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AMK > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

what is the cause of slow skin turgor

A

dehydration

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2
Q

what is anaphylaxis

A

it is a severe reaction to any antigen due to major histamine release of mast cells

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3
Q

when is it best to treat sepsis

A

golden hour - within an hour

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4
Q

why does diabetes decrease immunity

A

more sugar means more favourable environment for infections to grow

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5
Q

what is seen in torsades de pointes

A

polymorphic ventricular tachycardia
QRS axis is constantly shifting

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6
Q

treatment for torsades des pointes

A

magnesium sulphate

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7
Q

causes of torsades de pointes

A

MI
mitral valve prolapse
ischaemia

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8
Q

management of unstable and stable torsades des pointes

A

unstable: DC cardio version
stable: Magnesium sulphate

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9
Q

what is given to treat severe hyperkalaemia

A

calcium gluconate
- potassium is intracellular
- calcium is extracellular
calcium is given to push the potassium back inside the cells

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10
Q

treatments for hyperkalaemia

A
  1. insulin with dextrose - pushes K into the cells
  2. salbutamol
  3. sodium bicarbonate - works on collecting duct to push the K into the urine
  4. potassium resin bond
    or dialysis
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11
Q

what is a lucid interval

A

after an injury for a period of time the person looks fine but isn’t

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12
Q

what bleed in the brain presents immediately after injury

A

arterial

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13
Q

what bleed in the brain presents slowly after an injury

A

venous bleed

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14
Q

what type of bleed is an extradural bleed

A

arteriall

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15
Q

what type of bleed is subdural

A

venous

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16
Q

treatment anagram for MI

A

Morphine
Oxygen
Nitrate GTN
Aspirin

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17
Q

patient comes in with flu-like symptoms, chest pain, ECG shows PR depression and ST elevation and raised troponin levels

what does the patient have and management?

A

pericarditis and given NSAIDS

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18
Q

What is given in management of paracetamol overdose

A

Activated charcoal if OD was taken within an hour
Or
N-acetylcysteine

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19
Q

Halitosis

A

Bad smelling breath

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20
Q

Schatzi ring

A

Narrowing of lower oesophagus

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21
Q

Optic neuritis

A

Painful loss of vision
Abnormal perception of colours

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22
Q

Epigastric hernia

A

Protusionod the fat

Advise weight loss

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23
Q

Reverse tick in ST depression with first degree heart block
Dizziness
Nausea

What is it

A

Digoxin overdose

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24
Q

What is the antidote for digoxin overdose

A

Digibind

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25
Q

Patients who had an accident and have a GCS of <13 on admission or <15 after 2 hours should be given a CT scan when?

A

within one hour

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26
Q

anaphalaxsis attack treatment

A

adrenaline IM 0.5ml of 1:1000

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27
Q

numbness in hand and wrist
inability to straighten fingers
wrist drop due to direct pressure on upper medial arm

A

Saturday night palsy

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28
Q

vomiting
abdo pain
breathing fast and high blood glucose

A

diabetic keto acidosis

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29
Q

what is acute coronary syndrome

A

also called coronary artery disease
causes a cessation in the blood supply to the myocardium
ischaemic heart disease

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30
Q

symptoms of ACS

A

chest pain
SOB
sweating
palpitations
pain radiating to the jaw and arms
light headedness

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31
Q

what comes under ACS

A

unstable angina
NSTEMI
STEMI

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32
Q

stable angina presentation

A

pain on exertion

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33
Q

unstable angina presentation

A

pain all the time

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34
Q

NSTEMI presentation

A

troponin levels are increased but no changes on ECG
t wave inversion

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35
Q

STEMI presentation

A

ECG will show ST elevation

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36
Q

when is troponin best tested

A

when the pain is there
as this is when the troponin is released

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37
Q

what is MONA - in management for ACS

A

morphine
oxygen
nitrates
aspirin

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38
Q

when should PCI be done for STEMI

A

within 2 hours

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39
Q

If the patient cannot be given PCI in 2 hours then?

