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General Medicine > Emergency > Flashcards

Emergency Flashcards

1
Q

% oxygen given by different masks / nasal specs

A 
Venturi - 24 - 60% depends on colour
Nasal specs - 28% @ 2L/min
                    - 35% @4L/min
Hudson - 50 - 60% 
Reservoir mask - 80- 90% 
CPAP 80%
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2
Q

Examples of crystalloids

A

Normal saline
Hartman’s solution
Ringers lactate

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3
Q

What is a colloid

A

Solution containing large molecules.

Helps keep fluid in the intravascular

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4
Q

Examples of colloids

A

Dextran

Salt poor albumin

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5
Q

In a healthy adult what % blood volume must be lost before hypotension occurs

A

20%

1.5 - 2 L

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6
Q

Causes of cardiogenic shock

A 
Acute MI
HF
Tension pneumothorax 
Cardiac tamponade
PE
Aortic dissection
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7
Q

Symptoms of anaphylaxis

A 
Urticaria 
Angioedema
Hypotension
Tachycardia
Bronchospasm + wheeze
Skin flushing
Abdo cramping
Diarrhoea and vomiting
Dizziness, syncope, shock
Sweating
Cyanosis
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8
Q

Management of anaphylaxis

A 
Secure airway - 100% O2
Remove cause
Elevate feet
IM adrenaline 1:1000 0.5ml
IV hydrocortisone 200mg
IV chlorphenamine 100mg
IV saline 
Salbutamol nebuliser for wheeze
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9
Q

Signs of SIRS

A 
2 or more of:
Tachycardia >90
Tchypnoea >20
Pyrexia >38
Hypothermia < 36
WBC >12 or <4
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10
Q

What is sepsis

A

SIRS + confirmed infection

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11
Q

What is severe sepsis

A

SIRS + source of infection + organ dysfunction

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12
Q

What is septic shock

A

Severe sepsis where hypotension is unresponsive to fluid challenges.
Inotropic support needed to maintain BP

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13
Q

What is the sepsis 6

A

Done within 1 hour

1) high flow 02
2) blood culture
3) IV antibiotics
4) fluids
5) check Hb + lactate
6) urinary catheter + output monitor

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14
Q

Symptoms of opiate overdose

A 
Euphoria
N+V
Constipation
Anorexia
Hypotension
Respiratory depression 
Tremor
Pin poin pupils
Erectile dysfunction
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15
Q

Management of opiate overdose

A

ABC

Naloxone IV or IM

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16
Q

Symptoms of opiate withdrawal

A 
Dilated pupils
Lacrimation
Sweating
Diarrhoea
Insomnia
Tachycardia
Abdo cramps
N+V
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17
Q

Syx of cocaine intoxication

A 
Formication = coke bugs
Tachycardia
Mydriasis 
Hypertension
N+V
Euphoria
Increased libido
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18
Q

Syx of alcohol withdrawal

A 
12 hrs after last drink
Anxiety
Insomnia
Sweating
Tachycardia 
Tremor
Seizures
Delirium tremens
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19
Q

Duration of action of lignocaine

A

20min

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20
Q

Syx of lignocaine toxicity

A 
Perioral tingling
Metallic taste
Dizziness 
Light headedness
Tinnitus 
Difficulty focusing
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21
Q

Duration of bupivicaine

A

6-8 hours

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22
Q

8 reversible causes of cardiac arrest

A 
Hypoxia
Hypovolaemia
Hyper/hypokalaemia/hypocalcaemia
Hypothermia
Tension pneumothorax
Tamponade 
Toxins
Thromboembolism
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23
Q

Signs of tension pneumothorax

A 
Hypotension
Respiratory difficulty 
Raised JVP
Decreased breath sounds
Trachea deviated away
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24
Q

Treatment of tension pneumo

A

16 or 14 G cannulae, 2nd ICS, MCL

Replace with chest drain

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25
Q

Signs of open pneumothorax

A 
Open chest wound
Loss of breath sounds 
Reduced chest expansion
Hyper-resonance 
Surgical emphysema
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26
Q

Signs of cardiac tamponade

A 
Shock
Increased JVP
Muffled heart sounds
ECG voltage may be decreased 
Increased cardiac shadows
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27
Q

