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Oishi's Final year flashcards > Emergency Med > Flashcards

Emergency Med Flashcards

1
Q

What GCS or below do we worry about airway compromise?

A

8 or below

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2
Q

What is the toxic dose of paracetamol?

A

75mg/kg

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3
Q

What bloods should be done at 4 hours post ingestion in paracetamol OD?

A 
VBG
INR
U&Es
LFTs
FBC
Paracetamol level
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4
Q

How long is the standard course of NAC?

A

21 hours

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5
Q

What 3 criteria do the bloods need to meet post NAC?

A

INR is 1.3 or less AND
ALT is less than two times the upper limit of normal AND
ALT is not more than double the admission measurement

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6
Q

What to do if a pt on warfarin is actively bleeding?

A

Stop warfarin
Give 5mg IV Vit K
IV prothrombin complex concentrate (octaplex)

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7
Q

What does Geriatric Admission Profile (GAPS) include?

A

U&E, FBC, LFT, glucose, CRP, calcium, B12 & folate, ferritin, iron and transferrin, TFT, vitamin D

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8
Q

Bamford stroke classification for TACS?

A 
Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)
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9
Q

Bamford stroke classification for PACS?

A

2 of 3 symptoms:
Unilateral weakness (and/or sensory deficit) of the face, arm and leg
Homonymous hemianopia
Higher cerebral dysfunction (dysphasia, visuospatial disorder)

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10
Q

What is a lacunar stroke?

A

Purely motor or sensory?

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11
Q

Mx of HTN in in the acute management of ischaemic stroke?

A 
Avoid tx unless any of the following:
hypertensive encephalopathy
hypertensive nephropathy
hypertensive cardiac failure/myocardial infarction
aortic dissection
pre-eclampsia/eclampsia
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12
Q

Causes of VF arrests?

A

Electrolyte abnormalities (hyperkalaemia, hypokalaemia, hypocalcaemia)
Toxins (particularly TCA od)
Hypothermia
Less commonly the other causes of cardiac arrest

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13
Q

What rhythm is seen in cardiac arrest?

A

PEA

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14
Q

What should be administered in cardiac arrest with non-shockable rhythm?

A

IV adrenaline

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15
Q

5Ds of Charcot’s foot?

A 
Density change (areas of lucency and sclerosis)
Destruction
Debris (loose bodies and bone fragments)
Distension (joint effusion)
Dislocation (e.g. metacarpophalangeal joints)
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16
Q

Gas gangrene abx?

A

Tazocin + clindamycin

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17
Q

Tx for orthostatic hypotension?

A

Fludrocortisone

Midodrine

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18
Q

What temp increase should we aim for in hypothermia?

A

1 degree rise per hour

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19
Q

What formula should be used for burns victims fluid requirement in first 24 hrs?

A

Parkland Formula
Fluid required in 1st 24 hr = 4ml x patients weight in kg x % burn
Half should be given in first 8 hours and remainder over 16 hours

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20
Q

When to catheterise burns patient?

A

Patients with burns >20% TBSA or intubated

Patients with perineal burns or 15-19% TBSA catheterisation should be considered

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21
Q

When to refer to burns unit?

A

Burns > 10 % TBSA in an Adult
Burns > 5 % TBSA in a Child
Full thickness burns > 5% TBSA
Burns of face, hands, feet, perineum, genitalia, and major joints
Circumferential burns
Chemical or electrical burns
Burns in the presence of major trauma or significant co-morbidity
Burns in the very young patient, or the elderly patient
Burns in a pregnant patient
Suspicion of Non-Accidental Injury

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22
Q

First aid for minor burns?

A

Hold under cool running water for 20mins

Wrap in cling film

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23
Q

What layers do superficial, partial and full thickness burns affect?

A

Superficial - epidermis
Partial thickness - dermis
Full thickness - underlying subcutaneous tissue

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24
Q

What should you do with blistered areas of a burn?