A

give them fibrinolysis - shouldn’t give if there’s a risk of bleeding then clopidogrel and low molecular weight heparin and then PCI after

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40
Q

NSTEMI management

A

Beta blockers (not to give to asthmatics)
A - aspirin
T - ticagreolor
M- morphine
A - anticoags
N- nitrates

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41
Q

ACS secondary prevention

A

aspirin 75mg daily
another Antiplatelet
atrovastatin
ACE inhibs
atenolol
aldosterone antagonist

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42
Q

ACS prevention

A

stop smoking
reduce alcohol

then rehab

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43
Q

Cardiac Tamponade - what is it

A

fluid of blood fills in the pericardial sac
pericardium cannot stretch
pressure increases and compresses the heart

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44
Q

causes of cardiac tamponade

A

trauma
pericarditis
TB
malignancy

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45
Q

becks triad

A

hypotension
raised JVP
quiet heart sounds
kussumauls signs - JVP rises on every inhale and produces a wheeze
pulses paradoxus - systolic BP just goes up and down and not constant

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46
Q

what is kussumauls sign

A

JVP rises on every inhale and produces a wheeze

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47
Q

what is pulses paradoxus

A

systolic BP just goes up and down and not constant

48
Q

investigation for cardiac tamponade

A

ECHO
chest x ray
ECG - tachycardia and electrical alternanas

49
Q

management for cardiac tamponade

A

urgent needle pericardiocentresis
cardiac surgery

50
Q

what is SHOCK

A

acute failure of the CVS to perfuse the tissues enough
not enough oxygen

51
Q

what is cardiac output

A

HR x Stroke volume

52
Q

what is stroke volume

A

how much blood pumped out in each ejection

53
Q

different types of shock

A

cardiogenic
hypovalemic
obstructive
distributive

54
Q

hypovalaemic

A

Due to blood of fluid loss
low BP
low CO2
high HR

55
Q

management for hypovalaemic shock

A

IV fluids

56
Q

cariogenic shock

A

low CO2
low cardiac output
due to MI
low BP
high HR

57
Q

management for cariogenic shock

A
58
Q

obstructive shock

A

due to tension pneumothorax
cardiac tamponade
PE
low BP
high HR

59
Q

what is distributive shock

A

septic
anaphylactic
neurogenic

60
Q

septic shock

A

low SVR
caused by peripheral vasodilation
due to infection
low BP
high HR

61
Q

anaphylactic shock

A

low SVR
severe allergic reaction
SOB
hives
angioedema
low BP
high HR

62
Q

management of septic shock

A

iv antibiotics

63
Q

management of anaphylactic shock

A

adrenaline 500mg 1:1000

64
Q

neurogenic shock

A

due to CNS injury
can be due to trauma to head and spine

65
Q

mgt of neurogenic shock

A

corticosteroids

66
Q

sepsis vs septic shock

A

sepsis - consistent hypotension
it is the infection that can then go onto causing shock

67
Q

what is sepsis

A

life threatening organ dysfunction caused by an infection

68
Q

sepsis is more common in:

A

very young children
very old
immunosuppressed
recent surgery
IV drug use

69
Q

clinical sigs of sepsis

A

temperature >38 degrees
high RR
blood pressure is <90
confusion
>9 HR
urine output is <0.5 Ml/Kg/hour
clammy skin
cyanosis

70
Q

management of sepsis

A

take 3:
blood cultures, urine output and lactates

give 3:
high flow oxygen
IV fluids
antibiotics

71
Q

golden hour of treatment for sepsis

A

1 hour

72
Q

target for oxygen for patients with COPD

A

89-92%

73
Q

what is neutropenic sepsis

A

sepsis
fever >38 degrees
neutrophil count will be less that <0.5x10^9
due to treatment related toxicity

74
Q

features of neutrogenic sepsis

A

same as sepsis
additional: on chemo
had a recent UTI
pneumonia

75
Q

management of neutrogenic sepsis

A

antibiotics immediately - don’t wait for WBC count
give piperacillin and tazebactum

