Emergency Flashcards

1
Q

AMPLE

A
allegies
meds
past hx
last ate/ drank
event
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2
Q

3 major radiographs of trauma

A

chest
lateral cervical spine
pelvis

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3
Q

Secondary survey

A

4 people to log roll
examine thoracolumbar spine, listen to lung fields, examine perineum, do rectal exam
Ix, documentation etc

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4
Q

In cardiac arrest, who should get adrenaline and when?

A

In shockable rhythms, 1 mg IV adrenaline after alternate shocks
Or every 3-5 mins

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5
Q

Emergency medical mx STEMI

A

Aspirin 300 mg (thereafter 75 mg/ daily)
Ticagrelor 180 mg (thereafter 90 mg BD - don’t give if hx bleeding or already anticoagulated)
Morphine 2.5-5 mg (1 mg/min) - further dose if needed
Cyclizine 50 mg IV

GTN spray - consider IV if BP ok/ no sildenafil

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6
Q

Emergency medical mx acute HF

A

IV furosemide 40-80 mg bolus
(followed by infusion 5-20 mg/h)

consider IV GTN

stop CCBs and NSAIDs, if possible
if hypotensive can omit beta-blockers/ ACEi - but try not to stop

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7
Q

Emergency medical mx sinus bradycardia

A

only needs mx if symptomatic

atropine 600 - 1200 mcg IV

if persistent, pacing

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8
Q

How best to terminate AF of recent onset?

A

IV fleicainide

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9
Q

How best to treat AF in presence of HF or acute ischaemia?

A

IV amiodarone

consider cardioversion

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10
Q

Medical mx stable VT

A

Lidocaine 1.5 mg/kg IV

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11
Q

Mx DVT

A

Book USS (if can’t be done within 4 hours, treat)

Rivaroxaban 15 mg BD (from day 22 just 15 mg OD maintenance)

If contraindicated, dalteparin, UH or warfarin (dalteparin bridging)

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12
Q

Mx PE

A

If life-threatening, IV heparin (alteplase too if haemodynamcally unstable). Arrange echo and/ or CTPA.

If non life-threatening, do Wells.
Either D-dimer, or rivaroxaban therapy.
(LMWH if preg)

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13
Q

Mx opiate OD

A

naloxone 0.4 mg IV (repeat every 2-3 mins until depression is reversed)

can be given IM/ SC if no access

doesn’t work well for buprenorphine

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14
Q

Mx benzo

A

IV flumazenil

caution if pt may have taken other psychotropic drugs, or if benzo-dependent (eg epileptic)

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15
Q

Mx acute asthma

A

2.5 - 5 mg salbutamol nebs (oxygen-driven, at least 6 L/ min) - REPEAT EVERY 15-30 MINS

500 mcg ipratropium bromide - every 6 hours (helps in 1/3 patients)

40-50 mg oral pred, or hydrocortisone 100 mg IV 6-hourly (CONTINUE FOR 5 DAYS)

Consider IV Mg, aminophylline

Should be reviewed by GP within 2 days of asthma attack and by asthma specialist within 4 weeks

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16
Q

When should spontaneous pneumothorax be admitted

A

tension!
Primary - usually not
Secondary (ie underlying lung disease)

aspirate usually if over 2 cm

17
Q

Mx acute upper GI bleed

A

Endoscopy!

Low-risk: 40 mg BD oral omeprazole

High-risk: HDU, restore fluid volume, if no imminent OGD give IV omeprazole (same dose)

18
Q

Mx bleeding oesophageal varices

A

Resuscitate

Terlipressin 2 mg IV (repeat every 4-6 h) - start before diagnostic endoscopy

Abx prophylaxis (send blood cultures + MSU)

15-20 ml TDS oral lactulose (prevent encephalopathy)

(beta-blockers are prophylaxis)

19
Q

Immediate Ix for bloody diarrhoea

A
Blood (FBC, U&Es, CRP, LFTs)
Stool x2 (MC&S + C.diff toxin)

Sigmoidoscopy

AXR

20
Q

Mx acute severe UC

A

Mild-to-moderate: topical mesalazine suppositories (proctitis), foam enemas (distal) or liquid enemas (L-sided colitis)

Fluids + potassium
LMWH

21
Q

How to differentiate between DKA and HHS?

A

Urinary ketones in DKA only

22
Q

Initial investigations for DKA

A

Bloods: FBC, U&E, BG, lactate, VBG, culture

Urinalysis, ECG, CXR

23
Q

Mx DKA

A

NaCl 1 litre (over 10-15 mins)
NaCl 1 litre (over 1 hour)
Catheterise if oliguric

Actrapid 50 units in saline (up to a volume of 50 mL)

If 14 mmol or less, infuse 10% glucose at 100 mL/h - don’t stop insulin

Check electrolytes every 2h via VBG
Check BM every 1h

24
Q

Mx hypoglycaemia if conscious

A

X2 glucogel, x4 glucotabs, or other high-sugar
check BM after 15 mins

follow up with starchy food

don’t omit insulin dose

25
Q

Mx hypoglycaemia if unconscious

A

If IV access, 100 mL 10% glucose

or 1 mg IM glucagon

26
Q

Immediate mx Addisonian crisis

A

Cannula. Take bloods (U&Es, glucose, cortisol)

0.9% saline (corrects dehydration and hyponatraemia)

100 mg IV bolus hydrocortisone
repeat 6-hourly for 1-2 days (until able to take oral

27
Q

Thrombolysis time for stroke

A

4.5 h

28
Q

What stroke assessment should be done in A&E?

A

Rosier

29
Q

Stroke Ix

A
FBC
ESR
Coag screen (consider thrombophilia screen if under 60)
U&Es
Glucose
Cholesterol 

ECG
CXR
Echo if under 65/ significant cardiac pathology

(Urgent echo and cultures if suspected endocarditis)

If ischaemic, doppler carotid/ vertebral

30
Q

Mx stroke

A

thrombolysis if indicated
300 mg aspirin
300 mg clopi

lower BP gradually if super-high (if moderately high, is pretty normal)

31
Q

Imaging for ?carotid dissection

A

MRI with cross-sectional views of carotid artery

32
Q

Seizure mx

A

Make pt safe
TIME

Give oxygen, check glucose
(IF ALCOHOL, GIVE PABRINEX BEFORE GLUCOSE)
Inter-ictal establish IV access

33
Q

Status epilepticus mx

A

4 mg IV lorazepam (2 mins)
OR 10 mg IV diazepam
OR 10 mg buccal midazolam

[STAT doses not PRN]

repeat within 10-20 mins

Give usual AEDs if already on treatment

STAGE 2 (skip to this if already had 2 doses in last 24h)
Phenytoin (others not licensed, but may be preferable)

After 30-90 mins, may need GA

34
Q

What is apomorphine?

A

Anti-Parkinsonian med!

35
Q

What is the dose of adrenaline for anaphylaxis?

Where is it administered?

A

0.5 mL 1:1000 (i.e. 0.5 mg)

antero-lateral medial aspect of thigh. Repeat as needed every 5 mins

36
Q

Mx for anaphylaxis

A

Adrenaline

ABCDE

Fluids 500 mL - 1000 mL, keep repeating
10 mg chlorphenamine, IM or slow IV

Consider corticosteroids
Consider salbutamol

Measure tryptase levels within 4 h

Observe for 6-12 h