Emergency Medicine Flashcards
What species commonly causes Acute Epiglottitis
Haemophilus Influenzae
Management of Acute Epiglottitis
Emergency intubation and treatment with IV antibiotics
What is the GOLD standard for diganosing epiglottitis
Fibre-optic paryngoscopy
If a laryngoscopy is contraindictaed for epiglottitis, what should be done
Lateral neck X Ray for thumbprint sign
Causes of Acute Pancreatitis
GET SMASHED:
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmume disease
Scorpion Bite
Hypercalcaemia, hypertriglyceridaemia, hypothermia
ERCP
Drigs
What drugs can cause pancreatitis
FATSHEEP
Furosemide
Azathioprine
Thiazines/Tetracyclines
Statines/Sodium Valproate/Sulfonamides
Hydrocholrothiazide
Oestrogens
Ethanol
NRTIs
Symptoms of Acute Pancreatitis
Stabbing-like, epigastric pain which radiates to the back
How is pancreatitis pain relieved
Sitting forwards or lying hunched over
WHat other conditions can elevate amylase
Duodenal ulcer
Cholecystitis
Mesenteric infarction
What imaging is preferred and why
ERCP over MRCP as it is more therapeutic
What criteria can be used to predict the severity of pancreatitis
GLasgow criteria
When is the glasgow criteria used for pancreatitis
At admission and 48 hours after
What score on the glasgow criteria indictaed transfer to ITU or HDU
over 3
Outline the glasgow criteria for pancreatitis
PaO2 < 8kPa
Age > 55
Neutrophils > 15 x 10^9
Calcium < 2mmol/L
Renal Function > 16mmol/L
Enzymes (AST/ALT > 200 or LDH > 600)
Albumin <32
Sugar > 10 mmol/L
Management of pancreatitis
1 L Fluid at a rate of 3-5 ml/kg/hour
Analgesia (co-codamol)
Antiemetics
What is Pulseless Electrical Activity
ECG shows electrical activity that should produce a pulse but a pulse cannot be felt
Management of PEA and Asystole
CPR:
Adrenaline 1mg IV in first cycle and then every other cycle tehreafter.
Management of Ventricular Fibrilation and Pulseless Ventricular Tachycardia
Defibrillation and CPR
Seconnd Line: Amiodarone 300mg IV + Adrenaline 1mg IV (1:10,000) after third shock
WHen is suction indictaed for airway management
If foreign body, blood or vomit is visible
Contraindications to suction management
C-spine injury
Name two other simple airway manouevres other than suction that can improve airway management
Head tilt
Jaw Thrust
How does a Guedel work
Inserted upside down and rotated 180 degrees to hold tongue from posterior pharynx
WHat is the need for nasopharyngeal airway adjuncts
Used to keep tongue forward in patients with gag reflexes
When is NPA contraindicated
Basilar skull fracture
Indicatino of a supraglottic airway
Can be used with ventilation machine
Presentation of alcohol withdrawal (6-12 hours)
INsomnia
Tremour
Anxiety
Agitation
Nausea and vomiting
Sweating and palpitationa
Onnset of alcohol hallucinations
12-24 hours post drink
Presentation of delirium Tremens
Delusions
COnfusion
Seizures
Hypertension
Hyperthermia
Seizures
Indications for inpatient withdrawal management
> 30 units a day
30_ on SADQ score
COncurrent withdrawal from BDZs
Vulnerable patients
<18
Previous seizures, deleirium tremens or epilsepsy
Indications for assisted withdrawal management in alcoholics
> 15 units or >20 on AUDIT
Managemebt of Alcohol Withdrawal
Chlordiazepocide
IV Pabrinex to stop wernicke’s
First line management of delirium tremens
Oral Lorzapeam
If denied, offer IV
Management of a conscious choking patient
5 back blows centrally
5 abdo thrusts from behind
Managemnet of choking in adults who are unconscious
ABCDE
First line managemnet of compartment syndrome
Urgent Fasciotomy
Analgesia
Fluids
What aggravates pain in compartment syndrome
Flexing toes
Define moderate asthma
PEF: 50-75%
Define severe asthma
PEF: 33-50%
RR > 25
HR > 110
Can’tr complete sentences
Define life threatening asthma
33,92 CHEST
PEF < 33
SO2 < 92
Cyanosis
Hypotrension
Exhaustion
SIlent Chest
Tachycarrythmias
NORMAL PCO2
FIrst line managemnet of life trheateing asthma
Admission to hospital
Criteria in asthmatics to intensive care
Requires ventialtory support
PEF getting worse
Worsening Hypoxia
Hypercapnia
Exhaustion
Respiratory arrest
