Emergencies & Trauma Flashcards
What are the causes of shok=ck?
CHOD
Cardiogenic - MI, arrhythmia
Hypovolaemic - haemorrhage, endocrine (Addisons/DKA), Excess loss
Obstructive - PE, tension pneumo
Distributive - sepsis, anaphylaxis, neurogenic
What medications and doses should be given in anaphylactic shock?
500mcg adrenaline (0.5ml of 1:1000)
200mg hydrocortisone
10mg chlorphenamine
salbutamol nebs
What type of shock would you not prescribe fast fluid resuscitation for?
Cardiogenic
What blood test should be done to confirm the diagnosis of anaphylactic shock?
Mast cell tryptase (released by mast cell degranulation due to IgE cross linking)
What should be done before discharge of a patient with anaphylactic shock?
Teach adrenaline self injection and provide >=2 epipens
Advise medic alert bracelet
Educate re allergen exposure
Arrange OPD followup
What are the four classes of SVT?
Sinus tachy
Atrial (AF, flutter, tachy)
AVNRT
AVRT
What is the management priniciple of SVT?
§ If adverse signs, sedate and DC cardiovert
N-B - If pt in AF:
a) Rate cont w. B blocker or digoxin
b) Cardiovert w amiodarone if <=48 hours/DC shock
c) Consider heparin
- Vagal manouvres (carotid sinus massage, valsalva)
- Adenosine 6mg IV bolus, then 12, then 12
- Choose from Digoxin, Atenolol, Verapamil, Amiodarone
- DC Cardiovert
What signs in an SVT patient might prompt you to skip adenosine and immediately DC cardiovert?
BP<90
HF
LoC
HR>200
What are the side effects of adenosine?
Feeling of impending death
Dyspnoea
Flushing
Headache
What are the differential sfor a broad complex tachy?
VT
TdeP
SVT w BBB
What are the causes of VT?
IM QVICK
Infarction Myocarditis QT prolongation Valve abnormality Iatrogenic Cardiomyopathy (dilated) K/Mg/02 low
What is the management of a broad complex tachy?
- Assess for adverse signs
a) If present -> sedate + DC
b) If not -> 2. - Correct electrolyte imbalance (KCl/MgSO4)
- Assess rhythm:
a) Regular (VT) -> Amiodarone 300mg over 30 mins then 900mg over 23 hrs
b) Irregular - AF (rate control) - If failure -> DC cardiovert
What drugs are given acutely in STEMI?
Oxygen 2-4L aiming for 94-98%
Antiplatelets:
Asp 300 PO then 75mg daily
Clopi 300 PO then 75 daily
Analgesia:
Morphine 5-10mg IV
Metoclopramide 10mg IV
Anti-ischaemia:
GTN
B-Blocker e.g. atenolol 5mg IV
DVT proph:
Enoxaparin 40mg SC OD
What is the secondary prevention regimen for STEMI?
ACEi started <24hrs post MI B-blocker e.g. bisoprolol Cardiac rehab DVT proph till fully mobile Atorvastatin 80 Continue Clopi for1 month COntinue Aspirin indefinitely
Lifestyle - smoking, diet, exercise
What are the causes of cardiogenic shock?
MI HEART
MI Hyperkalaemia Endocarditis Aortic dissection Rhythm disturbance Tamponade
What drug should be considered in cardiogenic shock?
Dobutamine (B-agonist)
What are the signs seen in cardiac tamponade?
Beck’s triad:
Hypotension
Raised JVP
Muffled heart sounds
Kussmaul’s sign - Raised JVP on inspiration
Pulsus paradoxus - pulse fades on inspiration
What medications should be given in suspected bacterial meningitis?
Community - IM Benpen
<50 - Ceftriaxone 2g
>50 - Cef 2g & Ampicillin 2g
Dexamethasone
What is the first step in the management of encephalitis?
10mg/kg/8hr IVI Aciclovir
What is done/looked for on A-E in head injury?
A - ?intubate, immobilise C-spine B - 100% O2, RR C - HR, BP, IV access D - GCS, pupils, treat seizures E - Expose for other injuries
What should be looked for on 2ary survey in head injury?
Lacerations Skull deformation CSF leakage Skull base fracture signs TM blood C-spine tenderness
When would you do a CT scan for a head injury?
BANGS LOC
Break/depressed/base of skull
Amnesia >30 mins
Neuro deficit/seizure
GCS <13 @ any time or <15 2 hrs post injury
Sickness - >= 1 vomit
LOC w. dangerous mechanism, age>65 or coagulopathy
What is neuroprotective ventillation and when is it used?
Aim for:
PaO2>13kPa
PaCO2 4.5kPa
Used in case of raised ICP
What are the different types of herniation?
Tonsillar - cerebellum through posterior fossa
Transtentorial/uncal - temporal lobe against free margin of tentorium cerebelli
Subfalcine - Cingulate gyrus (MFL) under falx cerebri
What is used to treat b-blocker poisoning?
Atropine
What is used to treat ethylene glycol poisoning?
Ethanol
Haemodialysis
What is used to treat lithium toxicity?
Saline
When would you use activated charcoal for an aspiriin/paracetamol OD?
IF ingested <1hu=r
What are the components of the secondary survey in trauma?
Hx - allergies, meds, PMH, last ate/drank, events
Exam - every system
Ix Trauma series (C spine lat + peg, CXR, pelvis) FAST scan (focussed assessement sonography in trauma), CT when stable)
What is a FAST scan?
Basically an abdo USS looking for free fluid
