Emergency Medicine Flashcards
1
Q
What species commonly causes Acute Epiglottitis
A
Haemophilus Influenzae
2
Q
Management of Acute Epiglottitis
A
Emergency intubation and treatment with IV antibiotics
3
Q
What is the GOLD standard for diganosing epiglottitis
A
Fibre-optic paryngoscopy
4
Q
If a laryngoscopy is contraindictaed for epiglottitis, what should be done
A
Lateral neck X Ray for thumbprint sign
5
Q
Causes of Acute Pancreatitis
A
GET SMASHED:
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmume disease
Scorpion Bite
Hypercalcaemia, hypertriglyceridaemia, hypothermia
ERCP
Drigs
6
Q
What drugs can cause pancreatitis
A
FATSHEEP
Furosemide
Azathioprine
Thiazines/Tetracyclines
Statines/Sodium Valproate/Sulfonamides
Hydrocholrothiazide
Oestrogens
Ethanol
NRTIs
7
Q
Symptoms of Acute Pancreatitis
A
Stabbing-like, epigastric pain which radiates to the back
8
Q
How is pancreatitis pain relieved
A
Sitting forwards or lying hunched over
9
Q
WHat other conditions can elevate amylase
A
Duodenal ulcer
Cholecystitis
Mesenteric infarction
10
Q
What imaging is preferred and why
A
ERCP over MRCP as it is more therapeutic
11
Q
What criteria can be used to predict the severity of pancreatitis
A
GLasgow criteria
12
Q
When is the glasgow criteria used for pancreatitis
A
At admission and 48 hours after
13
Q
What score on the glasgow criteria indictaed transfer to ITU or HDU
A
over 3
14
Q
Outline the glasgow criteria for pancreatitis
A
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
15
Q
Management of pancreatitis
A
1 L Fluid at a rate of 3-5 ml/kg/hour
Analgesia (co-codamol)
Antiemetics
16
Q
What is Pulseless Electrical Activity
A
ECG shows electrical activity that should produce a pulse but a pulse cannot be felt
17
Q
Management of PEA and Asystole
A
CPR:
Adrenaline 1mg IV in first cycle and then every other cycle tehreafter.
18
Q
Management of Ventricular Fibrilation and Pulseless Ventricular Tachycardia
A
Defibrillation and CPR
Seconnd Line: Amiodarone 300mg IV + Adrenaline 1mg IV (1:10,000) after third shock
19
Q
WHen is suction indictaed for airway management
A
If foreign body, blood or vomit is visible
20
Q
Contraindications to suction management
A
C-spine injury
21
Q
Name two other simple airway manouevres other than suction that can improve airway management
A
Head tilt
Jaw Thrust
22
Q
How does a Guedel work
A
Inserted upside down and rotated 180 degrees to hold tongue from posterior pharynx
23
Q
WHat is the need for nasopharyngeal airway adjuncts
A
Used to keep tongue forward in patients with gag reflexes
24
Q
When is NPA contraindicated
A
Basilar skull fracture
25
Indicatino of a supraglottic airway
Can be used with ventilation machine
26
Presentation of alcohol withdrawal (6-12 hours)
INsomnia
Tremour
Anxiety
Agitation
Nausea and vomiting
Sweating and palpitationa
27
Onnset of alcohol hallucinations
12-24 hours post drink
28
Presentation of delirium Tremens
Delusions
COnfusion
Seizures
Hypertension
Hyperthermia
Seizures
29
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
30
Indications for assisted withdrawal management in alcoholics
>15 units or >20 on AUDIT
31
Managemebt of Alcohol Withdrawal
Chlordiazepocide
IV Pabrinex to stop wernicke's
32
First line management of delirium tremens
Oral Lorzapeam
If denied, offer IV
33
Management of a conscious choking patient
5 back blows centrally
5 abdo thrusts from behind
34
Managemnet of choking in adults who are unconscious
ABCDE
35
First line managemnet of compartment syndrome
Urgent Fasciotomy
Analgesia
Fluids
36
What aggravates pain in compartment syndrome
Flexing toes
37
Define moderate asthma
PEF: 50-75%
38
Define severe asthma
PEF: 33-50%
RR > 25
HR > 110
Can'tr complete sentences
39
Define life threatening asthma
33,92 CHEST
PEF < 33
SO2 < 92
Cyanosis
Hypotrension
Exhaustion
SIlent Chest
Tachycarrythmias
NORMAL PCO2
40
FIrst line managemnet of life trheateing asthma
Admission to hospital
41
Criteria in asthmatics to intensive care
Requires ventialtory support
PEF getting worse
Worsening Hypoxia
Hypercapnia
Exhaustion
Respiratory arrest
42
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
43
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
44
What shoul dbe monitored at A and E during an asthm attack
PEF
SpO2: keep > 92%
45
How is troponin level affecte din unstable angina
NO rise in troponin
46
Name two features of a STEMI on an ECG
ST-Elevation
LBBB
47
Management of Anaphylaxis
Oxygen
Then lie patient flat and rise legs
THEN;
Administer 500mg Im adrenaline + Chlorphenamine + Hydrocortisone after ABCDE
48
What diagnoses carbon monoxide poisoning
VBG/ABG: Carboxyhaemoglobin >20% concentration
49
Management of Carbon Monoxide poisoning
100% oxygen via face mask
Second Line: Hyperbaric Oxygen
50
Clinical Features of Cardiac Tamponade
Beck's Triad: Raised JVP, hypotension and muffled heart sounds
Kussmaul's sign: JVP rise on inspiration)
Pulsus paradoxus
51
ECG finding in cardiac tamponade
Electric alternans (QRS height changes)
52
What is pulsus paradoxus
Drop in systoic BP on inspiration
53
Management of cardiac tamponade
Pericardiocentesis
54
Where is ethylene glycol found
Anti-freeze
55
Management of ethylene glycol poisoning
Gastric lavage if <1 hour
>1 hour: Fomepizole or Ethanol if unavilable
56
If Ethylene glycol poisoning can't be treated with fomepizole or alcohol, what should be done
Haemofiltration
57
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
58
Management of pericarditis
Analgesia and bed rest
59
What is a parimary spontaneous pneumothorax
No underlying pathology caused this (tall young men)
60
What is a secondary sponatneous pneumothorax
Issues:
Marfan's
Ehlers-Danlos Syndrome
COPD and Asthma
TB and pneumonia
CF
Bronchial carcnioma
61
Name an iatrogenic cause of traumatic pneumothorax
Insertion of a central line
Positive pressure ventilation
62
What is a non-iatrogenic traumatic cause of a pneumothorax
Blunt trauma
63
What is pleuritic chest pain
Chest pain on inspiration
64
Management of a tension pneumothorax
ABCDE:
Ocygen through a non-rebreather mask
immediate needle decompression
65
Where is the needle decompression given in a tension pneumothorax
Second intercostal space, mid clavicular line on the affected side
66
Following needle decompression, what should be done
Insertion of an intercostal chest drain
67
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
68
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
69
If a patient with primary pneumothorax presents with sob or has a pneumothorax > 2cm, what should be done
16-18g cannula aspiration
70
If a needle decompression fails, what should be done
Intercostal drain
71
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
72
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
73
If a patinet has a simple secondary pneumothorax and IS sob or has a pneumothorax >2cm, what should be done
INTERCOSTAL drain
74
When is thrombolysis with alteplase indicated for a PE
Features of haemodynamic instability
75
First line management of a PE
DOAC
76
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
77
What physiological change in the heart causes Torsades de Pointes
Long QT Interval
78
What are the causes of TOrsades de Pointes (long QT intervals)
TIMMES:
Toxins
Inherited
Ischaemia
Myocardities
Mitral Valve Prolapse
Electrolyte Abnormalities (hyperkalaemia, hypomagnesemia)
SAH
79
Management of Torsades de Pointes
IV Magnesium Sulphate over 1-2 minutes
80
Under what circumstances is the Glasgow-Blatchford score used
Prior to endoscopy
81
What Glasgow-Blatchford score indicates the need for medical intervention before endosocpy
Over. 0
82
What is the Rockall score
Used in patients AFTER endosocpy to estimate the risk of rebleeding and mortality
83
What is the treatment for any upper GI bleed
ABCDE
Insert 2 large bore IV cannulaes to take bloods for cross matching and FBC etc
IV FLuids if hypotensive
Catheterise
Urgent Endoscopy
84
Management of a peptic ulcer
Endosocopic clipping or thermal coagulation
85
IF a patient is haemodynamically unstable following endosocpy, what should be done
Interventional radiology/precutaneous angiography to find point of bleeding
Then ebolise bleeding artery
86
Under what circumstances should a PPI not be offered to a patient prior to endoscopy
If a non-variceal bleed is suspected - only given after evidence of bleeding is elsewhere
87
Management of acute variceal bleeding
ABCDE
2 IV cannulas
IV Flluids
Catheterise
Urgent Endoscopy
88
Medical Management of variceal bleeding
Terlipressin for 5 days
89
What prophylaxis is given for variceal bleeding
Tazocin (antibiotic)
90
Surgical management of variceal bleeding after terlipressin management fails
N-butyl-2-cyanoacrylate or band ligation
TIPS if all else fails (final line)
91
Management of ventricular tachycardia
IV Amiodarone
92
Management of Myxoedema coma
1. ITU referral
2. IV T3/T4
3. 50-100mg Hydrocortisone
4. Correct hypothermia/hypoglycaemia
5. Treat HF
93
Management of an addisonian crisis
1. FLUID RESUS first
THEN
IV Hydrocortisone 100mg
IV GLucose if hypoglycaemic
Swap back to oral steroids after 3 days
COnsider fludrocortsione
94
SIgns of Aspirin Overdose
Tinnitus
Initial respiratory alkalosis THEN metabolic acidosis
95
Diagnosis of aspirin overdose
VBG: Looking for acid-base imbalance
Slicylate levels
96
Management of Aspirin Overdose
Activated charcoal if <1 hour ingestion
IV Fluid, Sodium Bicarbonate and KCL
We need to alkalise the urine to increase salicylate excretion
97
Management of Digoxin tocicity
Digibind
98
Management of Phaeochromocytoma
Phentolamine iV to contorl BP (short acting alpha blocker)
Phenoxybenzamine to control BP before surgery can be arranged (llonger acting)
Labetolol if there is tachyarrthmia after alpha blockers given
Then
Adrenalectomy
99
Management of a Thyroid Storm
IV Propranolol
Iv Digoxin
Propulthiouracil followed by Lugol's iodine 6 hours later.
Prednisolone/Hydrocortisone
100
Sins of hypothermia on an ECG
Sinus bardycardia
J Waves (osbourne waves)
Prolongued PR, QRS and QT intervals
101
Criteria for performing a CT head within 1 hour
GCS <13 in initial assessment
GCS <15 up to 2 hours after injury
Suspected skull fracture
Signs of basilar skull fracture
Post-Tarumatic seizure
Focal deficits
More than 1 episode of vomiting
102
Signs of basilar skull fractures
Pana eyes
Bleeding behind ear
Battle sign
Leakeage of fluid from nose
103
Criteria for performing a CT head within 8 hours of head injury
>65 years
History of bleeding or clotting
Dangerous mechanism of injury
>30 minutes of retrograde amnesia
104
What non cardiac conditions can raise troponin leels
CKD
PE
Sepsis
105
What is the first line management of head trauma
ABCDE
Stabilise C spine and airways
106
Management of Paracetamol overdose
Within 1 hour ingetsion AND dose >150mg/kg: Activated charcoal
If staggered overdose or >15 hours = N-Acetylcysteine immediately
If >4 hours: take blood levels THEN N-Acetylcysteine
If between 4-15 hours ago: Take immediate level and treat based on levels
107
What is the criteria for sepsis
2 of:
>38 degrees or <36 degrees
HR > 90
RR ? 20
WBC > 12 or <4
108
WHat lactate level defines septic shock
>4 mmol/L
109
Management of sepsis
Take BLoods
Take cultures
Oxygen
I Antibiotics
IV Fluids
Monitor fluid output
110
What urinary output indicates stage 1 shock
>30
111
WHat urinary output indicates stage 2 shock
20-30
112
What urinary output indicates stage 3 shock
5-15
113
What urinary output indicates stage 4 shock
<5
114
What is the management for sepsis
SEPSIS 6:
1. Blood (VBG for lactate)
2. Oxyegn sats if <94%
3. IV ANtibiiotics IMMEDIATELY
4. Fluid challenge (crystalloid) if BP <90 or lactate >4
5. Blood cultures
6. Catheterisation
115
First line management of hypovalaemic shock in trauma
1.5-2 L warmed IV Crystalloid
Then cross-match blood for O-negative infusion
116
SIgns of retinal detachment
FLoaters and flashes followed by CURTAIN falling vision loss (like amaurosis fugax)
117
Fundoscopy findings for retinal detachment
Pale grey area of retina ballooning forward
118
Define an anastamtoic leak
Most fatal complications of surgery: when contents of hollow organ leak between the gaps of two junctions joined together
119
Management of an anastamotic leak
IV FLuids, antibiotics and bed rest
120
What blood test should be used to check for an anastamotic leak
Lactate levels
121
What is a rapid sequence induction
Endotracheal intubation and ventilation in people who are at high risk of pulmonary aspiration
122
What is an arterial line used for
TO directly measure BP and obtain ABGs
123
What is a FAST scan
Rapid USS scan at the time of presentation for a patient
124
Indications for a FAST scan
Any traumatic events to check for intenral trumatic injuries (e.g., chest stabbings)
125
What type of blood is given in trauma patients
O negative
126
FAST scan vs Whole Body CT Scan
WBCT is more accurate, and usually gold standard
FAST scan is only chosen as first line if they're very unstable and likely to go to theatre imminently.
127
What is an adjunct to the primary survey (what should be done following ABCDE)
WHole body CT
Then do a secondary survey
128
Describe the mechanism of action of Transexemic acid
Anti-fibrinolytic
129
What is a haemothorax
A pleural effusion that is caused by the presence of blood
130
Management of a haemothorax
Thoracostomy
131
How does a tension pneumothorax cause shock
It increases intrathoracic pressure, reducing venous return to the heart
132
What is the first line management of an axial loading injury (kick or blow to the head)
C-spine CT
133
Management of life-threatening Asthma
OSHIT!
Oxyegn
Salbutamol
Hydrocortisone
Ipratropium
Theophylline
Mg
134
Main management of a rib fracture or flail chest
NSAIDs
135
What is a flail chest
When two or more consecutive ribs on the same side of the chest fracture in two or more places.
136
If a patient has had a haemorrhagic shock, should fluids be given?
NO crystalloid fluids should be given - only for hypovolaemic shock. Should be like for like, give blood transfusions not fluids.
Fluids will just dilute the clotting factors.
137
Indications for a whole body CT
Injury to multiple body regions
High speed motor vehicle collisions
Low GCS
Big Falls (>2m)
138
What splint is used for a shaft of femur fracture
Thomas splint
139
What type of nailing is used for neck of femur fractures
Intramedullary nails
140
When is adrenaline indicated for anaphylaxis
Only when severely ill. If BP is normal and there is just mild cyanosis, leave alone.
141
Anaphylaxis vs anaphylactoid reactions
Anaphylaxis is IgE mediated
Anaphylactoid is not IgE mediated
142
If IM adrenaline does not work in anaphylaxis, what is done next
Repeat IM adrenaline
Third line: IV Adrenaline refer to resus team.
143
What serum levels are used to diagnose anaphylaxis
Mast cell triptase levels (repeat later on as if it increases = anaphylaxis)
144
What species is often associated with IV drug abuse people who have pneumonia
Staph aureus
145
What gram organism is associated with HAP
Gram-negative
146
Why does klebseilla often colonise in the upper lobes in pneumonia
Usually cause by aspiration
147
At what CRB-65 score is hospital admission required or considered at
2
148
If someone originally presents to the hospital with a CURB-65 of 1, is sent home, but does not recover after 72 hours, what should be done
Consider hospital admission
149
Treatment of low-severity CAP
5 day course of amoxicillin
Erythromycin in pregnancy
150
Management of moderate to severe CAP
5 days co-amoxiclav + Clarithromycin (or erythromycin in pregnancy)
151
If a patient is allergic to penecillin, what should be given for low severity CAP
Doxycycline
152
If an atypical penumonia is suspected, what should be given
Doxycycline
153
For severe CAP, what can be given to someone who is allergic to penecillin
Oral levofloxacin
154
Name three types of atypical pneumonias
M.pneumonia
C.pneumoniae
Legionella pneumoniae
155
Signs distinctive of legionella pneumophila
Hyponatraemia (SIADH)
Typically gone to cheap hotel holidays
156
Sigsn distinctive of mycoplasma pneumoniae
Target lesions (erythema multiforme)
157
What type of people get a pneumonia known as q fever
Farmers with a flu like illness
158
What species causes pneumonia from parrots or other birds
Chlamydia psittaci
159
What is the main cause of HAP
Strep pneumoniae (in first 5 days)
H.influenzae after 5 days
160
At what respiratory rate should the emergency care team be called
<5 or >36
161
At what pulse rate should the emergency team be called
<40 or >140
162
Sepsis vs septic shock
Sepsis is organ dysfunction from a dysregulated response to infection vs metabolic and circulatory disorder caused from this organ dysfunction
163
Most common sign of sepsis in the elderly
Confusion (mild) and unexplained hypotension
164
First line management of haemorrhage shock
Blood transfusion NOT fluids
165
What medication can be given for hypotension in sepsis
Noradrenaline
166
What is the role of Dobutamine in septic shock
Increases cardiac output
167
What causes Type I respiratory failure
Damage to lung tissue causing V/Q mismatch:
Pneumonia, lung injury or fibrosis
168
What causes Type II respiratory failure
Occurs due to failure of ventilation:
COPD< chest-wall deformities, GBS, drug overdoses
There is a great resistance to ventilation
169
What is the criteria for mechanical ventilation in Type I respiratory failure
Paco2 > 8Kpa (rising) + signs of respiratory distress
170
What is the criteria for mechanical ventilation in type II respiratory failure
Vital Capacity < 10mL/kg
171
Indication for a tracheostomy
Long-term use: control bronchial secretions + chronic respiratory depression that is refractory to treatment
172
Indication for a cricothyroidotomy
Life-threatening obstruction of the upper respiratory tract
173
Common causes of acute respiratory distress syndrome
Pneumonia
Sepsis
Aspiration of gastric contents
174
Signs of ARDS
Pulmonary oedema and hypertension
175
What are the diagnostic tests for brainstem death
- Ocular reflexes
- Corneal reflexes
- Pupilary reflex
- Vestibulo-ocular reflex
- Gag reflex
- no response to pain
- Spontaneous respiration gone
176
What cause exudative Pleural Effusion
Increased permeability of capillaries
177
Causes of exudative pleural effusion
Pneumonia
TB
PE
Lung cancer
178
Cause of transudate pleural effusions
Increased hydrostatic pressure and reduced oncotic pressure
179
Causes of transudative Pleural effusions
HF
Hypoalbuminaemia
Cirrhosis
Nephrotic sytndrome
180
What is the LIght's criteria for exudative pleural effusions
POsitive
181
What is the LIght's criteria for transdative pleural effusion
Negative
182
What CPR ratio is given for PEA and Asystole
30:2
183
In an anaphylactic shock, what is given first
Adrenaline IM + FLuids
Do not give chlorhenamine and hydrocortsone at first line
184
Management of a ventricular tachycardia if systolic BP <90
DC Cardioversion
185
First line treatment for supraventricular tachyardias
Vagal manoeuvres
186
If vagal manoeuvres fail to treat the Supraventricular tachycardia, what should be done
IV Adenosine
187
In what type of tachycarythmias is IV amiodarone the first line treatment
Broad complex tachycardias (first line) if there are no BP upset AND there is a pulse
188
If a patient has a ventricular tachycardia and no pulse what should be done
Immediate defibrilation
189
What electrolyte imbalance is a common cause of ventricular tachycardias
Hypokalaemia
Hypomagnesemia
190
What two things are needed to diagnose COPD
SYmptoms of COPD: E.g., sputum production, sob and winter bronchitis
+
FEV1/FVC <0.7
191
First line management of COPD
Ipratropium bromide or Salbutamol
192
Second line mnGWMWNT OD COPD
LABA + LAMA
Only if not asthmatic symptoms
If asthmatic: LABA + ICS
193
Managing COPD exacerbation
Prednisolone or hydrocortisone 30mg for 7 days
+ Nebulised Salbutamol 5mg + Ipratropium bromide 500mcg
194
First line investigation of Asthma
Fractional exhaled NO or Spirometry with bronchodilator reversibility
Second line: Peak flow variability
195
Management of asthma (stepwise approach)
1. Salbutamol
2. Salbutamol + ICS
3. Salbutamol + ICS + montelukast
4. Salbutamol + ICS + Montelukast + LABA
5. MART
196
What lung functions indicate obstructive lung disease
FEV!:FVC ratio < 75%
197
What lung function indicates restrictive disease
FEV1 and FVC are reduced + FEV1:FVC >75%
198
Management of superficial corneal injuries
1. Irrigate eye with normal saline to wash out foreign body
2. Swab to check for infection
