Emergency Flashcards
patient with sepsis, low BP
given IV 0.9% saline at 125ml/h
noradrenaline/norepinephrine!!!
adequate if not overhydration, needs vasoconstriction
amytriptiline hydrochloride overdose 4 hours ago
ECG shows QRS prolongation
most appropriate immediate management?
IV sodium bicarbonate!!!
bicarbonate is the treatment of choice in patients with prolonged QRS following a tricyclic antidepressant overdose
(within 1 hour and no qrs prolongation = activated charcoal)
26 yo. Head injury in car accident.
Eyes closed but opens them when asked to. Confused about where she is and what happened but attempts to talk about it. Repeatedly attempting to remove cannula from right wrist.
Best estimate of GCS score?
UKMLA ppq
12!!!
E3, V4, M5
Man weighting 70kg with underlying cardiac disease. What is the most appropriate volume of maintenance fluids to prescribe in next 24hours?
20-25ml/Kg in patients with underlying cardiac disease.
70 x 25 (upper limit) = 1750
Patient experiencing a myaesthenuc crisis. Most appropriate tests to monitor respiratory function?
FVC
how does fat embolism present?
Multiple fractures followed by early onset (within 24 hours) of hypoxia, dyspnea, and
tachypnea are the most frequent findings. Neurologic manifestations range
from the development of an acute confusional state and altered level of
consciousness to seizures and focal deficits and usually follow respiratory
symptoms. A petechial rash is the last component to appear and only appears
in about a third of cases. Patients with PE may present in the same time frame
(ie, 24 to 72 hours), but neurologic abnormalities are not explained by this.
A 46 year old man has a cardiac arrest in the Emergency Department after an
episode of chest pain. He remains in ventricular fibrillation after three DC
shocks, and he is treated with a bolus of intravenous adrenaline/epinephrine.
what other drug treatment should be administered at this time?
amiodarone
If VF/VT persists after a third shock, resume
chest compressions immediately and then give adrenaline 1 mg IV and
amiodarone 300 mg IV while performing a further 2 min C
A 74 year old man is brought to the emergency department after falling down the stairs. he has no pain. he has atrial fibrillation and takes apixaban.
He has significant bruising to the left side of his face and left arm. His pulse rate is 80 bpm, irregular, BP 150/95 mmHg and oxygen saturation 96% breathing air. His GCS score is 14.
most appropriate next step in management?
UKMLA ppq
cervical spine immobilisation!!
sequence of care in trauma patients is airway!! -> then cervical spine!!!
a CT head will be required and a CXR most likely but later!!
A 55 year old man is brought to the Emergency Department with 2 hours of severe left sided chest pain A pre-hospital ECG shows left bundle branch block, for which paramedics gave aspirin and glyceryl trinitrate spray.
He is sweating and distressed. His pulse rate is 85 bpm, BP 99/54 mmHg, respiratory rate 22 breaths per minute and oxygen saturation 96% breathing air. His GCS score is 15/15.
Which is the most appropriate management?
A. Continue breathing air
B. Start 28% oxygen via a Venturi mask
C. Start 40% oxygen via a Venturi mask
D. Start oxygen 2 L/min via nasal cannulae
E. Start oxygen 15 L/min via a non-rebreathe mask
UKMLA ppq
Correct Answer(s): A
Justification for correct answer(s): Airway is patent and does not require intervention. Oxygen will increase mortality for STEMI with sats of >94%.
A 25 year old man has taken an overdose of 16 paracetamol tablets. He became very sad earlier that day after an argument with a friend. His mood changes between being happy and sad several times per week. He struggles with concentration and gets angry easily. He has frequently been excessively drunk on nights out. He has never experienced psychotic symptoms.
Which is the most likely diagnosis?
A. Adjustment disorder
B. Bipolar disorder
C. Borderline personality disorder
D. Dissocial personality disorder
E. Unipolar depressive episode
UKMLA ppq
Correct Answer(s): C
Justification for correct answer(s): Frequent changes in mood suggests borderline PD, not pervasive depression. Mood changes too rapid for bipolar disorder. Also impulsive self-destructive behaviours and unstable relationships are
