Emergency Flashcards
TRAUMA MX
i) what does a FAST scan look at? in how many areas? what is it important to maintain in D?
ii) what ECG changes indicate cardiac tamponade?
iii) what is becks triad? what is it a sign of and what mx needs to be done
iv) how should all patients with suspected c spine injury be positioned? how should their head be? what algorithm can be used to see whether imaging is needed?
i) FAST scan is POC US looks at free fluid (blood) collection around heart and other organs - 5 areas
cardiac, RUQ, LUQ, thoracic x 2 and pelvic
maintain body temp in D
ii) tamponade > low volume R waves (big then small then big)
iii) becks triad of cardiac tamponade - distended JVP, low BP and muffled heart sounds
confirm with transthoracic US and do urgent pericardiocentesis
iv) put on trauma board with head immobilised in blocks
use canadian C spine rules to see if imaging is needed - can they rotate head 45 degrees (need GCS 15 to do)
MAJOR HAEMMORHAGE
i) what four things in bleeding first aid can be done?
ii) should blood or fluid be given? why?
iii) what is the lethal triad of trauma?
iv) what is the secondary survey? what toxin needs to be covered against?
i) elevate legs, pressure to area, torniquet, pelvic binder
ii) give blood as fluid will further contribute to hypothermia (cold) and further dilute clotting factors
iii) lethal triad is hypothermia, coagulopathy and acidosis/hypoperfusion
iv) secondary survey involves CT trauma from head to proximal femur
ensure tetanus cover if trauma
SHOCK
i) name four ways shock may present? what sign is seen first? what is a late sign?
ii) what two specific blood markers can indicate shock? what urine output is a sign of end organ damage?
iii) name two things that can cause cardiogenic shock? what is HR, TPR and periph temp? hypovol? distrubutive? obstructive?
i) px as dehydrated, slow CRT, dry MM, new confusion, decreased urine output
early sign is high HR and low BP is a late sign
ii) lactate >2 and base excess (procalcitonin now being used)
urine output of < 0.5ml/kg/hour is concerning
iii) cardiogenic (cant pump effectively) - MI, HF, arrhythmia - high HR, high TPR cold peripheries
hypovolaemic - haemorrhage or dehydration, high HR, high TPR and cold peripheries
distributive - sepsis and anaphylaxis, high HR, low TPR, warm peripheries
obstructive (heart stops filling properly)- PE or tamponade - high HR and TPR, cold periph
MANAGING SHOCK
i) what should be given in anaphylaxis? what is dose based on?
ii) what should be done in decompensated HF or post MI?
iii) what type of anticoagulation is needed in PE (saddle embolism?
iv) how is tamponade managed?
i) 2 doses of IM adrenaline into the ant lat thigh 3-5 mins apart with dose based on age
ii) offload with furosemide
iii) strong anti coag - UFH or alteplase
iv) remove fluid and surgical drain (pericardiocentesis)
HEAD INJURY
i) what type of ventilation is useful in raised ICP? why?
ii) what is cushing triad?
iii) how should the head be positioned in a IC bleed? what needs to be done in C? what can be given IV?
iv) what prophylaxis may be given? what can be given tp prevent GI ulcer? what can be given in SAH?
i) hyperventilation to increase CO2 loss causing vasoconstriction and reduce ICP
ii) cushing triad is bradycardia, high BP and irregular breathing = response to increased ICP
iii) 30 degree head tilt (ventilate if GCS < 8)
reverse clotting abnormalities and give hypertonic saline or mannitol
iv) seizure prophylaxis
prevent GI ulcer (due to increased SNS and vagus stim) give pantoprazole
nifedipine if SAH to decrease risk of vasospasm and infarct
OVERDOSE - PARACETAMOL
i) what is the antidote to benzos? paracetamol?
ii) when should blood paracetamol levels be taken (when do they peak)?
iii) what constitutes a serious paracetamol OD?
iv) what can be given if taken within 1 hour? what if within 8 hours? what if after 8 hours?
v) what does a paracetamol nomogram show? what time period can it be used in?
vi) name four things that make a patient high risk for hepatotox
i) flumazenil
N acetyl cystiene
ii) take blood paracetamol levels at 4 hours post taking the tablets
iii) serious is > 12g or > 150mg/kg
iv) activated charcoal if taken within 1 hour
within 8 hours - calc peak dose at 4 hpurs may give prothrombin to prevent liver damage
after 8 hours - give IV acetylcystiene immediately dont wait for bloods
v) nomogram shows whether to give NAC and is only useful 1-8hours
normal or high risk line
vi) hepatotox risk increased if low body weight, hep c/fatty liver, malnourished, taking CYP inducers phenytoin, carbamaz, barbituarates, rifampicin, alcohol, sulphonyureas
CARDIAC ARREST
i) what are the 4Hs and 4Ts?
ii) name two shockable rhythms and how each is characterised? name two non shockable
iii) what ratio is CPR given in? if shockable - how many shocks given then how long for CPR? after how many shocks is IV adrenaline/amiodarone given?
iv) if non shock what is done? what is given immeditately? how often?
i) reversible causes of cardiac arrest
Hypovolaemia, Hypoxia, hypo/hyperkal, hypo/hyperthermia
Tamponade, tension pthx, thrombosis, toxins
ii) shock - VT (broad complex tachy, uniform repated waves), VF (low amplitude no ident p waves)
non shock is PEA or asystole
iii) CPR 30:2
shockable - 1 shock then 2 mins CPR - after 3 shocks give 1g IV adrenaline and amiodarone 300mg
iv) non shock - CPR for 2 mins give IV adrenaline immediately 1mg every 3-5 mins
STATUS EPILEPTICUS
i) how is it defined? (2)
ii) what needs to be checked first? what is given if there is access
iii) name two drugs that can be given in the community? what is the max number of doses that can be given
iv) what is given after this?
i) seizure > 5 mins or multiple seizures without return to conciousness for 5 mins
ii) check BMs - may be reversible cause
give lorazepam if access
iii) buccal midaz or rectal diaz
max number is 2 doses
iv) after two doses give phenytoin or keppra then RSI with anaesthetics