Immediate management of all asthma attacks
Sit UP
100% O2 non rebreatheable mask
Nebulised salbutamol 5mg + Ipratropium 0.5mg
IV Hydrocortisone IV or prednisolone 50mg pO
Management of life trheatning asthma
Immediate PLUS;
Refer to ICU
Magnesium Sulfate 2g IV over 20 minutes
Nebulised salbutamol every 15 mins
If no improvement: ITU transfer for invasive ventilation
What shoul dbe monitored at A and E during an asthm attack
PEF
SpO2: keep > 92%
How is troponin level affecte din unstable angina
NO rise in troponin
Name two features of a STEMI on an ECG
ST-Elevation
LBBB
Management of Anaphylaxis
Oxygen
Then lie patient flat and rise legs
THEN;
Administer 500mg Im adrenaline + Chlorphenamine + Hydrocortisone after ABCDE
What diagnoses carbon monoxide poisoning
VBG/ABG: Carboxyhaemoglobin >20% concentration
Management of Carbon Monoxide poisoning
100% oxygen via face mask
Second Line: Hyperbaric Oxygen
Clinical Features of Cardiac Tamponade
Beck’s Triad: Raised JVP, hypotension and muffled heart sounds
Kussmaul’s sign: JVP rise on inspiration)
Pulsus paradoxus
ECG finding in cardiac tamponade
Electric alternans (QRS height changes)
What is pulsus paradoxus
Drop in systoic BP on inspiration
Management of cardiac tamponade
Pericardiocentesis
Where is ethylene glycol found
Anti-freeze
Management of ethylene glycol poisoning
Gastric lavage if <1 hour
> 1 hour: Fomepizole or Ethanol if unavilable
If Ethylene glycol poisoning can’t be treated with fomepizole or alcohol, what should be done
Haemofiltration
Management of Hyperosmolar Hyperglycaemic state
1L of 0.9% saline
Then 1L of saline PLUS KCL
+ Insluin 0.05 units/lg.hour if ketones are over 1mmol/L
Management of pericarditis
Analgesia and bed rest
What is a parimary spontaneous pneumothorax
No underlying pathology caused this (tall young men)
What is a secondary sponatneous pneumothorax
Issues:
Marfan’s
Ehlers-Danlos Syndrome
COPD and Asthma
TB and pneumonia
CF
Bronchial carcnioma
Name an iatrogenic cause of traumatic pneumothorax
Insertion of a central line
Positive pressure ventilation
What is a non-iatrogenic traumatic cause of a pneumothorax
Blunt trauma
What is pleuritic chest pain
Chest pain on inspiration
Management of a tension pneumothorax
ABCDE:
Ocygen through a non-rebreather mask
immediate needle decompression
Where is the needle decompression given in a tension pneumothorax
Second intercostal space, mid clavicular line on the affected side
Following needle decompression, what should be done
Insertion of an intercostal chest drain
Management of a primary pneumothorax depends on what two factors
If the patient is short of breath or has a pneumothorax > 2cm on an X-Ray
If a patient with simple primary pneumothorax is not sob and has a pneumothorax < 2cm, what should be done
COnservative management and review in 2-4 weeks
If a patient with primary pneumothorax presents with sob or has a pneumothorax > 2cm, what should be done
16-18g cannula aspiration
If a needle decompression fails, what should be done
Intercostal drain
Management of a simple secondary pneumothorax if the patient has no sob and the pneumothorax is under 1cm
Admit for observation for 24 hours and. oxygen
If a patinet has a simple secondary penumothorax but is not sob and has a pneumothorax 1-2cm large, what should be done
Aspiration THEN admit for 24 hours
If a patinet has a simple secondary pneumothorax and IS sob or has a pneumothorax >2cm, what should be done
INTERCOSTAL drain
When is thrombolysis with alteplase indicated for a PE
Features of haemodynamic instability
First line management of a PE
DOAC
What are the indications to refer to SDEC
Ambulant
Acute medical complaint
NEWS <4
No frailty needs/falls
No new Ocygen Requirements
Likely to be discharged on the same day
What physiological change in the heart causes Torsades de Pointes
Long QT Interval
What are the causes of TOrsades de Pointes (long QT intervals)
TIMMES:
Toxins
Inherited
Ischaemia
Myocardities
Mitral Valve Prolapse
Electrolyte Abnormalities (hyperkalaemia, hypomagnesemia)
SAH
Management of Torsades de Pointes
IV Magnesium Sulphate over 1-2 minutes