Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 6 > Emergency Med > Flashcards

Emergency Med Flashcards

1
Q

You are called to a situation of anaphylaxis, how do you proceed?

A

ABCDE Approach
- assess, is this life threatening needing senior input?

Lie them down, put their legs up, Call for help

Adrenaline 500mcg 1:1000 IM (adult) - if had epipen may be enough or need 2nd dose

IV Fluids: 500ml-1L

IV Chlorphenaramine 10mg

IV hydrocortisone 200mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

when are iv fluids given in anaphylaxis? how much to give and which?

A

fluid if hypotension does not rapidly respond to adrenaline.

Rapid infusion of 1–2L IV 0.9% saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What situation during ABCDE indicate life threatening situation needing seniors?

A

From Resus council:

Airway: Swelling, hoarseness, stridor

Breathing: Tachypneoa, wheeze, cyanosis, fatigue, sats <92, confusion

Circulation: Pale, clammy, drowsy/coma, hypotension,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what do we do in the following situations:

  • profound shock or immediately life-threatening situations,
A
  1. Give CPR/Advanced Life Support (ALS) as necessary
  2. Consider slow IV adrenaline 1:10,000 or 1:100,000 solution.
  3. Glucagon 1–2mg intramuscular (IM)/IV every 5min
    • If no response to adrenaline

->This is recommended only for experienced clinicians who can also obtain immediate IV access.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the key bits of info iewth chest compressions?

A

Press down to depress the sternum 5–6cm.
• Release all the pressure and repeat at a rate of 100–120/min.
• Compression and release phases should take the same time.
• Use a ratio of 30 chest compressions to two ventilations (30:2).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which are the shockable rhythms?

what is the importance of a pulse?

A

Ventricular fibrillation (VF)/ventricular tachycardia (VT)

patients with pulseless VT/VF: give a single precordial thump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

best airway to use?

A
  1. Gold standard - Tracheal intubation
    - only attemptif experienced
    - End-tidal CO2 monitoring to confirm correct placement
  2. Supraglottic airway
    - igel, LMA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

which are the Non-shockable rhythms?

management?

A

PEA and asystole

Mx:
Continue CPR
Give adrenaline every 3-5 mins (asystole)

asystole has very poor prognosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List some measures by which to detect an unwell/ septic patient?

what do they entail?

which scores can indicate sepsis?

A 
NEWS2;
- systems that alert to deteriorating adult patients in hospital
• RR.
• SpO2.
• Systolic BP.
• Pulse rate.
• Level of consciousness or new confusion (delirium).
• Temperature.
- score 5+ = consider sepsis

qSOFA;
- septic organ failure assessment
• RR ≥22 breaths/min.
• Systolic BP ≤100mmHg.
• Altered mental state (lower GCS than usual).
- score 2+ = increased risk of death or ITU stay. Act fast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

components of the sepsis 6 bundle?

A

All must be done within 1 hour:

  1. Call seniors
  2. O2 100%
  3. IV access (2 large bore) - blood cultures, UEs, clotting, lactate, glucose, FBC, CRP
  4. IV antibiotics - Piptazobactam + Gentamicin (dep. local)
  5. IV fluids, 20-30kg/kg
  6. Monitor; blood lactate measurement, urine output
  • may need to start vasopressors (such as a noradrenaline infusion) for persistent hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

how do we manage neutropaenic sepsis?

A

giving broad-spectrum antibiotics according to local protocols—an example of one regime is:

  • Piperacillin–tazobactam IV 4.5g every 8hr or
  • If penicillin-allergic: ceftazidime IV 2g every 8hr.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

define sepsis

define shock

A

Sepsis occurs when life-threatening organ dysfunction is associated with infection.

Shock is circulatory failure resulting in inadequate perfusion and oxygenation of organs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

clinical features of shock?

A

Defined by;
1. low bp— systolic <90mmHg or
mean arterial pressure (map) <65mmHg

  1. with evidence of tissue hypoperfusion;
    eg mottled skin,
    urine output (uo) of <0.5mL/kg for 1 hour,
    serum lactate >2mmol/L

• Poor peripheral perfusion: cool peripheries, clammy/sweaty skin, pallor, and ↓ capillary return

  • Tachypnoea.
  • Purpuric rash.
  • Oliguria: ↓ renal perfusion with urine output <50mL/hr (in adults
  • Altered consciousness and/or fainting
  • Hypotension:
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

how do we approach shock generally

A

ABCDE approach

O2

Bloods - inc glucose and lactate, cultures if needed

ABG, ECG (hypoxia?), CXR

Monitor urine output hourly - catheter

Iv fluids - 0.9% saline, if low volume shock

Ivx & Treat underlying cause of shock eg ECG, Echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How do you approach a patient with Burns injury?

