Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 4 > Emergencies > Flashcards

Emergencies Flashcards

1
Q

What is the definition of a major haemorrhage?

A

50% blood loss within 3 hours

> 150mls per minute

Full circulatory volume lost in 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What should the management be during a major haemorrhage?

A
  1. Assess if this is a major haemorrhage
    - put out major haemorrhage protocol
  2. Restore circulating volume
    - IV access
    - Fluids - warm if possible
  3. Stop bleeding
  4. Send samples
    - emergency cross match
    - FBC
    - Clotting studies
    - ROTEM
    - U&;Es
    - ABGs
  5. Give blood products
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is made available following a major haemorrhage protocol?

A

6 units of RBCs

- O negative will be provided until a 2nd cross matched sample is received

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

If there is trauma, obstetric or risk of DIC what should also be requested upon the major haemorrhage protocol?

A

FFP

Platelets may also need to be requested

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How long does a group specific, cross match take?

- where can O neg blood be found?

A

Group and save: 25 mins
Cross match: 60 mins

O Neg can be found in:

  • Blood bank
  • Satellite fridges
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What haemoglobin should be aimed for in Major haemorrhage?

A

Hb> 80g/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How much time for products do you need to leave during a major haemorrhage?

A

20mins thawing time for FFP
25 mins for group specific RBCs
60 mins for crossmatch
Transport time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What drug can be given during a major haemorrhage to help control bleeding?

A

Tranexamic acid

IV infusion - slowly initially.

then transfusion over 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the ideal blood product use for DIC?

A

Cryoprecipitate - contains fibrinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the different types of shock?

A 
Cardiogenic shock 
Hypovolemic shock 
Septic shock 
Neurogenic shock 
Anaphylactic
Obstructive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the classifications of shock?

A 
Type I:
<750ml 
15% 
<100bpm 
BP normal 
slight anxious 
Type II: 
750-1500ml 
15-30% 
100-120bpm 
BP normal 
Mildly anxious 
Type III: 
1500-2000
30-40% 
120-140
BP lowered 
Anxious confused 
Type IV: 
>2000
>140 
BP lowered 
RR>35 
Confused lethargic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you manage a haemorrhage causing shock?

A
  1. Assess if this is a major haemorrhage
    - put out major haemorrhage protocol
  2. Restore circulating volume
    - IV access
    - Fluids - warm if possible
  3. Stop bleeding
    - active haemorrhage control
    - direct compression
    - pelvic binder
  4. Send samples
    - emergency cross match**
    - FBC
    - Clotting studies
    - ROTEM (assesses haemostasis in patients)
    - U&Es
    - ABGs
  5. Give blood products
    - give O neg blood initially then move to group specific when able
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How much and how quickly should a fluid bolus be given in an emergency situation?

A

500ml saline over 15 mins

or

250ml in heart failure over 15mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List some causes of cardiogenic shock:

A

M.I

Mitral regurgitation

Subarachnoid inducing catecholamine release causing cardiogenic stunning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name some causes of obstructive shock

A

P.E

Cardiac tamponade

Tension Pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List some causes of neurogenic shock, and explain the underlying pathological mechanisms:

A

High cervical cord trauma

Major brainstem or spinal injury

Guillain Barre syndrome

Loss of vasomotor control induces mass peripheral dilation.
Also damage to sympathetic nerves system can induce severe bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are some clinical features of septic shock?

A

Warm peripheries
Bounding pulse
Large pulse pressure (120/ 50)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some clinical features of Anaphylactic shock?

A 
Wheeze 
Stridor 
Angioedema - especially facial and laryngeal 
Itch 
Urticaria 
Bounding pulse
warm peripheries 
Large pulse pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some mimics of anaphylaxis?

A

Carcinoid syndrome
Pheochromocytoma
Angioedema
Mastocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What should be measured to confirm anaphylactic reaction and when?

A

Tryptase

1 - 6 hours following onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the management of hemorrhagic shock following from initial ABC (i.e. fluids and oxygen is already on)?

A

Stop bleeding

  • pelvic binders
  • Leg splints

Contact Haematology

Give blood and FFP (1:1 ratio)

  • O Neg
  • specific blood

Platelets (keep >100) - platelets

Fibrinogen (>1) - cryoprecipitate

Tranexamic acid

22
Q

Following ABCDE if someone is in cardiogenic shock, how are you going to treat them?

A

Diamorphine
- reduce pain and anxiety

Correct arrhythmias and U&E abnormalities

Optimise filling pressures:
Underfilled:
- Plasma expanders

Underfilled:

  • Inotropic support - dobutamine
  • Nitrates
23
Q

Name some complications of shock:

A

Hypoperfusion to vital organs which may cause irreversible damage.

  • Brain - coma
  • Kidneys
  • Ischemic Hepatitis
  • Myocardial ischemia
24
Q

What clinical signs may you see with cardiogenic shock?

A 
Low BP/ High diastolic 
Weak pulse 
Raised JVP 
Low GCS 
Oliguria
Cool peripheries
25
Q

What is the management of anaphylaxis ?

