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00 SpR > Emergencies > Flashcards

Emergencies Flashcards

1
Q

Anaphylaxis

Adult

A

ABCDE
Remove causitive agent
Lie flat, legs up

15L non rebreathe
0.5mg IM adrenaline (1:1000)
1 L IV fluid STAT
? Salbutamol/adrenaline Neb

After 2 doses IM
1mg adrenaline in 100ml
1ml/kg/hr then titrate

2-6h observation

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2
Q

Anaphylaxis
Child doses drugs
Adrenaline and IVF

A

Adrenaline:
>12 = 500mcg
6-12 = 300mcg
<6 = 150mcg

IVF = 20ml/kg

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3
Q

Choking

Adult

A

Effective cough
- encourage cough

Ineffective cough
Conscious:
- 5 back blows
- 5 abdominal thrusts
Unconscious
- start CPR
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4
Q

Pre alert Adult Cardiac arrest

Actions

A 
Check pulse (Trolley)
Roll, Transfer

Start CPR and clock
Pads and rhythm check
Airway and capnography
IV access and VBG

2 minute cycle; time
Hx
Arrest time, CPR start time, PMH, QoL

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5
Q

Unresponsive patient

Unconscious patient

A

Stimulate: verbal/pain
Signs of life: Pulse check
Pads and BVM
ABCDE

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6
Q

Cardiac arrest

Drug doses

A

Adrenaline 1mg IV (1:10000)
Amiodarone 3rd and 5th shocks
- 300mg IV
- 150mg IV

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7
Q

Bradycardia

Signs of decompensation

A

Shock, syncope, angina, HF

Risk of asystole:
Mobitz II, CHB, ventricular pause >3s

Consider High ICP, hypoxia

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8
Q

Bradycardia

Treatment

A

Atropine 500mcg IV
Isporenaline 5mcg/min
Adrenaline 2-10mcg/min
Glycopyrronium 200-400mcg

Transcutaneous pacing

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9
Q

Stable Tachycardia

Dx

A 
Narrow complex
- irregular: AF
- regular: SVT
Broad complex
- regular: VF ?SVT + BBB
- irregular: AF + BBB

Other:
Polymorphic VT
WpW

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10
Q

WpW

Tx

A

Electrical cardioversion
Consider amiodarone

Do not give
Adenosine, beta/Ca blocker
(Block AV node)

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11
Q

Polymorphic VT

Torsades de pointes

A

Magnesium 2g IV (over 10 mins)

Do not give amiodarone
Prolongs QT

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12
Q

Fast AF

Tx

A 
Stable
Rhythm control?
Rate control:
Bisoprolol 5-10mg
IVF bolus
Digoxin 500mcg
Amiodarone 300mg (30-60min)
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13
Q

SVT

Treatment

A
  • Modified valsava
  • Adenosine (?WpW?asthma)
    6,12,18mg
  • Sync shock
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14
Q

VT

Treatment

A

Unstable
Sync shock

Stable
Amiodarone 300mg (20-30mins)
Then 900mg over 24h

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15
Q

Unstable tachycardia

Treatment

A

Sync shock (x3)

  • Sedation
  • 100,150,200
Amiodarone 300mg (20min)
- repeat shocks
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16
Q

Adenosine

Contraindications

A

WpW

Asthma

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17
Q

Adenosine

Consent

A

Flushing and chest pain

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18
Q

Massive PE

Dx

A 
Hypoxia, tachycardia 
Hypotension
Signs of Right HF
- raised JVP
- TWI (V1-4 +/- inferior leads)
- S1Q3T3
- right axis deviation
- dominant R wave V1
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19
Q

Neutropaenic sepsis

Suspect in these groups…

A
  • Any unwell haematology patient (regardless of treatment or not)
  • Any unwell oncology patient within 6 weeks of systemic anti cancer Tx
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20
Q

STEMI

Dx

A 
ST elevation in 2 contiguous leads
>2mm chest leads
>1mm limb leads 
ST depression V1-2
\+\-Wellens syndrome
(Biphasic TW or deep inversion V1-3)
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21
Q