A

Check: Airway, Breathing, and Circulation

Particular problems associated with burns are:

  • Airway burns: suggested by hoarseness, stridor, dysphagia, facial and mouth burns, singeing of nasal hair, soot in nostrils or on palate.
  • Spinal injury: particularly seen with blast injuries and in those who have jumped from buildings to escape fire.
  • Breathing problems: contracting full-thickness circumferential burns (‘eschar’) of the chest wall may restrict chest movement.
  • Circulatory problems: hypovolaemic shock is a feature of severe burn

Then take a history

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the components of assessing a burn?

A

Assess the:

Extent - 9% etc
Depth - full/partial thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you manage a burn?

A

ATLS protocols !!!
Deal with shock before thinking about burns

  1. Airway and cervical spine protection
    - high flow o2, c-spine immobilisation if needed
    - intubation if impending obstruction
  2. IVs
    - 2 large bore grey cannulas
    - Take bloods
    - IV Morphine sulphate (pain), IV Cyclizine (antiemetic)
  3. IV Fluid resus
    - 0.9% saline
    - follow local guides, may request colloid
    - burns >10% may ned red cells
  4. Breathing
    - check COHb, get CXR, escharotomy?
  5. Burns
    - Cover the burn with cling film or dry sterile sheets
    - Call burns specialist (ie dont start burns dressing yet)
    - Tetanus prophylaxis

Note: no mention of abx!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

causes of cyanide poisoning and treatment?

A

burnt plastic furniture in a house fire

Mx: give an appropriate antidote, eg dicobalt edetate

19
Q

what are the Clinical features of smoke inhalation injury?

A

After exposure to smoke or fire in an enclosed space;

  • confusion or altered/loss of consciousness
  • oropharyngeal burns,
  • hoarseness/loss of voice, singed nasal hairs,
  • soot in nostrils or sputum, wheeze,
  • dysphagia, drooling or dribbling, and stridor.
20
Q

How do we ivx smoke inhalation injury ?

A

ABG - Hypoxia, hypercapnia, and acidosis
CXR - ARDS may develop

COHb - as SPO2 doesn’t detect CO poisoning
ECG - arrhythmias, ischaemia, or even MI

21
Q

How do we mx smoke inhalation injuries?

A

Secure airway
High flow humidified O2
Salbutamol for bronchospasm

IV fluids
Treat cyanide poisoning

22
Q

For simple burns, when do we consider escalation?

A

Refer patients (to a burns specialist eg regional burns unit) with the following:

  • Airway burns.
  • Significant full-thickness burns, especially over MAJOR joints.
  • Burns >10%.
  • Significant burns of special areas (hands, face, perineum, feet).

perhaps:
in pregnant patients, chemical/electrical ones

23
Q

what are the sx of CO poisoning?

A

Early features are headache, malaise, nausea, and vomiting

(sometimes misdiagnosed as a viral illness or gastroenteritis, especially if several members of a family are affected).

If severe:
coma with hyperventilation, hypotension,
↑ muscle tone, ↑ reflexes, extensor plantars, and convulsions.
Cherry-red colouring of the skin may be seen when dead

24
Q

List some complications of CO poisoning?

A

Cardiovascular - such as myocardial ischaemia, infarction, dysrhythmias, and cardiac arrest, MI.

Neurological symptoms include acute stroke-like symptoms, altered mental status, confusion, coma, and syncope.

MSK - Rhabdomyolysis

25
Q

Management of CO poisoning?

A

• Clear the airway and maintain ventilation with as high a concentration of O2 as possible.

  • ECG —arrhythmias and signs of acute MI.
  • VBG or ABG—SpO2 - acidosis

• COHb levels
- COHb >20% - serious poisoning.

• Correct metabolic acidosis by ventilation and O2—try to avoid bicarbonate, which may worsen tissue hypoxia.

  • Consider mannitol if cerebral oedema is suspected.
  • Hyperbaric O2 therapy is logical, but of no proven benefit for CO poisoning.
26
Q

how do we mx salicylate poisoning?

A

Mild: discharge if normal vbg

Moderate:
within 1 hour - activated charcoal/
sodium bicarbonate

Severe: haemodialysis/haemodiafiltration

27
Q

What is the difference between 2nd and 3rd degree burns?

A

2nd - has sensation, blanches

3rd - doesnt do the above, is leathery and dry

28
Q

how do we calculate fluid requirement in burns patient in first 24 hrs?

A

4ml x patient weight kg x % burn

give half in first 8 hrs

29
Q

what are the causes of sepsis?

A

Common;

  • Staphylococcus aureus
  • Enterobacteriaceae e.g. Escherichia coli, Klebsiella sp., Enterobacter sp.,
  • Pseudomonas sp.
  • Neisseria meningitidis
30
Q

what do NEWS scores mean?

A
  • Low risk (aggregate score 1 to 4) – prompt assessment by ward nurse to decide on change to frequency of monitoring or escalation of clinical care.
  • Low to medium risk (score of 3 in any single parameter) – urgent review by ward-based doctor to determine cause and to decide on change to frequency of monitoring or escalation of clinical care.
  • Medium risk (aggregate score 5 to 6) – urgent review by ward-based doctor or acute team nurse to decide on escalation to critical care team.
  • High risk (aggregate score of 7 or over) – emergency assessment by critical care team, usually leading to patient transfer to higher-dependency care area.
31
Q

How do you figure out the type of shock going on?

