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Acute Care and Emergencies > Emergency Management > Flashcards

Emergency Management Flashcards

1
Q

Anaphylaxis - Pathophysiology

A

Allergen exposure leads to Type 1 HS reaction (IgE mediated)

IgE cross-linking results in mast cell degranulation

Results in release of vasoactive mediators e.g. Histamine result in distributive shock

Lipid mediators e.g. leukotriene are released, resulting in bronchial constriction

Early phase: within minutes
Late phase: 2-24h (response sustains and amplified by eosinophils)

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2
Q

Anaphylaxis acute management

A
  • ABCDE Approach
  • Raise legs

IM Adrenaline 1:1000, 0.5ml
- Repeat every 5 mins if needed

  • Secure IV Access
  • Fluid bolus 0.9% NaCl

IV Drugs:

  • IV Hydrocortisone 10mg IV AND
  • IV Chloramphenicol 10mg IV

If wheezing:
- Salbutamol 5mg and Ipratropium 0.5mg nebulisers

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3
Q

Anaphylaxis discharge management

A
  • Give 2 epipens and teach how to use
  • Advise to wear a medic alert bracelet
  • Arrange OPD follow-up
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4
Q

Sepsis management

A

ABCDE

  • Airway
  • Breathing: give oxygen
Sepsis Six: to be done within 1 hour 
TAKE:
- Blood cultures
- Blood lactate 
- Measure urine output

GIVE

  • Oxygen (aim >94%)
  • Broad-spectrum Abx
  • Fluids

CALL FOR SENIOR HELP

Keep assessing and reassessing
May need a vasopressor e.g. noradrenaline

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5
Q

How long should clopidogrel be given after ACS?

A
  • STEMI: 1 month

- NSTEMI: 1 year

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6
Q

Mx of a patient with a high GRACE score?

A
  • Tirofiban

- Angioplasty ± PCI within 96h

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7
Q

Causes of severe pulmonary oedema

A

Cardiogenic causes

  • MI
  • Arrhythmia
  • Iatrogenic fluid overload
  • Renal fluid overload

Non-cardiogenic causes

  • ARDS
  • Upper airway obstruction
  • Head injury
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8
Q

How to manage cardiogenic shock?

A
  • Sit the patient up
  • 100% O2 via non-rebreathe mask
  • Diamorphine 5.2-5mg IV + metoclopramide 10mg IV
  • Correct any underlying causes
  • Consider dobutamine
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9
Q

Causes of cardiogenic shock

A

Cardiac causes: MI HEART

  • MI
  • Hyperkalaemia
  • Endocarditis
  • Aortic dissection
  • Rhythm disturbances
  • Tamponade

Non-cardiac causes:

  • Tension pneumothorax (compressing mediastinum)
  • Massive PE
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10
Q

How to manage meningitis?

A
  • Look for features of meningitis vs meningococcal septicaemia
  • Do Sepsis 6

Mainly Meningitis

  • Do LP if no contraindications
  • Give IV Dexamethasone 0.15mg/kg QDS
  • IV Ceftriaxone after LP

Mainly Meningococcal Sepsis

  • Do not do LP
  • IV Ceftriaxone

Household contacts: Rifampicin

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11
Q

Contraindications to LP

A
  • Where it will delay Abx
  • Infection over the puncture site
  • Raised ICP
  • Thromobocytopenia or bleeding disorders
  • Haemodynamically unstable
  • Focal neurological signs
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12
Q

Encephalitis - Ix

A

Bloods: FBC, U+Es, cultures, viral PCR

Contrast CT head: bilateral focal temporal involvement suggests HSV

LP: if no contraindications (viral PCR)

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13
Q

Encephalitis mx

A
  • Once suspected give IV ACICLOVIR STAT for 14 days

- Phenytoin for seizures

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14
Q

Features of raised ICP

A
  • Headaches (worst in morning)
  • Vomiting
  • Seizures
  • Pupils go from constricted to dilated
  • Cheyne-Stokes breathing
  • Cushing’s triad: High BP, Low HR and irregular breathing
  • Papilloedema
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15
Q

Management of raised ICP

A
  • ABCDE approach
  • Ventilation (aim for PaO2 >13 and PaCO2 <4.5)
  • Sedation
  • Can give IV mannitol or hypertonic saline (these provide short term reduction in ICP but there can be rebound rise in ICP)
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16
Q

How does tonsillar herniation present?

A
  • CN6 palsy
  • Upgoing plantars
  • Irregular breathing
  • Apnoea
17
Q

How does transtentorial herniation present?

A
  • Ipsilateral CN3 palsy

- Contralateral hemiparesis

18
Q

How does subfalcine herniation present?

A
  • Compression of ACA – STROKE
19
Q

How to manage an acute asthma attack?