STEMI

Tx

A

MONA
Aspirin 300mg
Ticagrelor 180mg PO
?GTN 1-10mg/hr

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22
Q

HHS
(Hyperosmolar hyperglycaemic)
Dx

A

BG>30
Serum Osmolality>320

Treat as per DKA if:
pH <7.3
HCO3< 15
Ketones >3(b) or 2(u)

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23
Q

Meningitis/ meningococcal sepsis

Tx

A 
Blood cultures
Dex 10mg IV
Ceftriaxone 2g IV BD
\+\-
Amoxicillin 
(Low immune, EtOH, DM, pregnant)
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24
Q

Rhesus negative woman

Sensitising event

A
  • Complete and incomplete miscarriage after 12 weeks

- Threatened miscarriage with heavy or recurrent bleeding

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25
Q

Primary pneumothorax

Dx and Tx

A

Breathless +/- rim of air >2cm at level of hilum

Tx
Aspirate 16-18G canula
>2.5L aspirated or unsuccessful
-> intercostal drain

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26
Q

Secondary pneumothorax

Dx and Tx

A

Any of:
>50yrs, smoker, underlying lung disease
With:
Breathless +/- Tim of air >2cm (hilum)

Tx
Intercostal drain

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27
Q

Neutropaenic sepsis

Tx

A

Tazocin 4.5g QDS
+
Gentamicin 3-5mg/kg

If
Penicillin allergy
Or myeloma
See protocol

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28
Q

Encephalitis

Tx

A

Aciclovir 10mg/kg IV TDS

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29
Q

Upper GI/ Variceal bleeds

Abx

A

<64yr
Ceftriaxone 1g IV OD
>65
Ciprofloxacin 400mg IV BD

Penicillin allergy = cipro

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30
Q

Gentamicin dose

A

<65
5mg/kg
>65
3mg/kg

eGFR 10-30
2-3mg/kg
eGFR 5-10
2mg/kg

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31
Q

Metastatic spinal cord compression

Suspect if…

A

Bone mets +
Back pain, worse on lying or moving, prevents sleep
New nerve root pain

(Do not wait for weakness or sensory level)
Ix and Tx!

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32
Q

Metastatic spinal cord compression

Tx

A

16mg dexamethasone IV
With ranitidine

MRI whole spine

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33
Q

General principle

Unstable
Vs
Stable
Tachycardia

A

Unstable

  • sync DC shock
  • sedation ?conscious

Stable

  • 300mg Amiodarone IV over 20-30mins
  • unless TdP - IV MgSO4 2g (10min)
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34
Q

Upper GI bleed (severe)

Tx

A

2222 major haemorrhage
2 large bore IV canula

Blood if Hb<10 or significant ongoing bleeding

Vit K 10mg IV
Terlipressin 2mg IV
Tazocin 4.5g

GBS score
?endoscopy
Reverse clotting?

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35
Q

Traumatic cardiac arrest

Pre-alert -> prepare

A 
Trauma team
Call Consultant 
Prioritise HOT
H: 
- Pelvic splint/ tourniquets
- IO kit
- Blood
- Level 1 infuser 
O:
- Intubation/ Capnography 
T:
- Chest drain kit
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36
Q

Traumatic cardiac arrest

Algorithm

A

Trauma to chest/epigastrium?

  • bilateral finger thoracostomy
  • penetrating wound <10min down time -> clamshell
HOT +/- CPR
Hypovolaemia
- pelvic binder/ tourniquets 
- IV/IO blood
Oxygen
- I+V
Tension PNX
- bilat thoracostomy
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37
Q

