EMERGENCY MED

Question 1

Differentials for fitting patient

Answer 1

Status epilepticus
Hypoglycaemia
Alcohol withdrawal
Electrolyte abnormalities - mainly hypos

Question 2

How does hypomagnesaemia cause seizure

Answer 2

Mg aids calcium channels - calcium channels needed for GABA release - loss of Mg = loss of calcium channel activity = loss of gaba = increase glutamate = seizure

Question 3

what is a coma

Answer 3

sleep like state where person is unresponsive to the environment (verbal commands and painful stimuli) and cannot be aroused

Question 4

Describe the presentation/ features of a coma

Answer 4

Eyes closed
Unresponsive to voice
Unresponsive to pain

Question 5

What is the pathology / anatomical basis of coma

Answer 5

Disturbance in the function of brainstem reticular activating system above the mid pons or of both cerebral hemispheres

Question 6

When can paracetamol levels be taken in suspected poisioning

Answer 6

4 hours

Question 7

How long does it take a paracetamol overdose to cause liver injury

Answer 7

Around 8 hours

Question 8

red flags for immediate NAC treatment in paracetamol overdose

Answer 8

> 150 mg/kg (8-12 g depending on weight)
Signs of liver or kidney injury, or encephalopathy
Staggered overdose <24 hours
Can’t get bloods back within 8 hours to start treatment

Question 9

How should you replace intravascular volume in haemorrhagic shock

Answer 9

250 ml crystalloid bolus (over 10-15 minutes) if needed whilst awaiting blood
Need RBC to replace volume

Question 10

What are the issues with using crystalloids in haemorrhagic shock

Answer 10

No replacement of cells to carry oxygen

No clotting factors

Question 11

What is included in a blood request for trauma

Answer 11

1 unit RBC, 1 unit platelets, 1 unit FFP (clotting factors)

Question 12

How should you manage oxygen replacement in a COPD patient

Answer 12

If critical - start oxygen, then take blood gas to check if chronic retainer - if they are then put on venturi - sats 88-93
If not critical - known chronic retainer - venturi

Question 13

What are the signs of a chronic retainer on a blood gas

Answer 13

High carbon dioxide 
High bicarb (because of long standing metabolic compensation)

Question 14

How should you take group and save bloods

Answer 14

Twice

2 separate occasions - 2 different people - 15 minutes apart

Question 15

what treatment do you give for worms

Answer 15

Mebendazole

Question 16

how are worms spread

Answer 16

Ingest eggs and then excrete eggs

Children get as they scratch bum then put hands in mouth or hold hands