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Emergency & Critical Care Flashcards

1
Q

FB high risk ingestion

A

Rx: endoscopic
Button battery
Magnet
Large toy
Sharp toy
Desiccant
Lead etc

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2
Q

3 points for FB ingestion

A
  1. Site of obstruction Cricopha/ mid esophagus (aortic arch)/ LES
  2. FB object
  3. Timing (6-8 hrs)
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3
Q

Snake bite 1st step

A

1.Pressure Bandage & immobilisation
- helps for 4 hrs
-15cm width
-remove after antivenom administration

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4
Q

Anti venom indication

A

Absolute:
Hemodynamic effects
INR deranged
Early sign of paralysis eg ptosis
Relative:
Systemic sx
APTT deranged
WBC 📈
CK 📈

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5
Q

Irukandji Syndrome

A

Box jellyfish
Catecholamines surge
HR 📈
BP high
Abd pain and cramps
APO due to acute LVF

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6
Q

Jellyfish sting

A

Hot water 45 degree Celsius immersion: pain relief
Vinegar: mixed study,; recommended for box jellyfish
No PBI ! !

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7
Q

SVDK+

A

1.To detect type of snake
2.Venom was present
*It does not indicate systemic envenomation occurred or for initiating therapy
If neg, but systemic+ need to start antivenom

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8
Q

Urine for snake 🐍 bite

A

Next sample if bite area not available
Only done if systemic envenomation +
BLOOD not reliable !

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9
Q

Anti venom

A
  1. Used if systemic envenomation+
  2. SDVK +: monovalent
  3. SVDK neg/ need immediate treatment: polyvalent
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10
Q

20 whole blood clotting test (20WBCT)

A

Coagulopathy: >20min clot absent= coagulopathy+
Snake bite envenomation

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11
Q

Traumatic acute limb ischemia

A

By order:
1 Elevate limb > heart
2 Arrange to operation theatre
3 NV assessment every 15min
4 analgesia

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12
Q

Post stem cell transplant fever

A
  1. Fever day4-5 : common
    Resolves by d6
    2 Blood cultures & X-ray initial step
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13
Q

Gun shot wound
Abd tender ( epigastric)
X-ray : bullet at psoas, no exit wound
Next step

A

CT scan 1st
Then
Exploratory laparotomy

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14
Q

Post operative complication carotid endarterectomy with 📈 sob and dyspnoea

A

Cervical wound hematoma
Rx: remove the bandage at ED
Prevention of airway tract distortion

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15
Q

Fall from height with severe foot pain and back pain
Appropriate next step

A

X-ray spine : 23% of calcaneal # has lumbar spine #
Not to overlook

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16
Q

Inhalation injury in enclosed space

A

CO poisoning

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17
Q

CO poisoning RX in stable patients

A

High flow O2 15L non rebreathing mask

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18
Q

CO poisoning in pregnant women and comatose/seizure/mi

A

Hyperbaric oxygen ASAP within 6-8hrs

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19
Q

Signs of CO toxicity

A

Mild: mild headache, light headed,naussea
Mod: severe headache,, giddy,visual impairment, gait, weakness
Severe: Coma,seizure,resp cardiac arrest

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20
Q

Ix for CO toxicity

A

Serum Carboxyhemoglobin (COHb) every 2-4 hrs till asymptomatic/levels norm
RP/CK/ABG/CXR

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21
Q

Human bite injury
6 steps

A
  1. Wound care
  2. Tetanus prophylaxis
  3. Hep B vaccine+/- immunoglobulin
  4. Abx cover ( site of injury,> 8 hrs presentation)
  5. Patient education
  6. R/v in 24-48 hrs
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22
Q

Pulmonary atelectasis
Onset?
Sx?

A

Within 24hr post op
Pleuritic Chest pain & SOB
Fever

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23
Q

Box jellyfish ( Northern Territory) / tropical areas

A

Vinegar as 1st choice

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24
Q

Tetanus booster

A

Clean & Less than 5 yrs: no action
Dirty& less than 5 yrs: no action
Clean &more than 10yrs: give booster
Dirty &more than 5 yrs: dT vaccine
No prior primary/booster: TIG and dT vaccine

