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4th Year > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

what is the primary survey

A

ABCDE

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2
Q

what are signs of airway obstruction

A

look for chest movement and assess airflow from nose and mouth
snoring, stridor, added noises, gurgling, paradoxical movement

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3
Q

what does snoring show

A

inspiratory obstruction

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4
Q

what does stridor show

A

inspiratory obstruction

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5
Q

what does wheeze show

A

lower respiratory tract obstruction

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6
Q

what does gurgling suggest

A

obstruction due to secretions/ blood

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7
Q

what does hoarseness show

A

oedema of chord- shows impending obstruction in burns pts

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8
Q

what does paradoxical movement suggest

A

complete airway obstruction: chest wall drawn in and abdomen expands when attempting to breath
accessory muscle use, intercostal recession and tracheal tug can be present in all forms of airway obstruction

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9
Q

what are the options for airway management

A

IF YOU HAVE CONCERN ABOUT THE AIRWAT SEEK SENIOR HELP IMMEDIATLEY
head tilt chin lift
in trauma jaw thrust (if worried about C spine)
suction (secretions), magills forceps (debris)
adjunct: NPA, OPA
endo tracheal tube
surgical airway

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10
Q

what are the primary breathing interventions

A

Bag valve mask
non rebreather mask
non invasive ventilation
mechanical ventilation

other: nebs, abx. needle decompression, chest drain, naloxone (depends on cause)

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11
Q

where is a chest drain inserted

A

4/5th intercostal space just anterior to the mid axillary line

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12
Q

what should you assume a patient to be when in shock

A

bleeding- look floor, abdo, pelvis, chest, long bones

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13
Q

what are the possible interventions within C

A 
2 orange/ grey cannulas for IV fluids/ RBC if bleeding 
pelvic binder, splints 
tranexamic acid 
permissive hypotension (to try and not disrupt fromed clots to prevent bleeding) 
inotropes for septic shock (alongside abx)
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14
Q

what fluid for shocked patients

A

crystalloid IV fluids: 0/9 NaCl or Hartmanns

boluses of 250-500ml of warmed 0.9% nacl should be given with A-e following each bag

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15
Q

what is included in D

A

AVPU
GSC
pupils (reactivity and equality- may show lateralisation)
glucose

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16
Q

what is cushings response

A

decreased Hr and incresed BP decreased RR response to decreased cerebral perfusion due to raised ICP

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17
Q

what are the components and minimum score of the GCS

A 
minimum 3 (unresponsive) 
eye response (max 4, min 1: 4 spontaneous, 3 sound/speech, 2 firm pressure, 1 no response) 
verbal response (max 5 min 1: 5 orientated, 4 confused conversation, 3 inappropriate words, 2 incomprehensible sounds, 1 no response) 
motor response (for best response, use best limbs, above level of injury, max 6 min 1: 6 obeying commands, 5 localising a pressure stimulus (purposeful movements towards stimuli), 4 normal flexion to pressure stimulus, 3 abnormal flexion to pressure stimulus, 2 extension to pressure stimulus, 1 flaccid, no response)
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18
Q

what treatment for seizures

A

lorazepam

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19
Q

treatment for low glucose

A

10% dextrose bolus 200ml

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20
Q

what is E

A

exposure: trauma, pressure areas, cellulitis

measure temp and maintain

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21
Q

what are the red flags for headaches

A

first and worst, thunderclap (SAH)
unilateral with eye pain (cluster HA, acute glaucoma)
unilateral HA with ipsilateral symptoms (migraine, tumour, vascular)
cough initiated, worse in morning/ bending over (increased ICP, venous thrombosis)
persisting HA with scalp tenderness (GCA)
fever or neck stiffness (meningitis)
change in the pattern of ‘usual’ HAs
decreased consciousness

