Emergency Flashcards
Define acute bronchitis
Lower respiratory tract infection which causes inflammation int he bronchial airways
What are the sings and symptoms of acute bronchitis?
Cough
±sputum, wheeze, SOB
Chest pain when coughing
Mildly ill
What is the management of acute bronchitis?
Self-care:
- OTC medications
- stop smoking
Acute bronchitis is usually self-limiting with cough lasting 3-4 weeks
Abs if systemically unwell or if higher risk of complications or if CRP >100mg/L
If abs: doxycycline first line or amoxicillin if pregnant
Describe the pathophysiology of acute coronary syndrome
Usually the result of a thrombus from a plaque blocking a coronary artery.
When a thrombus forms in a fast lowing artery it is made up mostly of platelets.
This is why anti-platelet medications are mainstay treatment
Give a description of the coronary arteries
The left coronary artery becomes the circumflex and left anterior descending arteries
Right coronary artery curves around the right side and under the heart and supplies the:
- R atrium and ventricle
- Inferior aspect of L ventricle
- Posterior septal area
Circumflex artery curves around the top, left and back of the heart and supplies the:
- left atrium
- posterior aspect of left ventriclee
Left anterior descending travels down the middle of the heart and supples the:
- anterior aspect of the left ventricle
- anterior aspect of the septum
What are the types of acute coronary syndrome?
- Unstable angina
- ST Elevation MI
- Non-ST elevation MI
Describe the diagnosis of acute coronary syndrome
If ST elevation or left BBB = STEMI
If no ST elevation, then perform troponin:
- If raised troponin or other ECG changes = NSTEMI
- if troponin normal and ECG normal = unstable angina or MSK
What are the symptoms with acute coronary syndrome?
Central constricting chest pain with:
- nausea and vomiting
- sweating and clamminess
- feeling of impending doom
- SOB
- Palpitations
- Pain radiating to jaw or arms
Symptoms should continue at rest for more than 20 mins, if they settle consider angina
Describe the ECG changes in acute coronary syndrome
STEMI:
- ST segment elevation
- New LBBB
NSTEMI:
- ST segment depression
- Deep T wave inversion
- Pathological Q waves
What are the arteries and corresponding heart areas and ECG leads in ACS?
Left coronary artery - anterolateral - 1,aVL, V3-6
LAD - anterior - V1-4
Circumflex - Lateral - 1, aVL, V5-6
Right coronary artery - inferior - 2, 3, aVF
What are the causes of raised troponin?
- Myocardial ischaemia
- Chronic Renal failure
- Sepsis
- Myocarditis
- Aortic dissection
- Pulmonary embolism
What are the investigations for ACS?
- ECG
- FBC (anaemia)
- U+Es
- LFTs
- Lipid profile
- TFTs
- HbA1c
Plus:
CXR, CT coronary angiogram, Echo
Describe the treatment for acute STEMI
Primary PCI: if available within 2 hours of presentation
Thrombolysis if PCI not available within 2 hours
MONA
Describe the treatment for acute NSTEMI
BATMAN
Beta blockers unless contraindicated
Aspirin 300mg stat
Ticagretor 180mg stat or clopidogrel 300mg
Morphine
Anticoagulant: LMWH
Nitrates
Oxygen only if <95%
What are the complications of MI?
DREAD
Death
Rupture of the heart septum or papillary muscles
Edema (heart failure)
Arrhythmia or anuerysm
Dressler’s syndrome
What is Dressler’s syndrome? (definition and cause)
Usually occurs around 2-3 weeks post MI.
Caused by a localised immune response and causes pericarditis.
What is the presentation of Dressler’s syndrome?
Pleuritic chest pain Low grade fever Pericardial rub Pericardial effusion Pericardial tamponade
What is the diagnosis and management of dressler’s syndrome?
ECG: global ST elevation and T wave inversion
Echo: pericardial effusion
Raised inflammatory markers (CRP and ESR)
Management: NSAIDs –> steroids (prednisolone) –> pericardiocentesis
What is the secondary prevention medical management of acute coronary syndrome?
6As
Aspirin 75mg daily Another antiplatelet (clopidorel or ticagretor) Atorvastatin 80mg daily ACEi Atenolol Aldosterone antagonist
What is the secondary prevention lifestyle for acute coronary syndrome/
Stop smoking Reduce alcohol Mediterranean diet Cardiac rehab Optimise treatment of other medical conditions
What are the types of MI?
Type 1: Traditional MI due to acute coronary event
Type 2: Ischaemia secondary to increased demand or reduced supply of oxygen (e.g. secondary to severe anaemia, tachycardia or hypotention)
Type 3: sudden cardiac death or cardiac arrest suggestive of an ischaemic event
Type 4: MI associated with PCI/coronary stunting/ CABG
Define Acute Kidney injury
An acute drop in kidney function. Diagnosed by measuring serum creatinine.
NICE:
- Rise in creatinine of >25micromol/L in 48 hours
- Rise in creatinine of >50% in 7 days
- Urine output of <0.5ml/kg/hour for >6 hours
What are the risk factors for AKI?
- CKD
- HF
- Diabetes
- Liver disease
- Older age (>65)
- Cognitive impairment
- Nephrotoxic medications such as NSAIDs and ACEi
What are the causes of AKI?
Pre renal: most common cause and is due to inadequate blood supply to kidneys
- dehydration
- hypotension shock)
- HF
Renal: where intrinsic disease in the kidney leads to reduced filtration:
- glomerulonephitis
- interstitial nephritis
- acute tubular necrosis
Post-renal: caused by obstruction to the outflow of urine from the kidney causing back pressure into kidney (obstructive uropathy)
- kidney stones
- masses such as cancer in abdo or pelvis
- ureter or urethral strictures
- enlarged prostate or prostate cancer