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25
Incomplete Tetanus vaccine or none
Clean: dT/DPT age dependent, no TIG Dirty :Give TIG + DPT together
26
Delirium MCC
Hypoxia (1st) !!! Others: electrolyte/glucose/alcohol wdrawal/ infection/urine or fecal impacted
27
Post op delirium, agitated
Haloperidol to calm then ABG Not agitated: ABG always comes 1st
28
Post op delirium and abnormal movement eg dyskinesia
Extra pyramidal sx : not to give haloperidol, give risperidone or olanzapine instead
29
Delirium tremens suspect
Benzodiazepine IV best choice
30
Post op fluctuant mass at site of operation
I&D 1st IV abx 2nd Not sure abscess/deep infection: USG !
31
Atelectasis post op 1st step 2nd
1st Chest physiotherapy Incentive spirometry Deep breathing Active coughing 2nd O2 Postural drainage Nippv Bronchoscopy removal of mucus plug
32
Post op Pulmonary Embolism
Usually Day 5 onwards Acute Fever, tachycardia, pleuritic Chest pain,sob
33
Post op oliguria MCC
Hypovolemia : renal hypoperfusion Rx : fluid challenge *Look intraop event: blood txn etc
34
Spinal shock
Stepwise ABC Airway check ✔️ Oxygen 1st if low Trendelenburg: 📈 preload Fluid resuscitation IV : crystalloids
35
Knife in chest wall Based on hemodynamic status
ABC Removal in OT
36
Thoracotomy indication
Q20 critical care
37
Chest wall trauma
Vitals Tracheal deviation Percussion Breath Sound Pneumo Vs hemo Vs cardiac tamponade vs tension pneumothorax
38
Tension pneumothorax
Tracheal deviation away Hypotension Shock Rx: needle thoracocentesis
39
Compensated hemodynamics in sharp chest wall injury
Tamponade by the clots around the knife, need to remove in OT and insert chest tube
40
Cervical spine # unconscious, stable hemodynamic
RSI with intubation Cricothyroidotomy for facial injury, Tracheostomy also esp if prolonged ventilation anticipated * child <12 yrs crico ✖️
41
Hypovolemia shock
Supplemental Oxygen is a MUST To prevent tissue hypoxia Fluid resuscitation with 2L 1st, the consider blood txn ( case by case basis)
42
Post op SSRI withdrawal sx
Anxiety,headache,dizziness Nightmare,insomnia Flu like illness
43
BZD withdrawal post operative
Agitation, insomnia, anxiety & SENSORY disturbance to noise
44
Sucking chest wound (!Open chest wall wound)
3 way sealed wound cover with 1 way valve
45
Sucking wound open chest wall trauma
> 75% diameter of tracheal lumen will worsen pneumothorax +/- tension pneumothorax
46
Thoracotomy
•20ml/kg blood upon insertion of chest tube •3ml/kg/HR blood drain •Failed to correct BP with fluid resuscitation
47
Flail chest
Oxygen Pain ctrl CPAP Intubation if needed
48
Fat embolism
LL Long bone # 24-72 hr post trauma onset By order Lung: dyspnea, hypoxaemia 1st CNS: confusion,, convulsions skin: petechiae at torso
49
Ix for Fat embolism
Clinical diagnosis TRO others: CXR, ECG, CT scan HAP: 48 hrs but fever etc
50
Orbital floor #
*Anesthesia of the cheek Vertical diplopia Subconj hemorrhage Periorbital ecchymosis Enophthalmos Proptosis 1st due to edema then enophthalmos
51
Zygoma #
Diplopia: vertical/horizontal/oblique Enophthalmos Pain to open mouth Subconj hemorrhage *TMJ not affected!!!
52
Cushing's triad/Reflex
Hypertension Bradycardia Irregular breathing ( Cheyne Stoke breathing)
53
Doll eye reflex
Same side with head movement i.e brain stem involvement
54
Methylprednisolone IV
Raised ICP due to tumor/ abscess Spinal cord compression/shock
55
Spinal Shock
SS : areflexia, flaccid paralysis , sensory loss 2°to spinal cord trauma lasts few hrs to weeks
56
Neurogenic shock
NS: bradycardia, hypotension, poikilothermia due to sympathetic loss from T6 vertebrae above Warm peripheries Trendelenburg *
57
Lesion cervical injury above C5
Intubation needed
58
Ionotropic support in neurogenic shock ? Atropine
Oliguria despite fluid challenge <0.5ml/kg/hr. Atropine if severe bradycardia<40bpm
59
Lung contusion
Within 48 hrs, blunt trauma to chest Clinically indistinguishable Hypoxaemia with resp distress main concern Initially CXR : whitish, not seen early CT scan : more valuable Complication: ARDS & pneumonia
60
Burn injury with facial and neck involvement
O2 1st while preparing for Intubation !

AMC Key (11 decks)

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