A

Cold and clammy suggests cardiogenic shock or Hypovolaemic shock.

Raised jvp - cardiogenic shock

Signs of anaemia or dehydration, eg skin turgor, postural hypotension? Abdomen; trauma, bleed, aneurysm - Haemorrhagic shock

Warm and well perfused, with bounding pulse points to septic shock.

Any features suggestive of anaphylaxis—history, urticaria, angio-oedema, wheeze? - anaphylactic shock

32
Q

how do we mx haemorrhage shock?

A

Depends on ATLS classification 1-4

Stop bleeding if possible.

• If still shocked despite 2L crystalloid or

present with class III/IV shock (1.5L+ loss) then crossmatch blood (request O Rh–ve in an emergency)

• Give FFP alongside packed red cells (1 : 1 ratio) and aim for platelets >100 and fibrinogen >1.

Discuss with haematology early.

33
Q

how do we mx hypovolaemic shock?

A

Identify and treat underlying cause.

Raise the legs.

• Give fluid bolus 10–15mL/kg crystalloid
- if shock improves, repeat,
• If no improvement after 2 boluses, consider referral to icu.

34
Q

causes of tamponade?

A

Trauma, lung/breast cancer, pericarditis, myocardial infarct, bacteria, eg tb.

coronraty artery dissection
ventricular rupture

35
Q

signs and sx of tamponade?

A

↓bp, ↑jvp, and muffled heart sounds (Beck’s triad);

↑jvp on inspiration (Kussmaul’s sign);

pulsus paradoxus (pulse fades on inspiration).

Echocardiography may be diagnostic. cxr: globular heart; left heart border convex or straight; right cardiophrenic angle <90°.

ecg: electrical alternans - alternating amplitude of qrs

36
Q

how do we manage NCT which is AF?

A

If NCT is irregular, manage as AF by far the most likely diagnosis;

• Control rate with:
o • β‎-blocker: eg metoprolol IV
o • rate-limiting Ca2+-channel blocker eg Verapamil 5–10mg iv

  • digoxin is an alternative in heart failure PO
  • Consider anticoagulation with warfarin or noac to ↓ risk of stroke.
  • Synchronised DC cardioversion - If onset definitely <48h, or if effectively anticoagulated for >6wk.
37
Q

complications of pneumonia?

A

Respiratory failure

Hypotension

Atrial fibrillation

Pleural effusion

Empyema

septicaemia, pericarditis, myocarditis, cholestatic jaundice, acute kidney injury.

38
Q

types of respiratory failure and mx?

A

(See p[link].) Type I respiratory failure (PaO2 <8kPa) is relatively common. Treatment is with high-flow (60%) oxygen.
Transfer the patient to itu if hypoxia does not improve with O2 therapy or PaCO2 rises to >6kPa.

Be careful with O2 in copd patients; check abgs frequently, and consider elective ventilation if rising PaCO2 or worsening acidosis. Aim to keep SaO2 at 94–98%, PaO2 ≥8kPa.

39
Q

list the causes of bradycardia

A
  1. Drug-induced:
    • β‎-blockers, amiodarone, verapamil, diltiazem, digoxin.
  2. Non-cardiac origin:
    • Vasovagal—very common (p[link]).
    • Endocrine—hypothyroidism, adrenal insufficiency.
    • Metabolic—hyperkalaemia, hypoxia.
    • Other—hypothermia, ↑icp (Cushing’s triad: bradycardia, hypertension, and irregular breathing -> Emergency).
  3. Physiological: athletes.
  4. Cardiac:
    • fibrosis of conduction pathways
    • Post-mi
    • Sick sinus syndrome
    • Iatrogenic—ablation, surgery.
    • Aortic valve disease, eg infective endocarditis
    • Myocarditis, cardiomyopathy, amyloid, sarcoid, sle.
40
Q

how do we manage problemativc bradycardia

A

IV Atropine 500mcg
- if risk of asystole or no adverse signs

If no response:
Repeat above every 3-5mins
Call anaesthetist for transcutaneous pacing
Give Adrenaline/Isoprenaline whilst waiting

If none of above:
Observe

41
Q

how to manage CO poisoning (carbon monoxide)

A

Give 100% O2 until COHb <10%. Metabolic acidosis usually responds to correction of hypoxia. If severe, anticipate cerebral oedema and give mannitol ivi

42
Q

which types of ventilation are indicated in pulmonary oedema, covid and copd?

A

cpap – pulmonary oedema, covid

bipap aka non invasive ventilation – COPD

43
Q

A patient who has 2nd degree heart block. Eventually their hr slows and bp drops and they become brardycardic. treatment?

A

Atropine wont work because of the heart block.

Give transcutaneous pacing.

Year 6 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions