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CP3 Medicine > Emergency > Flashcards

Emergency Flashcards

1
Q

What is the antidote for:
Paracetamol
B-blockers
TCAs

A

Para: N-AC

B-blockers: IV atropine / IV glucagon + dextrose

TCAs: sodium bicarbonate (if VT/SVT)

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2
Q

What are the features of salicylate (aspirin) overdose?

What is seen on ABG

A 
Tachypnoea
Vomiting
Sweating
Tinnitus/vertigo
ABG: resp alk → metab acid
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3
Q

What are the features of TCA overdose?

What is seen on ABG

A 
Dilated pupils / blurred vision
Urinary retention
Seizures / Reduced GCS
Dysrhythmia / Tachycardia
ABG: metal acid
ECG: wide QRS
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4
Q

What are the features of digoxin toxicity? (3)

A

Nausea / anorexia
Confusion
Hallucinations (yellow haloes over lights)

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5
Q

How is opioid overdose managed?

A

400ug IV naloxone
1min fail: 800ug
2min fail: +800ug (repeat until breathing adequate)
NB short t1/2 (needs repeating)

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6
Q

What are the features of BZD overdose (6)

How is it managed?

A

↓GCS / ↓Tone / ↓Reflexes
↓BP
Ataxia
Dysarthria

Flumenazil 200ug (in 15s) (+100ug every 1min)

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7
Q

What are the features of stimulant overdose (E/Cocaine/Amphetamine)
What is seen on ABG
How is it managed

A 
Thirst
Dilated pupils
Agitation / confusion / tremor
↑HR / ↑BP / ↑Temp
ABG (cocaine): metab acidosis
IV diazepam (if halluc/convulsing)
External cooling
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8
Q

What are the complications of acute alcohol intoxication?

How is it managed?

A

Hypoglycaemia** (esp children)
Severe: resp failure / coma / death

IV glucose (glucagon ineffective)
Haemodialysis (if conc >500)
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9
Q

List the reversible causes of arrest (8)

A

Hypothermia
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia / metabolic

Thrombosis (cardiac/pulmonary)
Tension pneumothorax
Tamponade (cardiac)
Toxins

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10
Q

List the different types of shock (7)

A

Hypovolaemic
• Haemorrhagic
• Non-haemorrhagic

Distributive:
• Septic
• Anaphylactic
• Neurogenic

Cardiogenic:
• Direct (MI/Arrhythmia/Electrolytes/Valve)
• Indirect (obstructive)

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11
Q

Which types of shock cause ‘cold shock’ and ‘warm’

What are the features of each

A

‘Cold shock’ – hypovol/cardiogenic
• Cold / pale / clammy
• Thready pulse / narrow PP

‘Warm shock’ – septic
• Hot / flushed / sweaty
• Bounding pulse / wide PP

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12
Q

What are the new Sepsis (2016) criteria (ARUHSS)

A

Appears Really Unwell, Heading to Septic Shock

  • Altered mental state (new)
  • RR >25 (or new need for O2)
  • Urine not passed 18hrs (or <0.5ml/kg/hr 2hrs)
  • HR >130
  • SBP <90 (or 40+ under usual)
  • Skin: ashen/mottled/cyanosed/non-blanching
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13
Q

What are the different classes of haemorrhagic shock and how is each managed

A

All: Titrated fluids / Transexamic acid

Class 1: HR >100 → fluid (crystalloids)
Class 2: HR >100 + Narrow PP → consider blood
Class 3: HR >120 → give blood + consider surgery
Class 4: >40% lost → surgery

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14
Q

List some specific aspects of management in cardiogenic shock

A

If pulm oedema → withhold fluids
Consider: Swan-Ganz / Central / A-line
Consider: ‘renal’ dose dopamine to protect

PCWP low → plasma expander
PCWP okay → ionotropes (dobutamine)

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15
Q

What is the ‘triad of death’?

A

Post-massive transfusion bleeding disorder:
• Coagulopathy
• Hypothermia
• Metabolic acidosis

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16
Q

What circumstances in burns might you suspect an airway issue?

A

Fire in enclosed space

Stridor
Harsh cough
Carbonaceous sputum
Tachy/dyspnoea
Burnt nasal hair
Facial burns
17
Q

Outline the immediate management in burns (5)

Outline the systemic management in burns (5)

A 
Remove clothing (contains heat)
Cold water tap
Cling film (removes pain)
Fluid resus (if >15% SA adults / >10% children)
Assess severity (depth etc)
IV opiates
Hartmann's
Catheterise
Systemic Abx (if evidence infection)
Nutrition (early parenteral if enteral not poss)
18
Q

What are some complications of burns (6)

A

Contractures
Sepsis (e.g. wound / inhalation-related chest)
Acute peptic ulceration (Curling’s ulcer)
AKI (hypovol / Hb / myoglobin)
Psychological

19
Q

What are the indications for specialist burns referral? (7)

Indications for outpatient management

A 
Burns >30% total SA
Partial thickness >10% (5% children)
Full thickness >1%
Circumferential burns
Assoc inhalation injury
Chemical/electrical burns
Age extremes

Outpatient:
Adults partial thickness <10%
Children partial thickness <5%
Full thickness <1%

CP3 Medicine (7 decks)

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