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AMC Key > Emergency & Critical Care > Flashcards

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
Q

Incomplete Tetanus vaccine or none

A

Clean: dT/DPT age dependent, no TIG
Dirty :Give TIG + DPT together

26
Q

Delirium MCC

A

Hypoxia (1st) !!!
Others: electrolyte/glucose/alcohol wdrawal/ infection/urine or fecal impacted

27
Q

Post op delirium, agitated

A

Haloperidol to calm then ABG
Not agitated: ABG always comes 1st

28
Q

Post op delirium and abnormal movement eg dyskinesia

A

Extra pyramidal sx : not to give haloperidol, give risperidone or olanzapine instead

29
Q

Delirium tremens suspect

A

Benzodiazepine IV best choice

30
Q

Post op fluctuant mass at site of operation

A

I&D 1st
IV abx 2nd
Not sure abscess/deep infection: USG !

31
Q

Atelectasis post op
1st step
2nd

A

1st
Chest physiotherapy
Incentive spirometry
Deep breathing
Active coughing

2nd
O2
Postural drainage
Nippv
Bronchoscopy removal of mucus plug

32
Q

Post op Pulmonary Embolism

A

Usually Day 5 onwards
Acute Fever, tachycardia, pleuritic Chest pain,sob

33
Q

Post op oliguria MCC

A

Hypovolemia : renal hypoperfusion
Rx : fluid challenge
*Look intraop event: blood txn etc

34
Q

Spinal shock

A

Stepwise ABC
Airway check ✔️
Oxygen 1st if low
Trendelenburg: 📈 preload
Fluid resuscitation IV : crystalloids

35
Q

Knife in chest wall
Based on hemodynamic status

A

ABC
Removal in OT

36
Q

Thoracotomy indication

A

Q20 critical care

37
Q

Chest wall trauma

A

Vitals
Tracheal deviation
Percussion
Breath Sound
Pneumo Vs hemo Vs cardiac tamponade vs tension pneumothorax

38
Q

Tension pneumothorax

A

Tracheal deviation away
Hypotension
Shock
Rx: needle thoracocentesis

39
Q

Compensated hemodynamics in sharp chest wall injury

A

Tamponade by the clots around the knife, need to remove in OT and insert chest tube

40
Q

Cervical spine # unconscious, stable hemodynamic

A

RSI with intubation
Cricothyroidotomy for facial injury,
Tracheostomy also esp if prolonged ventilation anticipated
* child <12 yrs crico ✖️

41
Q

Hypovolemia shock

A

Supplemental Oxygen is a MUST
To prevent tissue hypoxia
Fluid resuscitation with 2L 1st, the consider blood txn ( case by case basis)

42
Q

Post op SSRI withdrawal sx

A

Anxiety,headache,dizziness
Nightmare,insomnia
Flu like illness

43
Q

BZD withdrawal post operative

A

Agitation, insomnia, anxiety & SENSORY disturbance to noise

44
Q

Sucking chest wound
(!Open chest wall wound)

A

3 way sealed wound cover with 1 way valve

45
Q

Sucking wound open chest wall trauma

A

> 75% diameter of tracheal lumen will worsen pneumothorax +/- tension pneumothorax

46
Q

Thoracotomy

A

•20ml/kg blood upon insertion of chest tube
•3ml/kg/HR blood drain
•Failed to correct BP with fluid resuscitation

47
Q

Flail chest

A

Oxygen
Pain ctrl
CPAP
Intubation if needed

48
Q

Fat embolism

A

LL Long bone #
24-72 hr post trauma onset
By order
Lung: dyspnea, hypoxaemia 1st
CNS: confusion,, convulsions
skin: petechiae at torso

49
Q

Ix for Fat embolism

A

Clinical diagnosis
TRO others: CXR, ECG, CT scan
HAP: 48 hrs but fever etc

50
Q

Orbital floor #

A

*Anesthesia of the cheek
Vertical diplopia
Subconj hemorrhage
Periorbital ecchymosis
Enophthalmos
Proptosis 1st due to edema then enophthalmos

51
Q

Zygoma #

A

Diplopia: vertical/horizontal/oblique
Enophthalmos
Pain to open mouth
Subconj hemorrhage
*TMJ not affected!!!

52
Q

Cushing’s triad/Reflex

A

Hypertension
Bradycardia
Irregular breathing ( Cheyne Stoke breathing)

53
Q

Doll eye reflex

A

Same side with head movement i.e brain stem involvement

54
Q

Methylprednisolone IV

A

Raised ICP due to tumor/ abscess
Spinal cord compression/shock

55
Q

Spinal Shock

A

SS : areflexia, flaccid paralysis , sensory loss 2°to spinal cord trauma lasts few hrs to weeks

56
Q

Neurogenic shock

A

NS: bradycardia, hypotension, poikilothermia due to sympathetic loss from T6 vertebrae above
Warm peripheries
Trendelenburg *

57
Q

Lesion cervical injury above C5

A

Intubation needed

58
Q

Ionotropic support in neurogenic shock ?
Atropine

A

Oliguria despite fluid challenge
<0.5ml/kg/hr.
Atropine if severe bradycardia<40bpm

59
Q

Lung contusion

A

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
Q

Burn injury with facial and neck involvement

A

O2 1st while preparing for
Intubation !

AMC Key (11 decks)

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