A
  • Sit up
  • 100% O2 via non-rebreathe mask
  • Nebulisers 5mg salbutamol and 0.5mg ipratropium
  • Oral prednisolone or IV hydrocortisone
  • Keep assessing

If severe:

  • contact ITU
  • IV MgSO4 2g over 20 mins
  • Salbutamol nebulisers every 20 mins — keep monitoring ECG

If still no imporvement:

  • Aminophylline: 5mg loading dose followed by infusion
  • Transfer to ITU for invasive ventilation
20
Q

When can someone be discharged after acute asthma attack?

A
  • When PEFR >75%
  • Diurnal variation <25%
  • Been stable on discharge meds for 24h
21
Q

Discharge and long-term management post-asthma attach

A
  • Inhaler technique
  • Review asthma management plan - Discharge with 5-7 days oral prednisolone
  • See GP within 1 week
  • See in respiratory clinic within 1 month
22
Q

Blood gases in asthma

A
  • Respiratory alkalosis: due to high RR

- Arrange transfer to ITU if there is hypoxia or raised CO2 as this indicates exhaustion

23
Q

Mx of IECOPD

A
  • Sit up
  • 24% O2 via Venturi mask - aim 88-92%
  • Nebulisers: salbutamol 5mg/6h and Ipratropium 0.5mg/4h (monitor ECG)
  • IV hydrocortisone + Prednisolone PO
  • Abx
  • Monitor ABGs and contact ICU for NIV if increasingly acidotic
24
Q

Mx of PE

A
  • Once PE is suspected, give LMWH
  • 100% O2
  • Morphine + metoclopramide

Haemodynamically unstable
- Thrombolysis (alteplase) + UFH

Haemodynamically stable:
Calculate Well’s score

High Wells score:
- CTPA

Low-medium Wells score:

  • Measure D-dimer
  • D-dimer -ve – no PE
  • D-dimer +ve – CTPA

Once PE is confirmed:

  • Give warfarin
  • Continue LMWH until INR 2-3 and at least for 5 days
  • TEDS
25
Q

How long to continue therapy post-PE

A
  • Remedial cause: 3 mo LMWH
  • Non-remedial cause: 6mo LMWH
  • Ongoing cause: indefinitely
26
Q

Mx simple pneumothorax

A
  • Sit up
  • 100% O2
  • Morphine + Metoclopramide

Primary PTX
<2cm - discharge and repeat CXR
>2cm - aspirate

Secondary PTX
<2cm - aspirate
>2cm - insert chest drain

27
Q

Mx tension pneumothorax

A
  • Sit up
  • Insert large bore cannula into 2nd ICS, MCL
  • Insert chest drain
  • O2
28
Q

What are the indications for dialysis in AKI?

A
  • Acidosis: ph < 7.2
  • Electrolyte disturbance: K >7
  • Intoxication: lithium, aspirin, methylene glycol
  • Overload: pulmonary oedema
  • Uraemia: encephalopathy, pericarditis
29
Q

Benzodiazepine OD

Hx and Mx

A
  • Respiratory depression
  • Reduced GCS
  • Tx: flumenazil
30
Q

B-blockers OD

Hx and Mx

A
  • Severe bradycardia
  • Hypotension
  • Tx: Atropine
31
Q

Cyanide poisoning

Hx and Mx

A
  • Smell of almonds
  • Anxiety and confusion
  • Then change in pulse
  • Then fits and coma

Tx: Dicobalt edentate

32
Q

Digoxin toxicity

Hx and Tx

A
  • Reduced GCS
  • Nausea and vomiting
  • Visual halos (yellow/green)
  • Arrhythmias (typically SVT or AV block)

Measure levels 8-12h since last dose

Tx: Digibind + correct arrhythmias

33
Q

Ethylene glycol poisoning

Hx and Tx

A
  • Found in antifreeze
  • Confusion and slurred speech
  • Metabolic acidosis with high anion gap and high osmolality gap
  • AKI

Management

  • Fomepizole
  • Haemodialysis
34
Q

Lithium poisoning

- Hx and Tx

A
  • Ataxia
  • Coarse tremor
  • Confusion
  • Polyuria
  • Renal failure

Tx: saline

35
Q

Opiate poisoning tx

A

Naloxone

36
Q

TCA OD

Hx and Tx

A
  • Long QT
  • Torsades de points
  • Metabolic acidosis
  • Anticholinergic effects

Tx

  • activated charcoal
  • IV sodium bicarbonate
37
Q

Warfarin overdose - Tx

A
  • Vitamin K

- FFP

38
Q

Aspirin OD presentation and tx

A
  • Respiratory alkalosis + Metabolic acidosis
  • Vomiting
  • Dehydration
  • Vertigo

Tx
- if <1h since ingestion: activated charcoal

39
Q

Paracetamol OD Tx

A
  • if within 1h, activated charcoal
  • Measure INR
  • NAC if above line on graph

Acute Care and Emergencies (1 decks)

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