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22
Q

what should you worry about in HA in pregnancy

A

pre-eclampsia

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23
Q

what causes of HA might have signs of meningism

A

meningitis, SAH

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24
Q

what causes of HA may have no signs on examination

A

tension,migraine, cluster, post traumatic, drugs, CO poisoning, anoxia, SAH

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25
Q

what causes of HA may have decreased consciousness

A 
stroke
encephalitis/meningitis
cerebral abscess
SAH 
venous sinus occlusion 
tumour
subdural haematoma
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26
Q

what causes of HA can cause papilloedema

A 
tumour 
venous sinus occlusion 
malignant 
IIH
CNS infections present for >2 weeks
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27
Q

what can cause wheezing

A

asthma, COPD, HF, anaphylaxis

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28
Q

what can cause stridor

A

foreign body/ tumour
acute epiglottitis
anaphylaxis
trauma

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29
Q

what can cause crepitations

A

HF
pneumonia
bronchiectasis
fibrosis

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30
Q

what causes of breathlessness can have a clear chest on examination

A 
PE 
hyperventillation 
metabolic acidosis (DKA)
anaemia 
drugs 
shock
pneumocystis jivorecii 
CNS causes
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31
Q

what will be found on percussion in a pleural effusion

A

stony dullness

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32
Q

what are the life threatening causes of chest pain

A 
MI
ACS
Aortic dissection 
tension pneumothorax 
oesophageal rupture
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33
Q

what is a coma

A

state on unrousable unresponsiveness

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34
Q

what is the immediate management for a patient in a coma

A

ABCDE
protect cervical spine if trauma
examine and collateral Hx to find cause

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35
Q

what treatment for wernickes encephalopathy

A

pabrinex (thiamine) IV

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36
Q

what antibiotic for meningitis

A

if in community give Benpen/ cefotaxine/ ceftriaxone

in hospital ceftriaxone/ cefotaxime

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37
Q

what tx for enceophalitis

A

aciclovir

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38
Q

what is the decorticate position

A

arms flexed into chest, thumb in clenched fist

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39
Q

where is the damage if decorticate position present

A

above level of red nucleus in the midbrain

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40
Q

what is the decerebrate position

A

extended arms- pronated forarms by sides, adducted and internally rotated shoulders,

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41
Q

where is the damage in decerebate posture

A

below level of red nucleus in the brain

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42
Q

what is shock

A

circulatory failure causing hypoperfusion

systolic bp <90/ MAP <65 with evidence of tissue hypoperfusion (mottled skin, low urine output, lactate >2)

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43
Q

how do you calculate MAP

A

CO x SVR

CO= SV x HR

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44
Q

what can cause cardiogenic shock

A

ACS, arrythmias, AD, acute valve failure, secondary causes: PE, tension pneumothorax, cardiac tamponade)

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45
Q

what can cause loss of Systemic vascular resistance

A 
sepsis 
anaphylaxis 
neurogenic (spinal cord injury, epidural, spinal anaesthetic) 
endocrine (addisons, hypothyroidism) 
drugs
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46
Q

what does a raised JVP in shock show

A

cardiogenic shock likely

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47
Q

what does a difference in BP between arms mean

A

aortic dissection

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48
Q

how do you treat hypovolaemic shock

A 
treat underlying cause 
fluid bolus (10-15ml/kg crystalloid via large peripheral line, if improved repeat)
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49
Q

tx for haemorrhagic shock

A

stop bleeding if possible
give up to 2l crystalloid then crossmatch bloods if still in shock
five FFP with red cells
consider tranexamic acid

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50
Q

what is septic shock

A

sepsis + lactate >2 despite fluid resus or requirement of vasopressors to maintain MAP >65

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51
Q

what is the management of sepsis

A

B- blood cultures
U- urine output monitoring
F- 500ml boluses of crystalloids (saline) over 15 mins. get senior help after 2 boluses
A- broad spectrum Abx within 1 hr
L- blood gas for lactate
O- oxygen
get senior help after 1 hr if still not improving

