Emergencies Flashcards
What is the procedure for removing embolus in an emergency?
surgical embolectomy
What is xanthochromia?
It refers to the presence of bilirubin in the cerebrospinal fluid (CSF) and is used by some to differentiate in vivo hemorrhage from a traumatic LP.
What is transexamic acid used for?
Synthetic derivative of lysine => binds the 5 lysine binding sites on plasminogen => inhibit plasmin formation => displace plasminogen from the fibrin surface.
May also directly inhibit plasmin and partially inhibit fibrinogenolysis at higher concentrations
What is a FAST scan? What are its indications? What is it good for diagnosing?
FAST scan = Focused Assessment by Sonography in trauma exam.
Indications =
Good for =
Lungs: Look for pneumothorax
Thorax: Look for injury in peritoneum, pericardium and pleural cavities.
Abdomen: diagnose intra-abdominal haemorrhage
Methods = The FAST examination uses a bedside ultrasound to provide images of the right upper quadrant, left upper quadrant, and pelvis to assess for intra-abdominal haemorrhage.
Antifibrinolytics (such as tranexamic acid) should be considered in all trauma patients with acute severe haemorrhage as soon as possible, as they have been shown to increase survival when given within 3 hours of injury.
NA.
A 2009 study found that aggressive transfusion of packed red blood cells, fresh frozen plasma, and platelets improves the outcome in haemodynamically unstable trauma patients
NA.
What are the most important measures in an ABG to estimate the extent of bleeding and shock?
Serum lactate and base-deficit
What is Cushing’s reflex? What are its triggers? What is its etiology?
Cushing’s reflex = Bradycardia, increased systolic BP, increased pulse pressure, irregular RR
Triggers = Raised intracranial pressure
Etiology =
ICP > MAP => Arterioles in cerebrum compressed => Cerebral ischaemia
Stage 1: Sympathetic activity increases more than parasympathetic activity =>Stimulate alpha-1 adrenoreceptors => Arteriolar constriction => MAP>ICP => Restore blood flow
Stage 2: Baroreceptors in aortic arch detect increased MAP => Vagus nerve activity increases => Bradycardia => Complication: Cushing ulcers in stomach due to increased acid production by parietal cells
A 65 year old man with a history of self-harm presents to A&E with severe nausea and vomiting. He tells you that he took 'some tablets' but he didn't bother to look at what they were. He suffers from stable angina but his PMHx is otherwise unremarkable. His observations are as follows: HR 110 BP: 110/85 RR: 30 O2 sats: 100% Temp: 39.0
What is the most likely diagnosis? A. SSRI toxicity B. Paracetamol overdose C. MI D. Aspirin overdose E. Panic attack
D
A 21 year odl woman of average build is brought to A&E by her mother after she ingested 2 packets of paracetamol ~6h ago. She says she feels fine at the moment and wishes to be sent home. What is the next best step in the management of this pateitn?
A. Send her home with a referral to the Community Mental Health Team
B. Admit her to the local Mental Health Unit
C. Admit her to the renal ward for immediate dialysis
D. Admit her and prescribe activated charcoal
E. Admit her and start IV N-acetyl cysteine
E. Not D because D is more suitable for ingestion <4h before. This patient ingested paracetamol 6h ago.
An 18 year old girl is brought to A&E with difficulty in breathing. On examination, you note swelling of the lips and tongue and an erythematous rash over her face and trunk. Her Obs are as follows: HR 160 BP: 70/50 RR: 40 O2 sats: 92% Temp: 37.2
What is the next best step: A. IV adrenaline 0.5mg B. IM adrenaline 0.5mg C. IV adrenaline 0.25mg D. IM adrenaline 0.25mg E. Start high-flow oxygen
I think answer is E. According to the Oxford handbook, 100% oxygen delivery is the first step that should be done for patients with suspected anaphylaxis.
A 35 year old man presents to A&E in respiratory depression with needle track marks on his arms. He has pinpoint pupils on examination. His observations are as follows: HR 40 BP: 60/30 RR: 8 O2 sats: 90% Tempt: 37.2
What is the next best step in the management of this patient? A. IV naltrexone B: IV naloxone C: IV saline 0.9% 1L bolus D: IV flumazenil E: IV atropine
A.
A 62YO gentleman is brought to A&E by his wife who suspects that her husband has been drinking. It is clear that the gentleman is disoriented, and he has particularly unsteady gait. On examination, you note spider naevi, gynaecomastia, nystagmus on lateral gaze and mild peripheral neuropathy. His blood results are as follows: FBC - Hb 12.5g/dL (13.5-17.5g/dL) MCV: 105fL (80-96) HCT: 0.35 (0.4-05) Platelet: 200*10^9 (150-400*10^9) WBC: 8000/ml (4000-1000)
U&E: normal
CRP: normal
INR: 0.7 (<1.1)
What is the most likely diagnosis? A. Hepatic encephalopathy B. Wernicke's encephalopathy C. Encephalitis D. Normal Pressure Hydrocephalus E. Delirium tremens
Probably B because the spider naevi and drinking history suggests he drunk alot => Wernicke’s encephalopathy