A

De-roof, dress with non-adherent dressing and review in 48 hours

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25
Which types of anaesthesia can cause malignant hyperthermia?
Volatile anaesthetic agents | Suxamethonium
26
CIs to lidocaine Tx?
SAN disease and all forms of AV block
27
How long does lidocaine take to work and wear off?
Few mins | Lasts 1-2 hours
28
MOA of lidocaine?
Local anaesthetics act on the smaller C fibres, which transmit pain and temperature sensation, before the larger A fibres, which transmit touch and power
29
Causes of prolonged QTc? (TIMMES)
Toxins: drugs including anti-arrhythmics, anti-psychotics, TCAs, macrolides Inherited: congenital long QT syndromes such as Romano-Ward and Jervell and Lange-Nielson syndromes. Ischaemia Myocarditis Mitral valve prolapse Electrolyte abnormalities, such as hypokalaemia and hypocalcaemia Subarachnoid Haemorrhage
30
Mx of DKA in hour 1 in adults?
A to E 1L 0.9% saline over 1 hour (if SBP <90 add STAT bolus 500ml in 15 mins) Fixed rate insulin infusion (0.1 units/kg/hr) AFTER commencing fluid
31
What needs to be checked hourly in DKA?
Blood/capillary glucose Blood/capillary ketones Observations including GCS AND continuous ECG
32
Fluid resuscitation in DKA in hours 2-12?
If K+ <5.5mmol/L add KCl 1L 0.9% saline + 40mmol KCl over 2 hours then 1L 0.9% saline + 40mmol KCl over 2 hours again then 1L 0.9% saline + 40mmol KCl over 4 hours then 1L 0.9% saline + 40mmol KCl over 4 hours again then 1L 0.9% saline + 40mmol KCl over 6 hours
33
Until when do you continue fixed rate insulin in DKA?
Blood ketones <0.3mmol/L AND pH >7.3 AND Bicarbonate >18mmol/L
34
Mx of DKA in hours 12-24?
Aim to have normal biochemical parameters If patient unable to eat and drink then start sliding scale insulin If able to eat and drink then restart subcutaneous insulin regimen - this will need some crossover with IV insulin.
35
Mx of HHS?
Fluid resuscitation Insulin at 0.05 units/kg/hour VTE prophylaxis
36
Fluid resuscitation in HHS?
``` Fluid of choice is 0.9% saline: 1L over 1-2 hours 1L (+KCl) over 2-4 hours 1L (+KCl) over 4-6 hours 1L (+KCl) over 6-8 hours 1L (+KCl) over 8-10 hours ```
37
What score is used prior to endoscopy in patients with an upper GI bleed?
Glasgow-Blatchford score | Any score >0 suggests medical intervention needed
38
What score is used after endoscopy in patients with an upper GI bleed? What is it used to estimate?
Rockall score | Used to estimate the risk of re-bleeding and the risk of mortality
39
Define AKI
increase in serum creatinine of 26 μmol/L within 48 hours increase in serum creatinine ≥1.5 times above baseline value within 1 week urine output of <0.5 ml/kg/hr for > 6 consecutive hours
40
antidote for anti-freeze?
Fomepizole
41
Damage to which vessels causes extradural haemorrhage?
Middle meningeal vessels
42
Damage to which vessels causes subdural haemorrhage?
Bridging veins
43
drug-induced pancreatitis causes? FATSHEEP
``` Furosemide Azathioprine/Asparaginase Thiazides/Tetracycline Statins/Sulfonamides/Sodium Valproate Hydrochlorothiazide Estrogens Ethanol Protease inhibitors and NRTIs ```
44
Contraindications to thrombolysis in MI? AGAINST
``` Aortic Dissection GI bleed Allergic reaction Iatrogenic: recent surgery Neurological disease: recent stroke (within 3 months), malignancy Severe HTN (>200/120) Trauma, including recent CPR ```
45
What common SE can doxycycline cause?
Oesophagitis
46
4 adverse signs of tachycardia?
Shock Sycope Heart failure Myocardial ischaemia
47
When can you immediately safely cardiovert in AF?
No adverse signs | Onset <48 hours
48
How long do patients need anticoagulation before and after cardioversion in AF?
3 weeks before | 4 weeks after
49
Which meds are CI in WPW?
Digoxin | Verapamil
50
What carboxyhaemoglobin concentration is diagnostic of carbon monoxide poisoning?
>20%
51
Beck's triad of cardiac tamponade?
Raised JVP Hypotension Muffled heart sounds
52
What is Kussmaul's sign?
Rise in JVP with inspiration
53
What is pulsus paradoxus?
Drop in SBP of about 15mmHg with inspiration
54
Aspirin od blood gas findings?
Initially respiratory alkalosis | Later metabolic acidosis
55
Features of unstable angina
Chest pain at rest or minimal exertion lasting >15 minutes ECG changes (new ST-depression or T wave inversion) NO rise in troponin: no myocardial necrosis
56
Features of NSTEMI
Chest pain at rest or minimal exertion lasting >15 minutes ECG changes (new ST-depression of T wave inversion) Rise in troponin: myocardial necrosis
57
Features of STEMI
Chest pain at rest or minimal exertion, lasting >15 minutes ECG changes (new ST-elevation or left bundle branch block) Rise in troponin: myocardial necrosis
58
Tx of bradycardia with HISS?
``` Atropine 500mcg IV Can repeat up to max of 3mg Isoprenaline 5mcg/min IV Adrenaline 2-10mcg/min IV or transcutaneous pacing ```
59
RFs for acute closed angle glaucoma?
Female Asian Use of antimuscarinics
60
Tx of acute closed angle glaucoma?
IV Acetazolamide and a topical beta-blocker such as Timolol
61
Causes of VT?
Electrolyte abnormalities such as hypokalaemia and hypomagnesaemia Structural heart disease including Myocardial infarction and HOCM Drugs that cause QT prolongation e.g. clarithromycin, erythromycin Inherited channelopathies e.g. Romano-Ward syndrome, Brugada syndrome
62
Occlusion of the LAD puts you at increased risk of what?
Rupture of interventricular septum
63
What times should mast cell tryptase be measured?
Initially 4hrs 12hrs
64
What would you expect to find with an optic neuritis?
RAPD | A relatively dilated pupil on the affected side when a torch light is swung towards it
65
Clinical features of central retinal vein occlusion?
sudden painless loss of vision | stormy sunset on fundoscopy
66
Clinical features of central retinal artery occlusion?
sudden painless loss of vision over a few seconds | pale retina and cherry red spot at macula on fundoscopy
67
Clinical features of Ischaemic optic neuropathy?
sudden onset monocular vision loss and colour blindness RAPD o/e fundoscopy - optic disc swelling in the acute phase or a pale optic disc in the chronic phase that suggests optic atrophy
68
Clinical features of Retinal detachment?
floaters and flashes followed by a 'curtain falling over' their vision pale-grey area of retina ballooning forward on fundoscopy
69
Clinical features of Vitreous haemorrhage?
If minor, patients complain of floaters, if severe, patients complain of painless loss of vision Common in diabetics Retina hard to view on fundoscopy
70
Clinical features of optic neuritis?
Painful loss of vision over hours to days Pain on moving eyes 'red desaturation' Common in MS
71
What to do if a pt has an anaphylactoid reaction to NAC?
Stop infusion | Give 10mg IV Chlorphenamine
72
universal donor of fresh frozen plasma?
AB RhD negative blood
73
When to discharge in anaphylaxis after symptom resolution?
Minimum 2 hours: 1 dose of adrenaline Minimum 6 hours: 2 doses adrenaline Previous biphasic response ``` Minimum 12 hours: >2 doses adrenaline severe asthma ongoing reaction possible patient presents late at night when A&E access difficult ```
74
What to give in potential tetanus exposure and unclear vaccine hx?
booster vaccine + immunoglobulin
75
King's College Hospital criteria for liver transplantation (paracetamol liver failure)?
Arterial pH < 7.3, 24 hours after ingestion or all of the following: prothrombin time > 100 seconds creatinine > 300 µmol/l grade III or IV encephalopathy
76
Indications for thoracotomy in haemothorax?
>1.5L blood initially or losses of >200ml per hour for >2 hours
77
3 things usually given in acute variceal bleed?
Blood products Terlipressin Empirical abx: Ceftriaxone
78
When to offer platelet transfusions?
platelet count of <30 x 10^9 with clinically significant bleeding platelet count < 100 x 10^9 with severe bleeding or bleeding at critical sites, such as CNS
79
Mx of epistaxis?
1. Pinch the cartilaginous (soft) area of the nose firmly for 20mins 2. Cautery if bleeding point visible 3. Packing (rapid rhino) 4. Sphenopalatine ligation in theatre
80
Flail chest mx?
Analgesia | Respiratory support - consider PPV

Oishi's Final year flashcards (10 decks)

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