Emergency Med

Question 1

Investigations in shock.

Answer 1

Bloods - FBC, U+E, glucose, ABG, CRP, trop. X-match and coag. 
Blood cultures. 
Urine MCS. 
ECG. 
CXR. 
USS. 
Echo. 
CT

Question 2

Specific measures for anaphylactic shock.

Answer 2

Adrenaline 0.5mg.
Hydrocortisone 220mg.
Chlorphenamine 10mg.
Salbutamol.

Question 3

Specific measures for cardiogenic shock.

Answer 3

Remedy arrhythmias and MI.

Consider dobutamine.

Question 4

Specific measures for septic shock.

Answer 4

Sepsis 6:
Oxygen. Fluids. Abx. Urine output. Lactate. Blood cultures.
Consider vasopressors eg norad.

Question 5

Specific measures for hypovolaemic shock.

Answer 5

Fluid replacements.
Titrate to urine output, CVP and BP.
Haemodialysis if ATN.

Question 6

Pathogenesis of anaphylactic shock.

Answer 6

Type 1 IgE mediated hypersensitivity reaction.
Th2 driven IgE production following primary exposure.
Biphasic response after re-exposure.

Question 7

Biphasic inflammatory response in anaphylactic shock.

Answer 7

Early phase - within minutes.
IgE cross linking - mast cell degeneration.
Histamine and tryptase release.
Lipid mediator synthesis - leukotrienes and prostacyclin = increased vascular perm and bronchial constriction.

Late phase - 2-24 hours.
Eosinophils release enzymes and stimulate mast cells.
Amplify and sustain the initial response.

Question 8

Common precipitants of anaphylaxis.

Answer 8

Drugs - penicillins, contrast media.
Food - peanuts, eggs, fish, semen.
Latex.
Stings.

Question 9

Anaphylaxis - presentation.

Answer 9

Sweating.
D/V.
Urticaria, itching, oedema.
Wheeze, laryngeal obstruction, cyanosis.
Tachycardia, hypotension.
Possible improvement then deterioration as late phase initiates.