Emergency by Dr Cintia

Question 1

Snakes CLINICAL FEATURES

Answer 1

Bleeding, headache, muscle damage, nausea, vomiting, abd pain

Question 2

Snakes TREATMENT (4)

Answer 2

1.Pressure Immobilisation Bandage.
-Don’t clean the wound
-Don’t apply PIB if more than 1 hour has passed since bite,
2.IV line
3.Take blood
4.Give antivenom (Monovalent of most common snakes in area preferred)

• Admit all cases for at least 12 hours
• Remove PIB when pt is stable

Question 3

Jellyfish TREATMENT

Answer 3

• In Queensland: Vinegar + Antivenom, Morphine for Irukandji - In Victoria: Hot water (45C for 20 mins)

Question 4

Human, cat, dogs Bites TREATMENT (5)

Answer 4

1.Wound care (Wash, elevate, immobilisation)
2.Tetanus prophylaxis
3.Post-Exposure prophylaxis: HIV,
HBV (Vaccine+Ig)
4.Atb Prophylaxis (Amoxi/Clav): Indicated if >8hrs delay presentation, bite in hands, feet, face, genitalia, bones, joints, immunocompromised.
5.Review in 24-48 hours

Question 5

Deadly Sidney Funnel Web CLINICAL FEATURES

Answer 5

Resp depression, salivation, numbness, tingling around mouth

Question 6

Deadly Sidney Funnel Web TREATMENT

Answer 6

Tx=snakebite

Question 7

Victorian Funnel Web Spider CLINICAL FEATURES

Answer 7

Headache, nausea

Question 8

Victorian Funnel Web Spider TREATMENT

Answer 8

Wash area, apply cold pack and give simple analgesic.

Question 9

Red back spider (Black widow) CLINICAL FEATURES

Answer 9

Slow progression

Question 10

Red black spider (Black widow) TREATMENT

Answer 10

-Wash area, apply cold pack and give simple analgesic.
-No improvement, rest and reassure, immobilise w/ splint, antihistamine IM for 15 mins, give antivenom IM

Question 11

Lyssavirus CLINICAL FEATURES

Answer 11

Bats. Incubation: 3-8w

Question 12

Lyssavirus TREATMENT

Answer 12

Wash wound and give rabies vaccine (if immunised) and Igs (within 48hrs)

Question 13

Cardiac Arrest (Vfib) TREATMENT (4)

Answer 13

1. CPR (30:2)
2. Shock+CPR for 2 mins
3. 2nd Shock
4. Adrenaline IM

Question 14

Bleeding CLINICAL FEATURES (4)

Answer 14

• Class I (<15%): Normal
• Class II (15-30%): HR 100-120
• Class III (30-40%): Low BP
• Class IV (>40%): Very low BP, >140HR

Question 15

Gunshot Wound - INVESTIGATION (Stable Patient):

Answer 15

1. X-ray.
2. Triple Contrast CT

Question 16

Gunshot Wound - INVESTIGATION (Unstable Patient):

Answer 16

1. Exploratory Laparotomy

Question 17

Ramsay Hunt Syndrome CLINICAL FEATURES

Answer 17

Ipsilateral facial palsy, ear pain, vesicles in ear/mouth

Question 18

Ramsay Hunt Syndrome TREATMENT (3)

Answer 18

1.Control pain: Nortriptyline, amitriptyline, gabapentin
2.Famciclovir, Valacyclovir, Acyclovir (within 72 hrs)
3.Oral Steroids for 7 days (Esp>50yo)

Question 19

Head Trauma FIRST INVESTIGATION

Answer 19

1. CT

Question 20

Chest Trauma FIRST INVESTIGATION (2)

Answer 20

1. CXR
2. FAST US (Haem unstable)

Question 21

Chest Trauma BEST INVESTIGATION (2)

Answer 21

1.CT
2.MRI (For spinal cord, ligamentous injuries, epidural haematoma)

