Emergency Flashcards
Anaphylaxis is likely when all of the following criteria are met:
- Sudden onset and rapid progression (post exposure to allergen)
- Life threatening airway, breathing, circulation problems
- Skin and all mucosal changes (flushing, Urticaria and angioedema)
Most reactions occur over several minutes, IV triggers are often quicker.
The patient will look and feel unwell.
There may also be GI symptoms (ie. Diarrhoea and vomiting)
Livedo Reticularis=
Skin Mottling
In regards to septic shock what are some examples of obvious end organ dysfunction
Confusion
Reduced urine output
The Rule of Nines is one of the easiest ways to determine the percentage of skin affected by burns. As a rough guide the patients palm is what %
1%
With regards to the rule of Nines (Calculating burn percentages)What are the rough surface areas to remember
4.5% = front of arms, back of arms, front face, back to face
9% = front of chest, back, abdomen, front of leg and back of leg
The Parkland Formula gives an estimation of fluid requirements in the first 24 hours after the burn. All adults with What total body surface area burns should receive this?
Greater than 15% >15% TBSA
The Parkland FormulaIs is for what
Calculating food requirements for the first 24 hours after burn
>15% TBSA
The Parkland Formula Is as follows
Fluid required in 1st 24 hr = 4ml x patients weight in kg x % burn
E.g. 4ml x 70kg x 50 = 14,000 mL
In Burns patients fulfilled replacement fluid should be titrated to maintain what minimum urine output?
0.5ml/Kg/hr urine output
- Burns > 10 % TBSA in an Adult
- Burns > 5 % TBSA in a Child
- Full thickness burns > 5% TBSA
- Burns of face, hands, feet, perineum, genitalia, and major joints
- Circumferential burns
- Chemical or electrical burns
- Burns in the presence of major trauma or significant co-morbidity
- Burns in the very young patient, or the elderly patient
- Burns in a pregnant patient
- Suspicion of Non-Accidental Injury
Are all generally accepted criteria for what?
Referral to the regional burns unit
What are some generally accepted criteria for referral to the regional burns unit?
- Burns > 10 % TBSA in an Adult
- Burns > 5 % TBSA in a Child
- Full thickness burns > 5% TBSA
- Burns of face, hands, feet, perineum, genitalia, and major joints
- Circumferential burns
- Chemical or electrical burns
- Burns in the presence of major trauma or significant co-morbidity
- Burns in the very young patient, or the elderly patient
- Burns in a pregnant patient
- Suspicion of Non-Accidental Injury
Superficial burns are Described as
usually dry, sometimes with minor blistering and erythema. Painful. Often due to sunburn or minor scalds.
Involve the epidermis.
Partial thickness burns are Described as
moist and red, usually with broken blisters and normal capillary refill. Involve the dermis.
They are usually painful unless they are deep dermal. Deep dermal burns may also have sluggish capillary refill.
Full thickness burns are Usually described as
dry, charred and often white. They are painless and have absent capillary return.
They have destroyed the epidermis and dermis and have begun to destroy the underlying subcutaneous tissue.
Management of a partial thickness listed burn after it has been run under cold water and adequately given pain relief includes:
Deroofing the blister and dressing with a non-Adherent dressing followed by review in 48 hours
Type 1 respiratory failure=
pO₂ <8, normal pCO₂
Type 2 respiratory failure=
pO₂ <8, high pCO₂
In patients with aInfective exacerbation of COPD the mainstay of treatment includes
back nebulized salbutamol with atrovent.
Antibiotics
Prednisolone Can be given in additionIf unable to take oral medication IV hydrocortisone
Initial management of epistaxis is as follows
pressure applied to the anterior aspect of the nose (soft part- avoiding the nasal bones) for 15-20 mins.
Patients should sit forward to avoid blood dripping posteriorly into the stomach.
This controls around 90% of nose bleeds.
If epistaxis does not halt after 15 to 20 minutes of pressure The next step would be
Cautery with silver nitrate
This should only be done on one side of the nasal septum !
If Epistaxis continues Post Pressure and Cauterisation The next step=
Rapid Rhino
a type of nasal tampon consisting of an outer layer of carboxycellulose that promotes platelet aggregation, with an inflatable balloon that compresses the nasal cavity on insertion tamponading the bleeding site
In general, Rapid Rhino remain in place for ?
24 hours
Question
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