Define minor head injury

A

GCS >/= 13
+/- amnesia
+/- LOC

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28
Q

Indications for CT in minor head injury

A 
>65
Vomiting > once
Seizure
Warfarin or coagulopathy
GCS <15 after 2 hrs
Skull fracture
Neurological deficit
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29
Q

Appearance of SAH on CT

A

Blood in sulci + fissures

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30
Q

Features of extradural on CT

A

Bi-concave shaped

Doesn’t cross suture lines

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31
Q

Features of subdural haematoma on CT

A

Concave shape

Crosses suture line

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32
Q

Syx of Odontoid peg fracture

A

Pain
Inability to move neck
Instability of neck

33
Q

Types of wound closure

A

Primary - immediate within 24 hrs
Delayed primary closure - clean + antibiotics for 2-5d then close
Secondary healing - wound heals alone - slower - more scarring

34
Q

Management of burns

A 
C-spine ABC
morphine, entonox
Fluids -parkland formula
Blood if deep burns
Tetanus
Burns unit
Cling film
Sterile sheet 
Humidified 02
35
Q

Define hypothermia

A

<35 degrees

36
Q

CI to entonox

A 
Pneumothorax
Decreased LOC
pneumocranium
Intestine obstruction
Facial injury
37
Q

Management of compound fracture

A 
ABC
Analgesia
Clean + dress sterile dressing
Immobilise limb
Antibiotics
X-ray
Surgery 
Tetanus
38
Q

Treatment of salicylate OD

A

Activated charcoal within 1 hr

Urinary alkalinization

39
Q

Treatment of beta-blocker OD

A

IV atropine

Glucagon

40
Q

Antidote for benzodiazepines

A

Flumazenil

41
Q

Risk factors for PE

A 
Immobilisation
Pro-coagulant states - pregnancy / obesity
COCP
genetic thrombophilia
Cancer
Smoking
42
Q

When may rigors occur

A 
Lobar pneumonia
Pyelonephritis
Cholangitis
Empyema
Abscess
Malaria
Typhoid
43
Q

What is a trauma series

A

CXR
Pelvic XR
C-spine X-RAY

44
Q

Indications for referral to burns specialist

A

Airway burn
Full thickness burn
>10%
Hands,feet, face, perineum or genitalia

45
Q

Treatment of anaphylaxis

A

1 in 1000 adrenaline IM 0.5ml

IV chlorampheniramine
IV hydrocortisone
IV fluids
02

46
Q

Symptoms of CO poisoning

A

Headache
N+V
Not detectable on pulse oximeter

47
Q

Causes of chemical burns

A

Alkalis - cement, drain cleaner

Acids

48
Q

Features of a full thickness (3rd degree) burn

A 
Dry
Painless 
No blisters
Black / white / brown
Charred skin
Leathery/waxy
49
Q

Features of partial thickness burn (2nd degree)

A 
Painful
Red
Swollen
Blistered
Dry or weepy
50
Q

Features of a superficial burn (1st degree)

A 
Red 
Painful
No blisters
Sensitive to touch
Heals in 2-5d
51
Q

Features suggesting inhalation injury in burns patient

A 
Facial burn
Singed nose hair / eyebrows / eyelashes
Hoarse voice
Sooty sputum
Oropharyngeal soot / redness / swelling
Flared nostrils
52
Q

Management of acute neck sprain (whiplash)

A

Analgesia
Maintain mobility
Do not use a collar - delays recovery

53
Q

Symptoms of acute neck sprain (whiplash)

A 
Neck pain
Neck stiffness
Jaw pain
Dizziness
Paraesthesia 
Headache
Back pain
Shoulder / arm pain
54
Q

Define coup and contre coup injury

A

Cerebral contusions
Coup = site of blunt force
Contre coup = opposite side to impact

55
Q

Epigastic pain radiating to back suggests what

A

Acute pancreatitis

Check serum amylase

56
Q

Types of shock

A 
Anaphylactic 
Cardiogenic
Hypovolaemic 
Neurogenic
Septic
57
Q

Features of acute alcohol withdrawal

A

Low BP
raised HR
Visual hallucinations
10-72 hours after last drink

58
Q

Features of wernickes

A

Opthalmoplegia
Ataxic gait
Confusion

59
Q

What is battles sign?