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52
Q

management for anaphylactic shock

A 
secure airway, give 100% 02 
remove cause
raise feet to help circulation 
IM 0.5mg adrenaline repeat every 5 mins 
IV chlorphenamine and hydrocortisone 
fluids (saline) 
if wheeze treat as for asthma) 
measure tryptase 1-6 hours after suspected anaphylaxis
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53
Q

what are the life threatening causes of cardiac chest pain

A

MI, AD, PE

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54
Q

what are the urgent causes of cardiac chest pain

A

unstable angina, coronary vasospasm, pericarditis, myocarditis

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55
Q

what is the life threatening GI cause of chest pain

A

oesophageal rupture

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56
Q

what is an urgent GI cause of chest pain

A

pancreatitis

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57
Q

what scoring systems show cardiac risj

A

TIMI: stemi risk score
GRACE: patients with ACS determine their mortality in hospital

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58
Q

what scoring system for PE

A

well: suspected PE

PERC : PE rule out criteria

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59
Q

what are the abdominal causes of SOB

A

ascites, obesity, pregnancy

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60
Q

what are the common causes of resp acidosis

A

severe asthma, pneumonia, hypoventilation

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61
Q

what are the causes of respiratory alkalosis

A

hyperventilation, panic attack, salicylate poisoning

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62
Q

metabolic acidosis causes

A

DKA, lactic acidosis, alcohol

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63
Q

what are the causes of metabolic alkalosis

A

severe vomiting, loss of potassium

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64
Q

what symptoms should you include in an abdo pain history

A

(normal) + urinary, gynae and GUM

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65
Q

what is important to include in a head injury history

A 
mechanism 
LOC 
vomiting 
visual disturbances 
associated injuries 
seizure 
amnesia 
bleeding risk
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66
Q

what is in a head injury exam

A 
ABCDE 
GCS 
pupils 
ears 
external signs of head injury 
neurological examination 
cervical spine
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67
Q

what in trauma can cause a 3rd nerve palsy

A

CN3 nerve palsy- raised ICP

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68
Q

what are the signs of a base of skull #

A

haemotympanum, CSF leak, panda raccon eyes, battles signs

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69
Q

what is cushings triad

A 
an increase in ICP results in a decrease in cerebral blood flow- to over come the BP arterial pressure will increase 
cushings triad: 
-hypertension 
-bradycardia 
-irregular breathing
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70
Q

when should you do a cervical spine CT in HI patients

A

GCS less than 13

patient intubated

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71
Q

describe an extradural haemtoma

A

bleedinf between skull and outer layer of dura due to rupture of middle meningeal artery, happens in young peoepl: brief LOC, lucid interval then reduced GCS

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72
Q

describe a subdural haematoma

A

blood between dura and arachnoid matter, insidious onset in the elderly, reverse warfarin and evacuate the clot

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73
Q

what can cause inverted T waves

A

ischaemia, PE, BBB, raised ICP

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74
Q

treatment for STEMI

A

300mg aspirin ASAP, morphine, O2 if needed, GTN
if within 12 hours and can be given in 2 hours: PCI, give prasugrel and heparin
If within 12 hours but PCT not possible in 2 hours: fibrinolysis (streptokinase/ alteplase) and fondaparinux/ clopidogrel if already on AC

medical management (>12 hours): tricagrelol and consider clopidrel with aspirin

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75
Q

NSTEMI management

A

300mg aspirin
fondaparinux (anti thombin)
so grace score to calculate risk
if low risk (predicted 6 month <3/=%) tricagrelor and aspirin, consider clopidogrel
if high risk urgent angiography if unstable, within 72 hours if stable, tricagrelor and aspirin

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76
Q

what can haemotympanum be a sign of

A

base of skull #

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77
Q

when should you do a ct scan for head injury

A

~~~
lowered GCS
suspected skull #
signs if basal skull # (haemotympanum, panda eyes, CFS leak, battles sign)
post traumatic seizure
focal neurological deficit
>1 episode of vomiting
on anticoagulants

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78
Q

where do extra dural haematomas most commonly occur

A

under pterion due to middle meningeal artery rupture

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79
Q

what can be done to reduce ICP

A

hyperventillation, mannitol

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80
Q

what are signs of imminent coning

A

cushing reflex, dilated pupils

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81
Q

what can be given for wheeze

A

salbutamol, O2

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82
Q

O2 range for COPD patients

A

88-92

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83
Q

Tx for acute COPD presentation

A

salbutamol, prednisolone 40mg oral/ IV hydrocortisone if cant swallow, nebs iaptropium, IV magnesium/ salbutamol/aminophylline
abx and sepsis protocol if infective
NIV

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84
Q

what toxidrome does ectasy cause

A

sympathic- tachycardia, sweating, hypertension, dilated pupils

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85
Q

what is an opioid toxidrome

A

pin point pupils, reduces HR, RR and conscious level

86
Q

what is an anticholingeric toxidrome (tricyclic antidepressants)

A

tachycardia, confusion, dysarthia, urinary retention, pyrexia and arrthymias

87
Q

what is a sedative toxidrome (benzos)

A

reduced GCS and RR and HR and hypoxia

88
Q

what is the cholinergic toxidrome

A

pinpoint pupils, sweating, VandD, urination, frothing at mouth

89
Q

what substances need specific investigation

A

paracetamol 4 hours after ingestion
salicylates after aspirin
(if in doubt if these consumed do them anyway)

90
Q

how do you calculate anion gap

A

(Na+K)-(Cl+HCO3) normal 8-16

91
Q

what are the causes of a raised acid gap acidosis

A 
methanol 
uraemia
dka 
peradyhide
iron OD
lacftic acid 
salicylate
92
Q

what is a sign of cardiotoxicity in toxicology

A

prolonged QT interval

93
Q

what does activated charcoal

A

decontaminates the gut, prevents absorption by binding to toxins, can only be given within an hour of ingestion

94
Q

what is the treatment for glutathione

A

N-acestylcysteine (maintains glutathione levels prevention hepatocellular damage)
then after 21 hours of administration get LFTS and coagulation screen to look for hepatocellular damage

95
Q

what is the antidote for ticyclic antidepressants

A

sodium bicarb

96
Q

what is the antidote for beta blockers

A

glucagon

97
Q

how can a substance without an antidote be treated

A

by increasing renal elimination e.g. salicyltates (theophyline given)

98
Q

what is the treatment for patients presenting with STEMI >12 hours after symptom onset

A

THROMBLOLYSIS, fondaparinux

99
Q

what might be seen on ECG in a NSTEMI

A

st depression, flat or inverted T waves

or normal

100
Q

what should you gice morphine with

A

metaclopramide

101
Q

what is fondaparinux

A

a factor Xa inhibitor, anticoagulant

102
Q

what is pulsus alternatans seen in

A

pulmonary oedema

103
Q

treatment for severe pulmonary oedema

A 
oxygen if needed 
diamorphine 
furosemide 
GTN spray 
if high BP nitrate infusion
104
Q

tx for cardiogenic shock

A

oxygen
diamorphine
correct arrythmias
optimise filling pressure (pulse, JVP)- under filling plasma expander, over filling inotropes (dobutamine)

105
Q

Tx for cardiac tamponade

A

pericardiocentesis

106
Q

give examples of SVT with abberrant conduction

A

AF/ a flutter with BBB

107
Q

what should you do if you cant pinpoint rhythm in broad complex tachycardia

A

treat as VT

108
Q

Treatment for broad complex tachycardia

A

correct hypokalaemia and hypomagaesia
if unstable: DCV with sedation, IV amiodarone over <20mins, consider repeat shocks, if refractory procainamide or sotalol
if stable: amiodarone over 20-60 mins

find cause, ICD

109
Q

what is the treatment for VF

A

DCCV

110
Q

TX for SVT with abberant conduction

A

adensoine

111
Q

tx for sinus tachycardia

A

beta blockers

112
Q

tx for SVT

A

oxygen, correct electrolytes
if unstable DCC, IV amiodarone over <20 mins
if stable and rhythm irregular probs AF: beta blocker, verapamil, digoxin or amiodarone, anticoagulants, DC cardioversion.
if unstable rhythm regular: vagal maneovres, adenosine (if this achieves sinus rhythm likely paroxsymal re-entrant SVT, if not likley a flutter treat with BB)

113
Q

management for bradycardia

A

ecg, check electrolytes and digoxin levels, assess cause
if adverse signs (chock, syncope, HF, Myo ischaemia) atropine
if risk no adverse signs but risk of asystole/ no response to atropine: repeat atropine, TC pacing, adrenaline

114
Q

what is a severe asthma attack

A

unable to complete sentences in one breath
RR >/= 25
pulse rate >/=110
PEF 33-50% of predicted or best

115
Q

what is a life threatening attack

A 
PEF <33% 
silent chest, cyanosis 
arrythmia/ hypotension 
exhaustion, confusion, coma 
low PaO2, high PaCO2
116
Q

treatment for acute asthma attack

A

O2
5gm salbutamol nebulised
if severe/ life threatening add ipatropium
hydrocortisone IV/ prednisolone oral
reassess every 15mins
if not good response consider Iv magnesium
if still no improvement ICU

117
Q

treatment for acute COPD exacerbation

A

if dont need admitted: increase SABA dose, 30mg pred for 5 days, consider abx

CXR to rule out infection and pneumothorax
ABG
nebulised bronchodilators (salbutamol and ipatropium)
O2 therapy: oxygen via a Venturi 24% mask at 2-3 l/min or Venturi 28% mask at a flow rate of 4 l/min or nasal cannula at a flow rate of 1-2 l/min (if a 24% mask is not available).
The target oxygen saturation should be 88– 92%
steroids (Iv hydrocortisone/ Oral prednisolone)
if no response aminophylline
NIV
ABx if signs of infection
Physio to aid sputum expectoration

118
Q

what can cause a pneumothorax

A 
spontaneous (ruptured bulla, young thin men) 
chronic lung disease 
infection 
traumatic 
carcinoma 
CTD
119
Q

what are the signs of a pneumothorax

A

reduced expansion, hyperresonance, diminished air sounds, tracheal deviation in tension

120
Q

treatment for a pneumothorax

A

SOB and/or rim of air >2cm on CXR (dont do CXR if tension): aspiration: large bore needle into 2nd ICS mid clavicular line
chest drain 4-6th ICS mid axillary line

if secondary (underlying lung disease, smoker, trauma or on mechanical ventilation) go straight to chest drain

primary pneumothorax <2cm rim not breathless consider discharge and review in 2-4 weeks

secondary pneumothorax rim 1-2cm aspirate then repeat cxr, if now <1cm observe if >1cm chest drain

2nd with rim <1cm admit and observe w/ high flow oxygen

121
Q

commonest cause of pneumonia

A

strep pneumoniae

122
Q

signs of consolidation

A

diminished expansion, dull percussion, increased tactile vocal fremitus and resonance, bronchial breathing

123
Q

what makes up the curb65 score

A 
confusion 
Urea >7 
RR >30 
BP <90/60
age >/=65

0-1 home tx
2 hospital
3 severe ICU

124
Q

tx for pneumonia

A

02 if needed
treat septic shock if present
Abx:
-CAP 0-2 amoxicillin/doxy 3-5 co-amoxiclav + clarithromycin (erythromycin if preg, levoflox if allergic)
HAP- non severe co-amox/doxy PO, severe IV piperacillin and tazobactam

125
Q

what causes PE ECG changes

A

RV strain

126
Q

PE ecg changes

A 
sinus tachycardia 
RBBB
RC strain (t wave inversions V1-4) 
RAD 
SIQIIITIII (deep S waves, Q wave, inverted T wave)
127
Q

Ix for PE

A 
wells score 
ECG
CXR
ABG
CT pulmonary angiography
128
Q

tx for PE

A 
O2 if hypoxic 
morphine and antiemetic 
DOAC/ LMWH
Iv fluid bolus 
if stable- vasopressors: dobutamine/noradrenaline 
in unstable- thrombolysis: alteplase 
long term anticoagulation
129
Q

what do vasopressors do

A

support cardiovascular system:
-alpha adrenergic, venoconstriction increases SVR
used in vasodilatory/ distributive shock states
e.g. noradrenaline, metaraminol, ephedrine

130
Q

what do inotropes do

A

beta adrenergic
increase CP by increasing contractility
used in cardiogenic/ low flow shock
e.g. adrenaline, dobumatine

131
Q

which fluids for the critically ill

A

crystalloids first line: hartmans and plasma-lye better than saline

132
Q

what are plasma expanders

A

synthetic colloid fluids- HES, gelatins

133
Q

what treatment for refractive cardiogenic shock

A

intra-aortic balloon pump- improves cardiac output

134
Q

what are resuscitated patients at risk of

A

re-arrest and secondary hypoxic brain injury

135
Q

what can rapid infusion of saline in resus cause

A

metabolic acidosis

136
Q

what electrolytes does glucose 5% have

A

none

137
Q

what is glucose 5% good for

A

mainteance

138
Q

what is closer to plasma hartmanns or saline

A

hartmanns

139
Q

name a plasma expander (colloid)

A

gelofusine

140
Q

does ICF or ECF increase when you give a crystalloid (hartmans/saline)

A

ECF (interstitial and plasma)

141
Q

does ICF or ECF increase when you give glucose 5%

A

both increase (why not good for resus)

142
Q

what is the point of colloids

A

oncotic pressures draws more water into the plasma- but dont really work better than crystalloids in resus

143
Q

Frail 82 year old lady who broke her ankle and was found lying on the floor a day later. She is drowsy with dry mucous membranes. Urea and creatinine are raised. Glucose 5% or crystalloid

A

glucose 5%

144
Q

name a mild opioid

A

codeine

145
Q

name a mild opioid

A

codeine

146
Q

treatment for nociceptive pain

A

mild- paracetamol +/-NSAID
mod- paracetamol +/- NSAID + codeine
severe- paracetamol +/- NSAID + morphine

147
Q

treatment for neuropathic pain

A

amitriptyline

gabapentin/carbamazepine

148
Q

what is in a standard opioid PCA

A

1mg morphine bolus with a 5 minute lockout

149
Q

what oral morphine dose is equivalent to 60mg IV

A

120mg

150
Q

what is the conversion from oral oxycodone to oral morphine

A

oxycodone is half the morphine dose

151
Q

how do you calculate the breakthrough dose of opioids

A

one sixth of the daily total dose

152
Q

can you use NSAIDs if there is chronic renal impairment

A

no

153
Q

management for torsades de pointes

A

IV magnesium sulphate

154
Q

how do you calculate rate on ECG

A

number of R waves in 30 boxes in rhythm strip x10 or 50 squares by 6
or 300 divided by no. of big boxes between QRS complexes

155
Q

should you stop ACEi and ARBs before surgery

A

yes as risks hypotension and AKI

156
Q

if non blanching rash present what should you do before admission

A

give benzylpenicillin

157
Q

what is kernigs sign

A

