Emergency Care Flashcards
causes of normal anion gap metabolic acidosis
diarrhoea
RTA
Addisons
causes of shock due to low CO
CO = HR x SV
1. Hypovolaemia
2. Pump failure
causes of shock due to low SVR
MAP = CO x SVR
1. Sepsis
2. Anaphylaxis
3. Neurogenic
4. Endocrine failure
classes of shock
- <15% circulating volume (<750ml) = compensated
- 15-30% CV (750-1500ml) = tachycardic
- 30-40% CV (1500-2000) = hypotensive
- > 40% CV (>2000) = unconscious
when can you discharge in anaphylaxis?
don’t discharge for 6-12 hours
biphasic response
Canadian C-spine rules vs NEXUS rules
Canadian: do they need immobilisation
Nexus: need to meet to clear a C spine
resus of a significant haemorrhage
1:1:1 (plasma, platelets, packed RBCs)
what is included in secondary survey?
AMPLE
exam
other test
= minimise risk of missed injuries
what is tertiary survey?
24 hours later
detects changes
causes of coma
Metabolic: drugs, hypoxia, hypothermia, sepsis, hypoglycaemia, myxoedema
Neurological: trauma, infection, tumour, vascular, epilepsy
pupils:
normal direct and consensual reflexes
intact midbrain
pupils:
midposition (3-5mm), non reactive and irregular
midbrain lesion
pupils:
unilateral fixed and dilated
3rd nerve compression
pupils:
small and reactive
pontine
V1-V4 territory and supply
anteroseptal
LAD
II, III, aVF territory and supply
inferior
RC
V4-6, I, aVL territory and supply
anterolateral
LAD or LC
I, aVL, V5-V6 territory and supply
Lateral
LC
Tall R waves V1-V2 territory and supply
Posterior
LC or RC
treatment of heart block post-MI
Inferior = atropine
Anterior = pacemaker
differentials for acute rupture (3-5 days) post MI
papillary muscle or ventricular septal
differentials for rupture 5 days to 2 weeks post MI
LVFW rupture
symptoms of LVFW aneurysm
SOB
persistent ST elevation
no chest pain
LVF
management of LVFW aneurysm
anticoagulant
when to avoid fondaprinoux and give what instead?
if PCI is possible (only used for fibrinolysis)
if PCI, give LMWH
causes of cardiogenic shock
MI
arrythmias
tamponade
PE
myocarditis
investigations in cardiogenic shock
ECG
ABG
CXR
Echo
U&Es
Trop
BNP
UO
Swans Gantz catheter
management of cardiogenic shock
ensure fluid filled
dobutamine
ALTS, when to give adrenaline and amiodarone?
- adrenaline every 3-5 mins (10mL, 1 in 10,000 IV)
- amiodarone after 3 shocks
causes of bradycardia
physiological
cardiac: post MI, sick sinus
non-cardiac: vasovagal, hypothermia
drug-induced
management of bradycardia
atropine
transcutaenous pacing
COPD exacerbation immediate management
24% oxygen
nebs
steroids
indications for NIV (BiPAP)
- COPD with resp acidosis
- T2RF secondary to chest wall deformity, NM disease, OSA
- cardiogenic pulmonary oedema
- weaning from tracheal intubation
treatment of PE in someone who is hemodynamically unstable
thrombolysis (heparin and alteplase)
what measurement is used to classify ARDS?
dec arterial PaO2/FiO2 ratio
mild, moderate and severe ARDS
mild : 201-300mmHg
moderate: 101-200
severe: <100
management of ARDS
- central venous access = ionotropes
- IV = broad spectrum Abx, diuretics
- 60-100% oxygen
non-shocked = sit upright
shocked = colloid infusion
variceal bleed management
- terlipressin, Abx
- gastric varices: endoscopic injection, TIPS
- oesophageal varices: endoscopic band ligation, Sengstaken-Blakemore
non-variceal bleed management
endoscopic
- mechanical clips and adrenaline
- thermal coagulation, adrenaline
indications for immediate CT spine (<1 hour)
GCS < 13 on initial assessment
Patient intubated
Ruling out needed (e.g. for surgery)
Clinical suspicion and age >65yo, focal neuro deficit, high impact injury, paraesthesia in limbs
spinal cord compression above L1
UMN signs and sensory level
spinal cord compression below L1
LMN signs and peripheral numbness
DKA complications
VTE prophylaxis
cerebral oedema
aspiration pneumonia
measuring amount of burns
Lund and Browder rule
causes of distributive shock
sepsis
anaphylaxis
neurogenic
first drugs for STEMI
aspirin 300mg and Clopi 300mg
(DAPT continued for 1 year)
NSTEMI important drug
add fondaprinux
what drug to avoid in hypotension?
nitrates
management of Raised ICP
neuroprotective ventilation
mannitol/hypertonic saline
features of severe asthma
RR > 25
HR >110
can’t complete sentences
how frequent is monitoring in severe attack?
monitor PEFR every 15-30 mins
important formulas in Burns
Lund and Browder Charts to assess amount of burn
Parkland formula to guide replacement (4 x wt x %burn = mL of Hartman’s in 24 hrs)
how frequently do you give adrenaline and amiodarone in VF/pulseless VT?
adrenaline and amiodarone after 3rd shock
repeat adrenaline every cycle
how often to give adrenaline in PEA/asystole?
adrenaline 1mg as soon as IV access obtained
repeat adrenaline every other cycle