A

Secure Airway
- intubation may be needed

Remove cause

IM adrenaline - 0.5mg - 1:1000ml 
- repeat every 5 mins if needed 
\+ 
IV chlorpheniramine 
\+ 
IV steroids

IV saline

still hypotensive:
- ICU 
- IV Adrenaline 
\+ 
- IV aminophylline
26
Q

What are the generalised stages of shock?

A

Initial

Compensating

Progressive/ Decompensating

Refractory/ irreversible

27
Q

List some signs of hypovolemic shock?

A

altered mental status

Cool clammy skin
Mottled skin

weak, thready pulse
tachycardia

thirsty/ dry/ low JVP

Pupil dilation

28
Q

In E of the ABCDE, what are you looking for in shock?

A

Signs of blood loss:

  • injury sites
  • penetrations
  • bruising across the flanks / abdomen
  • High riding prostate

Signs of infection:
- Rash

29
Q

When should someone be admitted following a head injury?

A 
<15 GCS 
Focal neurological symptoms 
Vomiting 
Amnesia 
Alcohol ingestion 
Coagulopathy 
Suspected cranial fracture
30
Q

What are the signs of a basal skull fracture?

A 
Panda eyes 
Hemotympanum
Otorrhoea - CSF from ears
Rhinorrhoea - CSF from nose 
Battle's sign - bruising on mastoid
31
Q

What is a LBBB in keeping with in the setting of an M.I?

A

Large anterior M.I

32
Q

What are the rhythms that cause arrest?

A

PULSELESS VT

VF

Pulseless electrical activity

Asystole

33
Q

How are you going to monitor a patient with shock?

A 
Mental status 
Vitals - HR, BP, RR, Stats 
Cap Refill 
Urine output 
ECG 
Skin colour and temperature
CVP - if in place
34
Q

What immediate investigations do you want when someone is in shock?

A 
Bloods: 
- FBC 
- U&amp;Es 
- ABG 
- Coagulation studies 
- LFTs 
- Glucose 
\+/- 
CRP 
\+/- 
Blood cultures

Orifices:
- Urine output
+/-
urinalysis

X-rays:
- Ultrasound of heart (if cardiosuspected)
+/-
CXR

ECG

Special tests:

  • tryptase
  • D-dimer
35
Q

How are you going to monitor someone following shock?

A 
Mental status 
Urine output 
Vitals - HR, STATS, BP 
Skin Colour 
Cap Refill 
CVP 
ECG
36
Q

What makes up the trauma triad?

A

Hypothermia

Coagulopathy

Acidosis

37
Q

If you are at bedside with a patient who has collapsed, what bedside investigation should you always do?

38
Q

In addition to atropine, what additionally inputs can be done into severe bradycardia?

A

external pacing
Adrenaline
Temporary pacing wire

39
Q

What important medication must be given when there is stridor and oxygen sats falling?

A

Nebulised Epinephrine
+
Contact anesthetists

40
Q

List actions you would take during a AAA?

A

Major haemorrhage protocol
Give O negative blood
Senior help/ Vascular surgery

41
Q

What bedside tests can be done to confirm an AAA?

A

Ultrasound

FAST scan

**CT confirms whether it has rupture

42
Q

Give some differentials for stridor:

A

Inspiratory:

  • Epiglottitis
  • Glandular fever
  • Laryngitis
  • Croup

Expiratory:
- Tracheal compression

43
Q

If a person goes into cardiac arrest following a P.E and is treated with thrombolysis - how long should CRP be continued for?

A

90 minutes.

thrombolytic drug needs time to work

44
Q

If someone presents with a collapse - what is a very important aspect of the systemic enquiry history you want to ask about?

A

Melena or G.I bleed.

they be volume depleted leading to low BP

45
Q

What signs may you see during a P.E?

A

Tachypnea
Pleuritic chest pain
Hemoptysis
Syncope

Right ventricular heave
Loud 2nd heart sound
Splitting of heart sound
Increased JVP

46
Q

Management of a P.E?

A 
Oxygen 
Fluids 
LMWH 
or 
Thrombolysis
47
Q

Immediate management of NSTEMI:

A 
Beta blockers 
Aspirin 
Ticagrelor
Morphine 
Anticoagulation - LMWH 
Nitrates 
\+/- 
Oxygen (<94%)

GRACE Score
>10% = PCI or CABG

Follow up they will need:

  • Echocardiogram
  • Stress ECG
  • Angiogram
48
Q

During an upper G.I bleed, when should O- blood be given?

A

If they patient is severely unstable or Hb <7

49
Q

When in an upper G.I bleed is terlipressin and antibiotics given?

A

If high suspicion of varices i.e. liver failure.

given before scope

50
Q

What are the initial symptoms of anaphylaxis?

A

Tingling
Warmth
Itchiness
Mild oedema

followed by:

  • urticaria
  • generalised flush
  • wheeze
  • bronchospasm
  • hypotension
51
Q

What biochemical directly correlates with the severity of an anaphylactic reaction?

A

Serum Platelet Activating Factor

Phase 4 (49 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions