can remember what they were doing, papilloedema, meningism, focal neurological deficit)
  • Meningitis
  • SOL: positional, progressive, night and early morning, papilloedema
  • Acute close angle glaucoma: visual loss
  • Temporal arteritis (ESR, palpable pain, visual loss)
  • Vertebral artery dissection (neck pain)
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20
Q

6 emergency causes of SOB

Symptoms that differentiate cause

A
  • PE (DVT?)
  • Pneumonia (crackles/consolidation)
  • Anaphylaxis (significant airway swelling & airway compromise, urticarial, low systolic pressure (90), wheeze).
  • Heart failure (paroxosymal nocturnal dyspnoea, leg swelling, functional exercise ability)
  • Asthma (control/prev hospital admissions/ITU/intubation/steroid tablets)
  • Anaemia
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21
Q

Immediate treatment of anaphylaxis

A

IM adrenaline 1/1000. 0.5ml. (500micrograms).
Hydrocortisone
Fluids (due to distributive shock)

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22
Q

9 emergency causes of abdo pain

Symptoms/signs that differentiate cause

A
  • AAA rupture (sudden, epigastric(?) pain. Examination, USS!
  • Appendicitis (anorexia, intermittent epigastric pain->constant R iliac fossa pain)
  • Ectopic pregnancy (lateralised pain, Beta-HCG (urine or blood), PID/untreated PID, previous ectopic
  • Perforated peptic ulcer (erect chest x-ray
  • Bowel obstruction (complete constipation, no flatus) Abdo XRay
  • Toxic megacolon Abdo xray
  • Pelvic inflammatory disease (fever)
  • Renal colic
  • Pyelonephritis (loin->groin)
23
Q

9 causes of collapse

A
  • Hypoglycaemia
  • Acute airway obstruction
  • Large PE (obstructive shock)
  • Septic shock
  • Arrythmia
  • Valvular dysfunction
  • Vasovagal
  • Epileptic tonic-clonic syndrome
  • Toxic syndrome (drug)
24
Q

What is SBAR?

A

A way of communicating quickly and effectively with other healthcare professionals
Situation (I am__, F1 on __ ward. I am calling about pt ____ because _____)
Background (___ was admitted on __/__ with ____. They has ___, change, last obs, what is normal)
Assessment (I think problem is___ and I have given ___. But deteriorating/not sure)
Recommendation (I need you to come and see the pt, is there anything I can do in the meantime?)

25
Q

How to treat 4H’s for reversible causes of cardiac arrest

A

Hypoxia: open airway, ventilate patient
Hypovolaemia: trauma/upper GI bleed, sepsis. Give IV fluids, O-ve blood
Hypo/hyperkalaemia: Use ABG reading. Give replacement if hypo or insulin and glucose and calcium chloride if hyper
Hypothermia: eg drowning

26
Q

How to treat 4T’s for reversible causes of cardiac arrest

A

Tamponade: drain pericardial effusion
Thromboembolism: massive PE, thrombolyse/PCI if cardiac
Toxins: opioids, TCAs, Benzos.
Tension pneumothorax: trauma/central line placement. Large bore cannula 2nd intercostal space mid clavicular line

27
Q

2 categories of shock

A

High flow and low flow

28
Q

3 types of low flow and high flow shock

A

Low flow shock: hypovolaemic, cardiogenic, obstructive

High flow, vasodilatory: septic, anaphylactic, neurogenic

29
Q

What needs to be assessed in shock?

A

Cardiac instability (pulse/BPin both arms/cap refill/temp)
Respiratory distress (airway/resp rate/o2 sats/chest pain)
Appearance (cold&clammyin cardiogenic/hypovolaemic, warm&well perfused in septic, urticarial&angiodema&wheeze in anaphylaxis)
• Conscious level
• Pain
• Anxiety/agitation
JVP (up in cardiogenic, down in hypovolaemic)

30
Q

What 4 things make you worried about renal failure?

A

Uraemia
Pulmonary oedema
Acidosis
Hyperkalaemia (worsened by acidaemia)

31
Q

Define sepsis

A

Life threatening organ dysfunction due to a dysregulated host response to infection

32
Q

Define septic shock

A

Profound circulatory and cellular metabolic abnormalities, increased mortality.
Inadequate perfusion of vital organs
Hypotension after fluid resus or lactate>4

33
Q

How is genetics involved in sepsis?

A

Genetic variability of response to cytokines/toxins (TLR-4 toll like receptor expression)
Neutrophil activation-> injured endothelium-> permeability -> abnormal Nitric Oxide production

34
Q

Most common gram +ve causes of sepsis

A

Steptococci
Staphylococci
Clostridium (rods)
Listeria (rods)

35
Q

Most common gram -ve causes of sepsis

A

Neisseria gonorrhoeae, N. meningiditis (cocci)

H. influenza, E.coli, Psuedomonas, Legionalla, Klebsiella (rods)

36
Q

What is the sepsis six?

A
  • Administer high-flow oxygen to maintain target oxygen saturations greater than 94% (or 88-92% in COPD)
  • Take blood cultures (consider abscesses)
  • Give intravenous antibiotics (if septic shock use broad spectrum)
  • Start intravenous fluid resuscitation
  • Check lactate level & Hb
  • Monitor hourly urine output (catheterisation)
37
Q

Give 7 signs that indicate activation of Sepsis Six

A
  • Systolic BP<90 or MAP<65
  • Lactate > 2
  • HR> 130bpm
  • Resp rate>25bpm
  • O2 sats
38
Q

What operation related factors can cause AKI?

A
  • Hypovolaemia
  • Hypotension
  • Shot of gentamicin intra-op
  • Post op NSAIDs
  • Blockage of urinary catheter?
39
Q

What does REACT stand for in emergency care?

A
  • Recognise
  • Escalate it
  • Act
  • Communicate
  • Timely
40
Q

What type of blood is given in an emergency if you don’t know what blood type they are?

A

O negative

41
Q

Causes of excessive haemolysis

A
  • Abnormal red cells-> increased consumption (sickle cell disease, thalassaemia)
  • Normal red cells and abnormal breakdown (prosthetic heart valves, splenomegaly)
42
Q

What happens within seconds as a response to haemorrhage

A
  • Baroreceptors and chemoreceptors
  • Adrenaline mediated response
  • Tachycardia, tachypnoea
  • Vasoconstriction in splanchnic and renal vascular bed
43
Q

What happens within minutes as a response to haemorrhage

A
  • RAS system
  • Direct vasoconstriction
  • Thirst
  • Salt and water retention (ADH)
44
Q

What happens within days as a response to haemorrhage?

A

Erythropoetin leads to increased red cell production

45
Q

When do you transfuse blood?

A 
•	Rapid
•	Large volume (>5L)
•	Co-morbidity
•	On-going
•	Site of bleeding
Haemoglobin below 8
46
Q

What are blood products screened for?

A
  • Hep B antigen
  • Hep C antibody
  • HIV 1 and 2 antibody
  • HTLV
  • Syphilis
  • Special circumstances (CMV in neonates/infants)
47
Q

PE signs?

A 
Respiratory acidosis
Listen to chest, tachycardia, tachypnoea
O2 sats<91%
Hx (pleuritic chest pain)
ECG: right heart strain, tachycardia
BP: systolic<90mmHG
DVT?
Haemoptysis?
D-dimer positive
48
Q

Treatment of PE

A

CTPA to confirm?
IV unfractionated heparin/fondparinux stat if immediate CTPA available
Reversible (protamine, salmon sperm)

49
Q

Name the types of pump failure shock

A

Cardiogenic

Secondary (PE, tension pneumothroax, tamponade)

50
Q

Name the types of peripheral circulation failure shock

A
  • Hypovolaemic shock (blood on the floor, long bones, chest cavity, abdomen, pelvis) (excessive loss by burns/diarrhoea)
  • Anaphylaxis
  • Septic (from endo-toxin induced vasodilation)
  • Neurogenic (post spinal injury above T6)
  • Endocrine failure (Addisonian crisis or hypothyroidism)
  • Iatrogenic (Anaesthetics/antihypertensives)
51
Q

Management of shock

A

?Call the cardiac arrest team
ABC (including high flow O2)
Raise feet in bed (unless cardiogenic)
IV access x2 wide bore
Identify and treat underlying cause
Infuse fluid (500ml bolus, unless cardiogenic)
Catheter to monitor urine outputCentral line? Arterial line?

52
Q

Investigations for shock

A 
Find cause:
•	FBC, U&amp;E, ABG, glucose, CRP
•	Cross match and check clotting
•	Blood cultures, urine culture, ECG, CXR
•	Lactate/echo/ abdo CT/USS
53
Q

Treatment of shock

A
  • Septic: blood cultures and abx withing 1 hr, fluids, vasopressors?
  • Hypovolaemic: blood/fluid replacement, normalise ions
  • Heat exhaustion: fanning and sponging
  • Anaphylaxis: airway, raise feet, IM adrenaline 0.5mg every 5 mins, chloramphenamine 10mg IV. Salbutamol, aminophylline if wheezing.
  • Cardiogenic: O2, morphine, correct arrhythmia, thrombolysis if MI, cardiocentesis if pericardial effusion, dobutamine?

Acute Care (11 decks)

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