Question 22

Abdomen Trauma BEST INVESTIGATION

Answer 22

-Haem stable: CT
-Haem unstable: FAST US, dx peritoneal lavage

Question 23

Spine Trauma CLINICAL FEATURES

Answer 23

Neurogenic shock (Dec BP, Dec HR)

Question 24

Spine Trauma TREATMENT (5):

Answer 24

1.ABCDE
2.Ox if Sat<94%
3.Trendelemburg position
4.Atropine if HR<40
5.Adrenaline and Dopamine (If resistant)

Question 25

Flail chest CLINICAL FEATURES

Answer 25

Paradoxical resp

Question 26

Flail chest TREATMENT (4):

Answer 26

1. Oxygen 2. Pain management & Pulm toilet 3. Intubation & mechanical ventilation (Positive Pressure) 4. Prophylactic bilateral chest tube

Question 27

Haemothorax CLINICAL FEATURES

Answer 27

Dull resonance

Question 28

Haemothorax TREATMENT

Answer 28

1. Water-sealed chest tube

Question 29

Pulmonary Contusion CLINICAL FEATURES

Answer 29

Symptoms hours after initial injury (like lucid)

Question 30

Pulmonary Contusion TREATMENT

Answer 30

1. Oxygen & Pulm toilet.

Question 31

Urethral Injury CLINICAL FEATURES

Answer 31

Blood in urethra, inability to void

Question 32

Urethral Injury FIRST INVESTIGATION

Answer 32

1. Retrograde urethrogram

Question 33

Urethral Injury TREATMENT

Answer 33

1. Suprapubic catheter

Question 34

Foreign Body Ingestion CLINICAL FEATURES

Answer 34

High Risk: button batteries, >6cms, two magnets, sharp, lead object

Question 35

Foreign Body Ingestion FIRST INVESTIGATION

Answer 35

1. X-ray

Question 36

Foreign Body Ingestion TREATMENT (High/Low Risk):

Answer 36

1.  High risk: Referral 2.  Low risk: Observe

Question 37

Burns CLINICAL FEATURES

Answer 37

Anterior (Posterior is the same) -  Genitals: 1% -  Face: 4.5% -  Upper limb: 4.5% -  Lower limb: 9% -  Thorax and abdomen: 18% 1st Degree: Erythema 2nd Degree: Erythema + Blister 3rd Degree: Pale, charred skin

Question 38

Burns TREATMENT (5):

Answer 38

1.  Analgesia 2.  Hydration 3.  Clean with water 4.  Remove foreign material 5.  Deroofing blister

Question 39

Burns around face/neck, hoarseness TREATMENT (2)

Answer 39

1.  Oxygen by face mask 2.  Intubation

Question 40

CO poisoning TREATMENT (2):

Answer 40

1. High flow (10-15L) Normobaric Ox via Non-rebreathing mask 2. Hyperbaric oxygen to comatose, pregnant, MI, seizures.

Question 41

Dehydration CLINICAL FEATURES (3 levels):

Answer 41

- Mild: Normal - Mod: Mild hypotension, in kids (>2 refill time) - Severe: Marked loss of skin turgor, severe hypotension, in kids (>3 refill time)

Question 42

Dehydration TREATMENT

Answer 42

- Mild-Mod: Oral hydration (2-3Lt in 24 hours) - Severe: 20mL/kg of IV hydration (adults). 10-20mL/kg for children - If dehydration + Hypochloremic alkalosis: 0.9% NS+5% dextrose - For colostomy is 3lt for men and 2lt for women.

Question 43

Alkali Ingestion TREATMENT

Answer 43

Oral fluids. No gastric emptying

Question 44

Organophosphate Poisoning CLINICAL FEATURES

Answer 44

Diarrhoea, urination, miosis, bronchospasm, bradycardia, sweating, lacrimation

Question 45

Organophosphate Poisoning TREATMENT

Answer 45

Atropine + Pralidoxime

Question 46

Anticholinergic syndrome CLINICAL FEATURES

Answer 46

Constipation urinary retention reduced sweat and tears mydriasis, bronchodilation, tachycardia, Hypertension