Emergency Flashcards
What does ABCDE stand for?
Airway
Breathing
Circulation
Disability
Exposure
NEWS2 contents?
Respiration rate
SpO2%
Air or oxygen?
Systolic blood pressure
Pulse
Consciousness
Temperature
Normal range for respiration rate?
12-20
Normal SpO2 (scale 1 and 2)
Scale 1 - over 96%
Scale 2 - 88-92% (over 93% on air)
How many points if on oxygen?
2
Normal systolic blood pressure?
111-219
Normal pulse (per minute)
51-90
How many points if not alert?
3
Normal temperature?
36.1-38
NEWS2 score meaning?
0-4 - low risk, ward-based response
Red score (3 in any individual parameter) - low-medium risk, urgent ward-based response
Aggregate score 5-6 - medium, key threshold for urgent response
Aggregate score 7 or more - high, urgent or emergency response (with critical care skills)
NEWS2 scores frequency of monitoring?
0 - minimum 12 hourly
1-4 - minimum 4-6 hourly
3 in single parameter - minimum hourly
5 or more - minimum 1 hourly
7 or more - continuous monitoring of vital signs
Surgical sieve categories?
Primary neurological
Infection
Cardio respiratory
Gastro-intestinal
Metabolic/endocrine
Toxins
Psychiatric
MIDNIT
Metabolic
Inflammation
Degenerative
Neoplastic
Infection
Trauma
Airways assessment
Verbalising?
Foreign objects
Excessive secretions?
Snoring/stridor?
Mouth or tongue swelling?
consider airway opening manoeuvres if unsafe
Breathing assessment?
Respiratory rate
Oxygen saturation (before and after oxygen)
Respiratory distress?
Wheeze?
Smoker?
Circulation assessment?
Blood pressure?
Heart rate?
Heart sounds?
ECG?
Peripheral capillary refill?
Peripheries (temp and appearance)
Disability assessment?
Blood glucose?
Temperature?
Confused? (ACVPU or GCS)
Moving limbs?
PEARL?
Toxins? (Alcohol)
GCS?
Glasgow coma score
Eye opening response, verbal response and motor response
13-15 = minor brain injury
9-12 = moderate brain injury
3-8 = severe brain injury
PEARL
Pupils equal and reactive to light
Exposure assessments?
Rashes?
Injection/track marks?
Trauma to limbs or head?
External bleeding?
Abdominal examination
completely expose - front and back, top to bottom
Why is low systolic blood pressure so worrying?
It can lead to circulatory shock (inadequate blood flow to tissues)
Give IV fluids to manage
What is circulatory shock?
When inadequate blood flow results in damage to body tissues
Hypovolemic shock?
Loss of plasma or blood volume
due to dehydration, blood loss, burns
Cardiogenic shock?
Heart cannot generate enough cardiac output so arteries do not have enough blood flow and tissues are not being perfused
myocardial infarction, serious cardiomyopathy
Obstructive shock?
Due to obstruction in circulation, usually indirect impact on the heart
pneumothorax, pulmonary embolism
Distributive shock?
Most common form of shock
Blood volume is being distributed elsewhere due to very profound vasodilation
septic, anaphylactic, neurogenic
Percentage of each type of shock?
Distributive (septic) - 62%
Cardiogenic - 16%
Hypovolemic - 16%
Distributive (nonseptic) - 4%
Obstructive - 2%
Signs of tissue hypoperfusion?
Brain - altered mental state
Skin - mottled, clammy
Kidney - oliguria
Tachycardia
Elevated blood lactate
If cardiac output falls, which types of shock are considered?
Hypovolemic, Cardiogenic, obstructive
If cardiac output is high, which type of shock is considered?
Distributive
If cardiac output is low and venous pressure (CVP) is high, which types of shock are considered?
Cardiogenic, obstructive
If cardiac output is low and venous pressure (CVP) is low, which type of shock is considered?
Hypovolemic
Systemic inflammatory response syndrome (SIRS) criteria?
High or low temp
High heart rate
High respiratory rate
High or low WBC count
*2 or more needed *
Sepsis criteria?
SIRS criteria + infection
Severe sepsis criteria?
Sepsis + evidence of organ dysfunction, hypotension or hypoperfusion
Septic shock criteria?
Severe sepsis + hypotension despite adequate fluid resuscitation
Sepsis six?
- Give O2 to keep stats above 94%
- Take blood cultures
- Give IV antibiotics
- Give a fluid challenge
- Measure lactate
- Measure urine output
take 3 give 3
Which biochemical tests are most indicative of sepsis?
CRP - inflammation during infection
Lactate - high during tissue hypoperfusion
WBC and neutrophils - indication of infection
Which organs have pain localised in the left iliac fossa?
Descending colon, sigmoid colon
Example condition that will present as pain in left iliac fossa?
Sigmoid diverticulitis
What are diverticula?
A pouch-like out-pouching that is in the colon region.
When there is no pain, is called diverticulosis.
When there is pain it is called diverticula disease.
When it becomes infected and inflamed, it is called diverticulitis.
Left upper quadrant organs?
Left portion of liver
Larger portion of stomach
Pancreas
Left kidney
Spleen
Portions of transverse and descending colon
Parts of small intestine
Right upper quadrant organs?
Right portion of liver
Gallbladder
Right kidney
Small portion of stomach
Portion of ascending and transverse colon
Parts of small intestine
Left lower quadrant organs?
Majority of small intestine
Descending colon
Sigmoid colon
Left female reproductive organs
Left ureter
Right lower quadrant organs?
Caecum
Appendix
Right female reproductive organs
Right ureter
What is diverticulosis?
When the innermost layer of digestive tract pushes through weak spots in outermost layer of digestive tract
What causes diverticulosis?
Low fibre diets which leads to constipation and increased pressure in digestive tract
Symptoms of diverticulosis?
Bloating, abdominal cramps, constipation
How is diverticulosis diagnosed?
Sigmoidoscopy, CT scan or barium X-ray
Medications for diverticulosis?
Psyllium
Methylcellulose
Polycarbophil
Dietary changes for diverticulosis?
High fibre diet (20-35g recommended)
More fruit, vegetables, grains
Diverticulosis complications?
Diverticulitis - inflammation of pouches
Abscess/peritonitis - collection of pus
Diverticular haemorrhage
Colonic obstruction
