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Year 5 > emergency > Flashcards

emergency Flashcards

1
Q

what is anaphylaxis?

A

IgE mediated mast cell and basophil type 1 hypersensitivity reaction

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2
Q

adrenaline in anaphylaxis

A

0.5mg IM (0.5ml 1:1000)

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3
Q

other than adrenaline what other medication is given in anaphylaxis

A

chlorphenamine 10mg IV

hydrocortisone 200mg IV

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4
Q

what can be measured to identify anaphylaxis

A

serum tryptase

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5
Q

how long should anaphylaxis be monitored for?

A

up to 12 hours to look for biphasic reaction

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6
Q

how soon can you repeat adrenaline if no effect in anaphylaxis?

A

5 mins

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7
Q

causes of shock

A

obstructive- reduced cardiac flow (PE/ tension)/ reduced cardiac filling (tamponade)
distributive- sepsis, anaphylaxis, neurogenic
cardiogenic- MI, dysrhythmia
hypovolaemic- burns, haemorrhage, pancreatitis

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8
Q

what is a SOFA score

A

sequential organ failure assessment score

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9
Q

What is qSOFA score

A

quick SOFA
2+ refer to CCU outreach
used to diagnose sepsis

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10
Q

What is SIRS

A 
systemic inflammatory response syndrome 2+ of:
temp <36/ >38
HR >90
RR >20
WCC <4/>12
sepsis= SIRS + infection
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11
Q

what is septic shock

A

Sepsis + req vasopressive medication to maintain MAP >65 + serum lactate >2

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12
Q

stage I (compensated) blood loss

A 
<1000ml loss
HR <100
BP normal
RR normal
UO >30ml/ hour
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13
Q

stage II (Mild) Blood loss

A 
1000-1500ml
HR>100
CRT>2
posts hypotension
20-30ml/hr UO
Anxious/ agitated
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14
Q

stage III (moderate) blood loss

A 
1500-2000ml
HR>120
SBP<90
CRT >3
UO <20ml/hr
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15
Q

Stage IV (severe) blood loss

A 
>2000ml
HR>140
SBP<80
anuria
Reduced AVPU
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16
Q

hypovolaemic shock

A

preload decreased
CO increased
afterload increased
tx IV fluids

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17
Q

cardiogenic shock

A

preload increased
CO decreased
afterload increased
tx Inotropes and revascularisation

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18
Q

distributive shock

A

preload decreased
CO increased
afterload decreased
tx pressors, IV fluids

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19
Q

what is acute respiratory failure?

A

PaO2 <8
Type 1 normal PaCO2 due to ventilation:perfusion mismatch
Type 2 raised PaCO2 due to alveolar hypoventilation

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20
Q

flow rate through nasal cannula

A

2L (30%)

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21
Q

flow rate through face mask

A

6L (60%) can be combined with NC

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22
Q

Shockable pulse (VF/ pulseless VT)

A

shock immediately

after 3rd shock amiodarone 300mg IV and adrenaline 10ml of 1:10000 (1mg)

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23
Q

non-shockable (PEA/ Asystole)

A

adrenaline 10ml 1:10000 Asap then after every 3-5 minutes

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24
Q

4Hs and 4Ts

A 
Hypoxia
hypovolaemia
hyperkalaemia
hypothermia
thrombosis
tension
tamonade
toxins
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25
Q

opiate OD

A

naloxone

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26
Q

TCA OD

A

activated charcoal, diazepam or fits,
may require sodium bicarb
cardiac monitoring

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27
Q

paracetamol OD

A

N-acetylcysteine

28
Q

salicylate OD

A

charcoal if <1hr/ gastric lavage if >500mg/kg
urine alkalisation
correct glucose/ K
haemodylasis if no response

29
Q

what time should paracetamol levels be taken

A

> 4 hours <16 hours

30
Q

toxic dose paracetamol

A

> 12g or 150mg/kg, give N-acetylcysteine regardless of normogram

31
Q

what should N-acetylcysteine be given with

A

5% dextrose

may need chlorphenamine if allergic reaction (common)

32
Q

aspirin OD symptoms

A

tinnitus
deafness
confusion/ coma
hyperventilation-> late hypoventilation

33
Q

how might a TCA OD present?

A 
confusion
arrhythmia (prolonged QRS on ECG)
headache
hypotension
dilated pupils/ hyperthermia
34
Q

how might iron OD present?

A

GI bleeds

35
Q

iron OD tx

A

desferroxamine

36
Q

causes of falls

A 
Cardiac – e.g. arrhythmia
Neurological – e.g. seizure, stroke, peripheral neuropathy
Vasovagal
Intoxication / alcohol / pharmacological
BPPV 
Infection
Environmental
37
Q

investigations following fall

A 
CV + resp exam incl skin turgor
GALS- hip #
lying and standing BP
urine dip
neuro obs ?subdural
basic bloods and imaging
38
Q

normal score on MMSE

A

25+

39
Q

agitation in delirium

A

holperidol 0.5-1mg
lorazepam 0.5-1mg
but worsen/ prolong delirium

40
Q

benzo OD

A

flumezanil

41
Q

BB OD

A

atropine and glucagon

42
Q

digoxin OD

A

digibind

43
Q

warfarin OD

A

phylomenadione

44
Q

amoxicillin AE

A

rash with infectious mononucleosis

45
Q

co-amox AEs

A

cholestasis

46
Q

flucloxacillin AEs

A

cholestasis

47
Q

erythromycin AEs

A

GI upset, prolonged QT

48
Q

Ciprofloxacin AEs

A

lowers seizure threshold, tendonitis

49
Q

metronidazole AEs

A

reaction following alcohol ingestion

50
Q

doxycycline AEs

A

photosensitivity

51
Q

trimethoprim AEs

A

rash including photosensitivity, pruritus, suppression of haematopoiesis

52
Q

safe limits of alcohol

A

<14/ week

<3/ day

53
Q

what effect does alcohol have on the liver?

A 
hypooglycaemia
predisposes to fatty liver
cirrhosis
hepatits
varices
p450 inducer
54
Q

alcohol detoxification

A 
chlordiazepoxide (benzo, gradually reduce over 7-10 days)
thiamine to prevent wernicke's
fluid and electrolyte replacement
disulfiram- with psychotherapy 
acamprosate reduces cravings
55
Q

which is acute -wernicke’s/ korsakov

A

wernicke- ocular palsy, ataxic gait, memory problems

56
Q

what factors affect motivation to quit

A

desire
need
ability
reasons

57
Q

benzo abuse

A

disinhibited/ impression of intoxication

withdrawal-> hypersensitivity, depersonalisation

58
Q

psychostimulant abuse

A

rapid speech, large pupils, agitation, restlessness, high BP. (note ddx opiate withdrawal)

59
Q

cannabis

A

addictive
weak hallucinogen
can cause anxiety and depression

60
Q

opiates

A

smoking-> skin popping-> injection

61
Q

cocaine

A

stimulant

cardiotoxic

62
Q

amphetamine

A

stimulant
elation
excess energy
can be injected

63
Q

crystal meth

A

strong amphetamine

64
Q

MDMA

A

serotonin release causes social friendliness

tolerance high

65
Q

LSD

A

hallucinogenic

not addictive

Year 5 (12 decks)

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