A

Bruising over the mastoid process

Base of skull fracture

60
Q

Management of an open pneumothorax

A

Occlusive dressing over wound - tape down 3 sides to create a one way valve.
Chest drain insertion at a different site

61
Q

GP management of a child with suspected meningitis

A

IM benzylpenicillin

Call an ambulance

62
Q

Emergency management of a fitting patient in A+E

A 
ABC
Secure airway
15L O2 NRB
IV lorazepam 
If no IV access - rectal diazepam or Buccal midazolam
If benzos fail - IVI phenytoin
63
Q

Features of anaphylaxis

A

Sudden onset
rapid progression.
Life-threatening airway/breathing/circulation problems.
Skin/ mucosal changes - flushing, urticaria, angio-oedema

64
Q

Management of anaphylaxis

A 
Airway: 
Breathing 
Circulation
Disability
Exposure

high-flow oxygen
Lie the patient flat
Adrenaline IM 0.5 mg IM (0.5 mL of 1:1000)

Fluid challenge - 500 mL 0.9% saline in 10 min

Chlorphenamine - 10 mg IM or slow IV.
Hydrocortisone - 200 mg IM or slow IV.

65
Q

Features of MDMA (ecstasy) overdose

A

CNS

  • Change in mental status / Anxiety, paranoia
  • seizures / syncope
  • restlessness / ataxia
  • Hyperthermia,
  • Headache / blurred vision

Cardiovascular
- Palpitations / Chest pain

Gastrointestinal

  • Dry mouth / Nausea / vomiting
  • Abdominal cramping
  • Anorexia

Skin
- Sweating / hair standing on end

  • Urinary retention
  • Bruxism (jaw clenching)
66
Q

Symptoms of theophylline overdose / toxicity

A 
Nausea
Vomiting - Severe and protracted, 
Abdominal pain
Mild metabolic acidosis
Hypokalemia
Hypophosphatemia
Hypomagnesemia
Hypocalcemia/hypercalcemia
Hyperglycemia
Tachycardia

Seizures, hypotension, and significant dysrhythmias when serum levels approach 80 mcg/mL.

67
Q

Symptoms of aspirin overdose

A

Upset stomach
stomach pain
Nausea
Vomiting

Large overdoses may also cause:

Tinnitus
Tempoary deafness
Hyperactivity
Dizziness
Drowsiness
Seizures
Coma
68
Q

Management of aspirin overdose

A

Activated charcoal
IV fluids
Alkalinization of the urine - with IV sodium bicarb

69
Q

Symptoms of NSAID overdose

A

nausea,
vomiting,
epigastric pain,
diarrhoea.

Possible - Tinnitus, headache, GI bleeding

70
Q

Management of NSAID overdose

A

ABC

Activated charcoal

Stop seizures with lorazepam

71
Q

Symptoms of beta blocker overdose

A 
Dizziness
Bradycardia
Hypotension 
Decreased consciousness
Wheezing (in asthmatics)
Seizures
72
Q

Management of beta blocker overdose

A 
ABC
Fluid challenge
Ionotropes and chronogropes
Glucagon
Activated charcoal 
Haemodialysis in severe cases
73
Q

When may aortic disruption injuries occur

A

Rapid deceleration injury

90% fatality

74
Q

Features of splenic rupture

A

Haemorrhagic shock - Hypotension, tachycardia, peripheral vasoconstriction
Abdominal pain
Abdominal distension
Shoulder Tip pain

75
Q

How may solvent abuse cause death

A

Cardiac arrhythmia

76
Q

Feathers of septic shock

A 
Warm skin
Pyrexia
Tachycardia
Bounding pulse
Hypotension
78
Q

Investigations in paracetamol OD

A

Paracetamol level: @ 4 hrs
U&E, creatinine - renal failure .
LFTs: ALT >1000 IU/L indicate hepatotoxicity.
Glucose hrly - hypoglycaemia common in hepatic necrosis
Clotting screen: 12-hourly.
Arterial blood gas

79
Q

Antidote to benzodiazepine OD

A

Flumenazil

80
Q

At what time do you measure paracetamol levels after an OD

A

4 hours

Or as soon as arrived if >4 hrs or a staggered OD

General Medicine (25 decks)

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