76
Q

Steven John syndrome and toxic epidermal necrolysis

A

immune response causes epidermal necrosis
blistering and shedding of the skin

77
Q

SJS important fact

A

affects less that 10% of the body

78
Q

TEN (toxic epidermal necrolysis) important fact

A

affects more than 10% of the body

79
Q

Steven John syndrome and toxic epidermal necrolysis common cause

A

medications

80
Q

management for Steven John syndrome and toxic epidermal necrolysis

A

emergency!
supportive care - fluids
infection control
painkillers

81
Q

causes of burns

A

thermal
electrical
chemical
friction

82
Q

different types of thermal burns

A

contact
flame
scald - wet heat

83
Q

different types of electrical burns

A

high and low voltage
worse if done for a long period of time

84
Q

different types of chemical burns

A

acid and alkali

85
Q

burns are the most common type of injury
true of false

A

true

86
Q

what is the most common cause of burns in children

A

scald burns

87
Q

common cause of burns in adults

A

flames

88
Q

classification of burns - first degree

A

red and painful
superficial epidermal

89
Q

second degree burn 1

A

partial thickness superficial dermal
blistered
red
painful

90
Q

second degree 2

A

partial thickness
deep dermal
white and non blanching
reduced sensation

91
Q

third degree

A

white/brown or black
no blisters
no pain - all tissue is dead

92
Q

treatment fir burns

A

A-E approach - management of airways is important - smoke inhalation can cause narrowing of airways
iv fluids
wound care

93
Q

management for burns FATT

A

fluids
analgesia
tests
tubes

94
Q

burns can cause what shock?

A

hypovolaemic shock - as they can lose fluids

95
Q

burns on the back and chest can cause?

A

it can cause obstructive shock -

96
Q

what is a nilkolisky sign

A

when you apply pressure to a blister and it peels - looks like a burn
seen in SJS or TEN

97
Q

paracetamol OD management

A

give charcoal within an hour
then N-acetyl cisitine

98
Q

radial nerve injury at the humerous would cause?

A

wrist drop

99
Q

radial nerve injury at forearm would cause?

A

finger drop

100
Q

patient is unable to extend 4th and 5th digits of his hand
weakness in finger abduction and adduction

what nerve is damaged?

A

ulnar

101
Q

radial nerve injury at axilla would cause

A

wrist drop and tricep weakness

102
Q

median nerve injury would cause?

A

reduced finger flexion
reduced sensation - in median distribution of the hand

103
Q

flumazenil is the antidote for?

A

benzodiazepine

104
Q

naloze is the antidote for?

A

opioid

105
Q

IV glucagon is an antidote for?

A

beta blocker overdose

106
Q

terlipressin is given when?

A

in an oesophageal bleed to reduce portal hypertension

107
Q

how much glucose is a good amount to give IV

A

10%
as 50% can irritate the veins

108
Q

management for diabetic ketoacidosis

A

in the first hour - 1L of normal saline to reduce the acidosis

IF BP IS LOW:
give STAT of 500ml

IF BP IS NORMAL:
give 1L over 1 hour

109
Q

methadone overdose symptoms

A

pinpoint pupils
decreased heart rate
decreased rest rate
drowsiness

110
Q

what are the risks of referring syndrome

A

the electrolytes are very quickly taken up and used to make insulin which is released into the blood which then causes a massive drop in

potassium
magnesium and phosphate

this decrease can be fatal
and cause tachycardia

111
Q

where is an inguinal canal placed

A

it is superior and medial to the pubic tubercle

112
Q

where is a femoral canal placed

A

it is below and lateral to the pubic tubercle

113
Q

how long do you take medication for PE

A

unprovoked - 6 months
provoked - 3 months

114
Q

PE management

A

LMWH and apixaban for 5 days
and in an unstable patient give alteplase

115
Q

what are the visual symptoms for COPD poisoning

A

cherry pink and flushed skin

AMK (27 decks)

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