Emergency Flashcards
What is the risk of CT scan in pregnancy?
?doubled risk of child cancer from 1-2/1,000
about 10mSv dosage for CTAP
What are the common causes of colonic pseudo-obstruction?
Orthopaedic trauma/surgery
Pneumonia/sepsis
ARF
Medications (opiates)
Electrolyte abnormalities
What pathogens most frequently cause cholecystitis?
E.coli > Enterococcus > Bacteroides
What factors are vital to obtain informed consent ?
-Understand information relevant to decision
-Retain information
-Use or weigh up that information
-Communicate decision
What legal principle underlies capacity?
Mental Capacity Act 2005
Assumption of capacity until proved otherwise
Decision specific
What risk factors are there for C.Diff infection?
Host -immune status, comorbidity, age >65, IBD, malnutrition
Exposure - hospitalisation, community sources, care facilities
Disruption - antibiotics, surgery
What factors suggest Severe C.diff infection?
WCC >15
AKI stage 1+
T>38.5
Albumin<25
Fulminant 1-3%
What type of organism is C.Diff?
Gram +ve anaerobic spore-forming bacillus
Produces enterotoxin (A) and cytotoxin (B)
How can ERCP perforations be Graded?
STAPFER classification
1 - GI tract wall (traction)
2 - peri-ampullary (sphinctertomy)
3 - bile ducts (guide wire/basket)
4 - retroperitoneal
What are the risk factors for ERCP perforation?
Periampullary diverticulum
Ampullectomy
Small calibre CBD
Longer duration of procedure
Sphincterotomy
What adrenaline is used in UGIB?
1:10,000 in quadrants
NICE recommends this + something else
What are the NICE indications for CT scan after head injury?
GCS <13 any time
GCS <15 at 2 hours
Suspected open/depressed/basal skull fracture
Seizure
Neurological deficit
>1 episode of vomiting
Amnesia >30minutes
Also any LoC with age >65 or coagulopathy, dangerous mechanism
What are the causes of ischaemic colitis?
Occlusive (small vessel disease inc radiation/vasculitis)
Non-occlusive (flow)
What is the role of nuclear red cell scanning in LGIB?
Technetium-99m labeled RBC scan can detect as low as 0.1-0.5ml/min bleeding (>1 for CT)
What factors increase the likelihood of mesenteric venous thrombosis?
Portal hypertension (Liver Cirrhosis)
Inflammatory (Sepsis, IBD, pancreatitis)
Hypercoagulable states (Malignancy, Dehydration, thrombophilia, thromboyctosis, COCP)
What are the zones of the neck?
Zone 1 - Sternal notch to cricoid (Subclavian, inomminate, common carotid, vertebral, jugular)
Zone 2 - Cricoid to angle of mandible (common carotid, bifurcation, veterbral arteries and jugular veins)
Zone 3 - Angle of mandible to base of skull (branches of ECA, ICA, vertebral, internal jugular)
What are hard and soft signs of vascular injury?
Hard - absent pulses, bruit/thrill, active haemorrhage, expanding haematoma, distal ischaemia
Soft - haematoma, past haemorrhage, hypotension, peripheral nerve injury
What scoring system is helpful for Nec Fasc?
LRINEC scoring system
Biochemical markers
What is the definition of an infant, toddler, pre-school, school-age and adolescent?
Infant - 0-1
Toddler - 1-3
Pre-school 3-5
School age - 6-12
Adolescent >12
How can a Childs weight be estimated?
2 x (age + 4)
What size ET tube should be selected for children?
Cuffed - 3.5 + (age/4)
What abdominal injuries are more common in children than adults?
Duodenal haematoma
Pancreatic injury
Bladder rupture
Small bowel rupture at ligament of Trietz
What is acceptable SBP in children?
70 + (age x 2)
UO 1.5-2ml/kg
What fluid resuscitation should be given to children?
10-20ml/kg warmed crystalloid