Stroke

A 
NIHSS
IV access, VBG
ECG monitor 
Blood sugar
Immediate CT head

?Thrombolyse
ECG
Swallow screen
Aspirin 300mg

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38
Q

Severe HTN

Dx

A

Consistent BP of either

220/120

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39
Q

ABG (for hypoxia)
Normal bicarb and high CO2
Dx and Tx

A

Acute T2RF
Requires ventilation
?naloxone

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40
Q

ABG (for hypoxia)
High bicarb, high CO2, low pH
Dx and Tx

A

Decompensated chronic T2RF
Life threatening
Requires help ventilating
?naloxone

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41
Q

CPAP starting pressure

A

5-8cm H2O

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42
Q

BiPAP starting pressures

and increases

A

IPAP and EPAP
10 and 5 cm H2O

If hypercapnic
- increase IPAP by 2

If Hypoxic
- increase IPAP and EPAP by 2

Max 25/15

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43
Q

Max BiPAP

A

25/15 cm H2O

IPAP/EPAP

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44
Q

Suspected raised ICP

Tx

A

30deg head up
sBP>100
sBP>120 in isolated HI

Analgesia
Normothermia
PaCO2 4-4.5

100ml of 5% saline over 10min
Aim Na 150-155

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45
Q

Hypoglycaemia

Dx and Tx

A

<4mmol/L
(<3 neuro signs)

Give fruit juice or glucogel
1mg glucagon IM
50ml 50%, 100ml 20%, 200ml 10%

Maintenance
10% glucose 100ml/h

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46
Q

Severe hyponatraemia

Dx and Tx

A

Na<120 and Sx
- seizure, low GCS, headache

Tx
1.8% hypertonic saline 
150ml over 15min
Repeat VBG after 20min
Consider repeat bolus

If rapid over correction use IV dextrose

47
Q

Signs and Tx Addisons crisis

A 
Hypotension
\+/- 
Hyperkalaemia
Hyponatraemia 
Hypoglycaemia

Tx
IV hydrocortisone 100mg

48
Q

Midazolam conscious sedation

Dose

A

Initial
2mg under 60
1mg over 60

Boluses: (minimum 2 min)
1mg under 60
0.5mg over 60

Max 7.5mg

49
Q

NIHSS

A 
1ABC: LOC, Qs, command
2 Best gaze
3 visual fields
4 facial palsy
5AB Power arms
6AB Power legs 
7 limb ataxia
8 sensory
9 language
10 dysarthria
11 inattention
50
Q

Thrombolysis

BP control

A

Either >185/110
Intravenous nitrate
Or
Labetolol

51
Q

Thrombectomy

Inclusion criteria

A 
CT angiogram: 
major vessel occlusion 
(M1,M2,basilar)
And
NIHSS>6

Available even if had thrombolysis

52
Q

Pre-alert adult cardiac arrest

Team

A

MET; 2222 - adult arrest
5+scribe

  • CPR
  • Airway: capnography
  • Pads; defib, time
  • IV access, VBG
  • Drugs: 1L saline STAT, adrenaline
53
Q

Gloucester 2nd line

Anti epileptic

A

Phenytoin 20mg/kg (max 2g)

Keppra 20-30mg/kg

54
Q

Contra indication to thrombolysis

Stroke

A 
Warfarin/DOAC/TxLMWH
Recent CVA (3m)
Seizure at stroke onset
Previous intracranial haemorrhage
Recent intervention
Pregnancy
GCS<8
NIHSS>25
BP>185/110
Plt<100
BG>22
55
Q

Open fracture

Tx

A
  • IV Abx ASAP
    (?co amoxiclav)
  • Tetanus cover
  • Analgesia and splint

Orthopaedics ASAP
Wound >1cm -> trauma centre

56
Q

Renal colic aged over 50

A

Exclude AAA

- exam, USS, CT

57
Q

Trauma 5 sec round

A

Pulse
Airway
External haemorrhage

58
Q

Hypothermic arrest

Changes to ALS

A

3shocks then No shocks until over 30C

No drugs until over 30C
Then double drug times between 30-35deg

59
Q

Near drowning

Observe for

A

4-6h
To ensure no Resp distress
Loss of surfactant and atelectasis

60
Q

Diving emergencies

Types and Time period

A

Barotrauma v decompression illness

Any symptom within 48h
= dive related until proven otherwise

61
Q

Chest pain and syncope

Rule out

A

PE
Dissection
Tension PNX
ACS

62
Q

Chest drain insertion depth

A

8-16cm

At least 4cm past last hole

63
Q

Estimate position of chest drain

A

Mid axillary line
At level of nipple
Or breast crease

64
Q

Opiate OD

Or any unknown hypoventillation

A

100-400mcg IV
400mcg IM

IV infusion (mcg/hr)
60% resus dose that provided adequate ventilation for 15 mins
65
Q

