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MEDICINE FINALS > EMERGENCY > Flashcards

EMERGENCY Flashcards

1
Q

Talk through how you would approach a patient who has rapidly deteriorated and is now unconscious (describe until crash call is put out)

A
  1. Assess for response and signs of life
  2. If none are present → call for help and make bed flat
  3. Open the airway using head-tilt chin-lift and spend 10 seconds assessing if the patient is in cardiorespiratory arrest
    - Look for chest movement
    - Listen for breath sounds
    - Feel for air on your cheek, feel the carotid pulse
  4. Where there are no signs of life, call 2222 (or ask a colleague to do so) and follow the ALS protocol
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2
Q

Give the reversible causes of cardiac arrest

A

4 Hs and 4 Ts
Hypoxia
Hypothermia
Hyperkalaemia
Hypovolaemia

Trauma
cardiac Tamponade
Thrombus (PE)
Tension pneumothorax

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3
Q

What are the shockable rhythms?

A
  1. ventricular fibrillation
  2. pulseless ventricular tachycardia
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4
Q

What are the unshockable rhythms?

A
  1. asystole
  2. pulseless-electrical activity (PEA)
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5
Q

You arrive at a crash call and it is established that the pt is in cardiopulmonary arrest - what do you do?

A
  1. start chest compressions 30:2
  2. when help arrives start ventilation with bag valve mask
  3. apply defib pads to assess rhythm
  4. if VF or pulseless VT -> DC cardioversion
  5. Give 1mg adrenaline as soon as IV access secured
  6. Repeat 1mg adrenaline every 3-5mins
  7. After 3 shocks give 300mg amiodarone
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6
Q

How much time would you leave in between shocks in cardiac arrest?

A

2 mins in between shocks (carry on CPR)

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7
Q

How would you manage a patient with suspected sepsis?

A
  1. Give oxygen → non-rebreathe mask
  2. Give IV fluid boluses → maintain SBP
  3. Give IV broad spectrum antibiotics, as per local guidelines → usually co-amoxiclav or tazocin
  4. Take ABG → lactate measurement
  5. Take urine output → either catheterise the patient or commence hourly urine output monitoring
  6. Take blood cultures → consider an infective source
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8
Q

What is the NICE criteria for sepsis?

A

Suspected infection +
>1 red criteria
OR
>2 yellow criteria

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9
Q

What are 5 red criteria for sepsis according to NICE?

A
  1. Altered mental state
  2. RR >25
  3. HR >130
  4. SBP <90
  5. urine output <0.5 ml/kg/hr
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10
Q

What scoring system - other than NICE - can be used to assess for sepsis?

A

SOFA

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11
Q

Give 4 possible complications of sepsis

A
  1. ARDS
  2. AKI
  3. DIC
  4. encephalopathy
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12
Q

What is septic shock?

A

Sepsis +
- SBP <90 despite fluid resuscitation
or
- lactate >4

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13
Q

How would you treat septic shock?

A

noradrenaline + vasopressin

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14
Q

What is a massive haemorrhage?

A
  1. haemorrhage causing 25% reduction in SBP
  2. One blood volume (7% of total body weight) lost in 24 hours or loss of >50% of blood volume in 3 hours
  3. > 150ml/min of blood loss
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15
Q

What is the treatment given during the major haemorrhage protocol?

A
  1. packed cells, FFP and platelets in a 2:1:1 ratio
    - no more than 4 units of blood should be transfused without FFP or platelets
  2. 1g tranexamic acid bolus alongside packed cells
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16
Q

What causes spinal shock (2)?

A
  1. cervical and upper thoracic spine (<T6) injury leading to loss of sympathetic tone
  2. iatrogenesis from spinal anaesthesia
17
Q

What symptoms might you expect to see in anaphylactic shock?

A
  • Bronchospasm and wheeze
    – Urticaria ± pruritis
    – Angioedema (particularly of the eyes, lips, tongue, and
    larynx)
    – Diarrhoea and vomiting
    – Abdominal pain
    – Tachycardia and hypotension
18
Q

How do you manage someone in anaphylactic shock?

A

!! ABCDE
1. Remove the offending cause immediately e.g. infusion
2. Secure the airway and give 100% oxygen
3. Give adrenaline 0.5mg IM (0.5ml of 1:1000), repeating every 5 minutes as needed (guided by HR< BP, RR)
4. If 2 doses have been given and there is no
improvement in breathing/circulation → ensure 2222 called, ICU input required
5. Fluid bolus → 500-1000ml

MEDICINE FINALS (19 decks)

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