pain + resistance on passive knee extension with hip fully flexed: sign of meningism

158
Q

does all of the rash have to non blanching in meningism

A

no may only be one or two spots

159
Q

what management for meningitis

A

take blood cultures first and do LP prior to antibiotics where no evidence of shock and able to do in within an hour
ceftriaxone
if features of meningism give dexamethasone
fluid resus + airway
prophylaxis- contact public health, cirpofloxacin for contacts

160
Q

what does an LP show in the different types of meningitis

A

bacterial- turbid, polymorphs, low glucose, high protein
TB- fibrin web, low glucose
viral- clear, high glucose, low protein

161
Q

when should you suspect encephalitis

A

odd behaviour, decreased consciousness, focal neurology or seizure preceded by infectious prodrome - treat before cause known

162
Q

what causes encephalopathy

A

hypoglycaemia, hepatic encephalopathy, DKA, drugs, hypoxic brain injury, uraemia, SLE, wernickes,

163
Q

what is a sign of HSV encephalitis

A

focal bilateral temporal lobe involvement

164
Q

what is the treatment for viral encephalitis

A

aciclovir within 30 mins of patient presenting

165
Q

what does a ring enhancing lesion on CT show

A

brain abscess

166
Q

what is status epilepticus

A

seizures lasting >30 mins / repeated without intervening consciousness

167
Q

what is the management for status epileticus

A

aim to try and stop seizure ASAP to prevent brain damage
secure airway
lorazepam IV 4mg , second dose after 10-20 mins if no improvement
(thiamine, glucose if indicated)
phenytoin infusion
ICU

168
Q

when should you do CT in head injury patients

A 
in one hour 
GCS<13/ <15 at 2 hours post injury
focal deficit 
suspected skull # 
post traumatic seizure 
vomiting > once

in 8 hours
any LOC/amnesia AND
>65/coagulopathy/ high impact injury/ retrograde amnesia >30 mins

if suspected C spine injury
GCS<13 , patient has been intubated,>65, coagulopathy, high energy injury, focal deficit, parasthesia of lower limbs

169
Q

what is the management for raised ICP

A 
correct hyoptension 
elevate head to 30-40 degrees 
hyperventilate to reduce C02 
mannitol (osmotic diuretic)
dexamethasone for tumour oedema 
restrict fluids 
bore hole
170
Q

what is needed to make a diagnosis of DKA

A

acidaemia
hyperglycaemia >11
ketonaemia/ ketonuria >3

171
Q

what is the management for DKA

A

Admit to ICU if severe
fluid bolus
venous blood gas for pH
50 units of insulin in 50 ml saline at 0.1unit/kg/hour
check mg and ketones hourly
assess need for potassium when BM <14 start glucose alongside insulin

172
Q

management for a hypo

A

if orientated 15-20mg carbs (orange juice) and recheck bm after 10 -15 mins
if uncooperative glucose gel
if unconscious IV glucose 75 mls 20% or 1mg im glucagon
long acting carbs when glucose >4

173
Q

which patients do you see hypoglycaemic hyperosmolar states in

A

unwell type 2 DM
marked dehydration and glucose >30
no switch to ketone metabolism

174
Q

management foe diabetic HHS

A

LMWH to all except if CI
rehydrate slowly
only use insulin if BM not falling

175
Q

what diabetic drug carries a risk of lactic acidosis

A

metformin

176
Q

what is a myxoedema coma

A

most hypothyroid state before death

treatment- ICU, T3 (liothyronine), Iv hydrocortisone

177
Q

what is a thryoid storm

A 
severe hyperthyroid 
Tx 
propranolol (may need digoxin) 
carbimazole 
steroids to prevent peripheral conversion of T4 to T3 
treat suspected infection
178
Q

how might people in addisonian crisis present

A

in shock - vasoconstriction, in creased HR,

179
Q

treatment for addisonian crisis

A

IV hydrocortisone
fluid bolus
monitor for hypoglycaemia

