emergency and acute med Flashcards
alternative treatment to atropine/transcutaneous pacing for a symptomatic bradycardia
Isoprenaline/adrenaline infusion is an alternative treatment to atropine/transcutaneous pacing for a symptomatic bradycardia
Dressler’s syndrome typical presentation
A man presents with central, pleuritic chest pain and fever 4 weeks following a myocardial infarction. The ESR is elevated - Dressler’s syndrome
Acute coronary syndrome poor prognostic factors
The following groups of patients are at an increased risk of developing hepatotoxicity following a paracetamol overdose:
- patients taking liver enzyme-inducing drugs (rifampicin, phenytoin, carbamazepine, chronic alcohol excess, St John’s Wort)
- malnourished patients (e.g. anorexia nervosa) or patients who have not eaten for a few days
- HIV
- P450 inducers
Organisms causing post splenectomy sepsis:
Streptococcus pneumoniae
Haemophilus influenzae
Meningococci
patient has an acidosis with a normal anion gap. There are several causes of this including:
Causes of a normal anion gap or hyperchloraemic metabolic acidosis
* gastrointestinal bicarbonate loss: diarrhoea, ureterosigmoidostomy, fistula
* renal tubular acidosis
* drugs: e.g. acetazolamide
* ammonium chloride injection
* Addison’s disease
The anion gap is calculated by:
(sodium + potassium) - (bicarbonate + chloride)
A normal anion gap is 8-14 mmol/L
Causes of a raised anion gap metabolic acidosis
lactate: shock, hypoxia
ketones: diabetic ketoacidosis, alcohol
urate: renal failure
acid poisoning: salicylates, methanol
5-oxoproline: chronic paracetamol use
A patient is noted to have persistent ST elevation 4 weeks after sustaining a myocardial infarction. Examination reveals bibasal crackles and the presence of a third and fourth heart sound
left ventricular aneurysm
The most common organism causing neutropenic sepsis
Coagulase-negative, Gram-positive bacteria such as Staphylococcus epidermidis are the most common cause of neutropenic sepsis
investigation of choice for PE in renal impairment
Pulmonary embolism and renal impairment → V/Q scan is the investigation of choice
treatment of choice for methotrexate toxicity
folinic acid
If clopidogrel is contraindicated or not tolerated, give…for secondary prevention following stroke
If clopidogrel is contraindicated or not tolerated, give aspirin for secondary prevention following stroke
when do you thrombolyse in PE
Massive PE + hypotension - thrombolyse
Mesenteric ischaemia main points to remember
Mesenteric ischaemia: triad of CVD, high lactate and soft but tender abdomen
after a tricyclic overdose which is the most important investigation?
Perform ECG if tricyclic overdose is suspected. Widening of QRS > 100ms is associated with an increased risk of seizures whilst QRS > 160ms is associated with ventricular arrhythmias
tricyclic overdose features
Early features relate to anticholinergic properties: dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision.
Features of severe poisoning include:
* arrhythmias
* seizures
* metabolic acidosis
* coma
ECG changes in tryciclic antidepressants
ECG changes include:
sinus tachycardia
widening of QRS
prolongation of QT interval
Widening of QRS > 100ms is associated with an increased risk of seizures whilst QRS > 160ms is associated with ventricular arrhythmias
tricyclic overdose management
IV bicarbonate
* first-line therapy for hypotension or arrhythmias
indications include:
* widening of the QRS interval >100 msec or a ventricular arrhythmia
other drugs for arrhythmias
compartment syndrome definition and pathophysiology
compartment syndrome features
diagnosis of compartment syndrome
- Is made by measurement of intracompartmental pressure measurements. Pressures in excess of 20mmHg are abnormal and >40mmHg is diagnostic
- Compartment syndrome will typically not show any pathology on an x-ray
compartment syndrome management
- This is essentially prompt and extensive fasciotomies
- In the lower limb the deep muscles may be inadequately decompressed by the inexperienced operator when smaller incisions are performed
- Myoglobinuria may occur following fasciotomy and result in renal failure and for this reason these patients require aggressive IV fluids
- Where muscle groups are frankly necrotic at fasciotomy they should be debrided and amputation may have to be considered
- Death of muscle groups may occur within 4-6 hours
Risk factors for asystole in bradycardia (? needs…
Risk factors for asystole in bradycardia (? needs transvenous pacing)
complete heart block with broad complex QRS
recent asystole
Mobitz type II AV block
ventricular pause > 3 seconds
list the most common causes of bradycardia
list the most common causes of bradycardia and suggest a helpful mnemonic
Bradycardia (Physiological)
Electrolyte Imbalance
Sick Sinus Syndrome
Lower-than-normal Temperature (Hypothermia)
Obstructive Sleep Apnea
Well-trained Athletes
Subdural haemorrhage is caused by damage to
Subdural haemorrhage is caused by damage to bridging veins between cortex and venous sinuses