IV drugs for raised ICP

A

Mannitol 500ml, 20%

Hypertonic saline 150ml, 3%
Or
100ml of 5%

66
Q

Consider AAA USS in

A 
Old
Back pain
- can cause compressive neuropathy 
Renal colic 
Diverticula disease
67
Q

GI bleed with AAA or AAA repair is

A

Aorto enteric fistula until proven otherwise

68
Q

Causes of acute mesenteric ischaemia

A

Embolism
SMA thrombosis
Mesenteric venous thrombosis
Non occlusive ischaemia (low flow state eg HF)

69
Q

High lactate in mesenteric ischaemia

A

Late sign

70
Q

High suspicion of pancreatitis but lipase/ amylase negative

A

Refer and CT scan

71
Q

Bleeding
Fibrinogen <1.5
Give

A

Cryoprecipitate: 2 pools

72
Q

Bleeding
INR >1.5
Give

A

FFP 2-4units

73
Q

OOHCA

Decisions

A 
Urgent cardiac catheter?
Resus in best interests? 
Signs of cardiac cause?
- STEMI, cardiogenic shock, recurrent VF/VT
Significant HI? CTH+N
Other cause: CTPA/Aortogram
74
Q

OOHCA

A to E

A 
A: ?RSI, CO2
B: ?ventillator, A/E, Sats 
C: Defib, HR, BP (?bilat), ECG, Echo, ART line
D: BG, Pupils, ?GCS
E: ?HI
75
Q

Tx OOHCA

Likely ACS as cause

A

A to E
Aspirin 300mg PR
(Do not need CT head prior)
Emergency PCI

76
Q

Causes of obstetric haemorrhage

A

Antepartum:
Placenta praevia, abruption

Postpartum
Tone, trauma, tissue, thrombin

77
Q

Antidote

Dabigatran

A

Praxbind

78
Q

Antidote

Rivaroxiban and apixaban

A

Andexanet Alfa

Ondexxya

79
Q

OOHCA

Decisions

A 
Urgent cardiac catheter?
Resus in best interests? 
Signs of cardiac cause?
- STEMI, cardiogenic shock, recurrent VF/VT
Significant HI? CTH+N
Other cause: CTPA/Aortogram
80
Q

OOHCA

A to E

A 
A: CO2
B: A/E, Sats 
C: Defib, HR, BP (?bilat), ECG, Echo, ART line
D: BG, Pupils, ?GCS
E: ?HI
81
Q

Tx OOHCA

Likely ACS as cause

A

A to E
Aspirin 300mg PR
(Do not need CT head prior)
Emergency PCI

82
Q

Causes of obstetric haemorrhage

A

Antepartum:
Placenta praevia, abruption

Postpartum
Tone, trauma, tissue, thrombin

83
Q

Aims in major haemorrhage care

A 
Hb>10
Fibrinogen > 1.5
Severe trauma 1:1 RBC:FFP
INR< 1.5
TXA 1g 10min, 8h infusion
Platelet > 75
84
Q

Intra lipid dose

A

1.5ml/kg 20% over 1 min
(Up to 2x)

Start infusion
15ml/kg/h

85
Q

Tx hypoglycaemia

<4mmol

A

Fruit juice
Hypostop

150ml 10% Dec
Or 100ml/hr

1mg IM glucagon

Retest in 10min
Refer to diabetes team

86
Q

AF Sync DC cardioversion

A

Clexane 1.5mg/kg
200J sync DC shock
AP pad placement

87
Q

Haloperidol contraindications

A

Long QT
PD or LBD
IV can cause arrhythmia

88
Q

Restraint considerations

A 
Lack capacity 
Possibility of harm (self/others)
Last resort; de-escalate, oral meds
Least restrictive 
Proportionate to likelihood of harm
89
Q