180
Q

treatment for hypopituitary coma

A

IV hydrocortisone (signs= hypothermia, hypotension +/- septic signs without fever)

181
Q

signs and management of phaeochromocytoma emergencies

A

pallor
pulsing HA, hypertension, feels about to die, pyrexial
Tx ICU for combined alpha and beta bockade, (alpha started first as unapposed beta block can worsen hypertension)
alpha block- phentolamine

182
Q

when can activated charcoal be given

A

<1hr of dose

183
Q

when do you want to test paracetamol blood levels

A

4hrs after dose

if over this time and suspect large dose give acetylcysteine anyway

184
Q

antidote for paracetamol

A

acetylcysteine

185
Q

antidote for opioids

A

naloxone

186
Q

what blood should always be done in poisoning

A

salicylate, paracetamol and glucose

187
Q

what medications do you give in ALS and when

A 
shockable rhythms: 
• Give adrenaline every
3–5 min
• Give amiodarone after
3 shocks
non shockable: 
adrenaline asap
188
Q

what are the 4h’s and t’s of the reversible causes of cardiac arrest

A

hypoxia, hypovolaemia, hyperkalaemia/hypoglycaemia/hypocalcaemia, hypothermia
thrombosis, tension pneumothorax, tamponade, toxins

189
Q

doses of adenosine in SVT

A

6,12,18

get chest pain and doom

190
Q

doses of amiodarone

A

VT non resus: 200mg oral or 5ml/kg over 20-120 mins

resus- 300mg in 20ml glucose 5% then 150mg if required

191
Q

atropine dose

A

500mcg IV

192
Q

what is in a shock pack and how is it given

A

4 units RBC
4 units FFP
1 pool platelets
given 1:1 if trauma, 2:1 if other, with 1 gram TXA if trauma

193
Q

what vasopressor for sepsis

A

noradrenaline

194
Q

what abx for sepsis

A

IV amox (vanc) met and gent

195
Q

tx for TCA OD

A

sodium bicarb

196
Q

tx for Beta blocker OD

A

glucagon

197
Q

what is cushings reflex

A

bradycardia, hypertension, resp depression

198
Q

what is the decerebate postion

A

arms abnormal extended

199
Q

what is the decoritate position

A

arms abnormally flexed

200
Q

what is the motor score including decorticate and decerebrate of GCS

A 
6- obeys commands
5- localises to pain 
4- withdraws to pain 
3- abnormal flexion (decorticate) 
2- abnormal extension (decerebrate) 
1- none
201
Q

when is major haemorrhage protocol activated

A

bleed + BP <90, HR >110

202
Q

what do you need to do in major haemorrhage

A

call 2222 state massive harmorhage
call bloodbank state massive haemorrhage
send urgent : FBC, coagulation screen, fibrinogen, crossmatch, U+E, calcium

blood bank will give 4 red 4 ffp
consider tranexamic acid and 1:1 ratio if trauma, if not 2:1

if controlled re call to stand down

203
Q

what tests dont miss out in ABCDE

A

ECG
CXR if short of breath and low sats (check not pregnant)
cannulas

204
Q

what tests dont miss out in ABCDE

A

ECG
CXR if short of breath and low sats (check not pregnant)
cannulas

205
Q

what are the doses of adrenaline

A

cardiac arrest 10mls 1:10000 IV
anaphylaxis 500micrograms 1:1000 IM

206
Q

management of hyperkalaemia

A

if ECG changes and >6 or no ECG changes and >6.5
1. 10mls 10% calcium chloride/ gluconate over 10 mins (dont need if <6.5 and no ecg changes)
2. fixed rate insulin in 25g glucose infusion
3. salbutamol

207
Q

how to calculate breakthrough morphine

A

1/6th 24 hour dose

208
Q

10 of tramadol/ codeine/ dihydrocodeine= ? morphine

A

1

209
Q

10 oral morphine= ? sc morphine

A

5 (half dose)

210
Q

10 morphine = ? oxycodone

A

5

211
Q

what are the anticipatory care meds

A

morphine sulphate
midazolam
hyoscine butylbromide (secretions)
levomapropamize (nauseas)

4th Year (7 decks)

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