Red flag sepsis

A 
Unwell and source of infection
\+
Reduced GCS
sBP<90
HR>130
RR>25
O2 requirement
Rash/mottled
Anuric
Lactate>2
Recent chemo
90
Q

Place Major trauma call

Anatomy reasons

A 
A: ?airway concerns 
B; ?PNX ?Flail 
C: ?pelvic # ?crush injury torso
?2 or more long bone #
?Proximal limb amputation
?burns >20%
?penetrating injury torso/abdomen 
D: ?spine injury + neurology
91
Q

Place Major trauma call

Physiology concerns

A 
<75
RR<10 or >30
O2 >4L
HR<50 or >120
sBP<90
GCS<13

> 75
sBP<100
GCS<14

92
Q

Major trauma call

consider other teams

A 
Cardiothoracics
ENT
Maxfacs
Obstetrics 
Paeds
93
Q

Septic arthritis

Features

A

Short Hx (under 2 weeks)
Decreased ROM (all directions)
+- fever
RF other chronic ds or recent injury

94
Q

TXA in head injuries

A

Give if under 3hours from injury

CRASH 3

95
Q

Amniotic fluid embolism

Symptoms

A 
Anaphylactoid type syndrome 
- acute hypoxia
- haemodynamic collapse
- DIC 
Treatment is supportive 
- O2 
- fibrinogen and TXA
96
Q

Amniotic fluid embolism

Diagnosis

A

Maternal collapse with no clear cause and any of;
C Arrest
Arrhythmia
Coagulopathy
SOB
Seizure
Premonitory sx; restlessness, agitation, numbness

97
Q

Shoulder dystocia

Dx and Tx

A

After delivery of head if baby does not deliver on next contraction

Tx
McRoberts and suprapubic pressure

98
Q

Alteplase dose

A

CA
- 50mg (1 vial) push

Massive

  • 10mg over 1-2min
  • 1.5mg/kg (max 90mg) over 2h
99
Q

Chemical burn antidote

A

Diphoterine

Fast flow cupboards

100
Q

Stop and summarise

A 
X yo with X (PC) 
A to E or H&Ts
Main issues are 
1)2)3)
Plan is; immediate, 10mins, 30mins 
Any other thoughts
101
Q

Hyperthermia ddx

A

Heat stroke >40C
Heat exhaustion <40C
Malignant hyperthermia; sux/anaesthetic
Neuroleptic malignant syndrome
ABD
Serotonin syndrome; clonus
Sympathomimetic syndrome

102
Q

Collapsed neonate

A

Sepsis
Cardiac
Metabolic - send ammonia on ice
NIA

103
Q

Thyroid storm Dx

A

Burch Wartofsky score
Temperature
CNS effects
Gastrointestinal
HR
HF
AF
Precipitating event

Lab Dx; low TSH, high T3/4

104
Q

Thyroid storm Tx

A

Cooling
Abx
IVF
Propranolol 1mg every 5min until HR<100
Propylthyrouracil
Hydrocortisone 100mg
?lugols solution

105
Q

Collapsed patient request items

A

Can I get some pads and a BVM

106
Q

After treatment hypoglycaemia recheck BG at x minutes

A

15 minutes

107
Q

Age for surgical cricothyroidotomies

A

Under 12 needle cricothyroidotomy or tracheostomy

108
Q

Rule of 9s

A

All 9% except back and legs (18% each)

109
Q

Aortic dissection BP management

A

Aim sBP 100-120
Labetalol infusion

110
Q

SCAPE

A

Sympathetic crashing acute pulmonary oedema
Aka
Hypertensive pulmonary oedema
Tx GTN infusion and CPAP

111
Q

HF vs sepsis ix and signs

A

JVP, oedema, murmur
Ultrasound - b lines?, plethoric iVC, cardiac motility
CXR

112
Q

HF vs sepsis ix and signs

A

JVP, oedema, murmur
Ultrasound - b lines?, plethoric iVC, cardiac motility
CXR

113
Q

NIHSS LOC questions

A

Month and age

00 SpR (23 decks)

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