Emergency Medicine Flashcards
what is the cause of slow skin turgor
dehydration
what is anaphylaxis
it is a severe reaction to any antigen due to major histamine release of mast cells
when is it best to treat sepsis
golden hour - within an hour
why does diabetes decrease immunity
more sugar means more favourable environment for infections to grow
what is seen in torsades de pointes
polymorphic ventricular tachycardia
QRS axis is constantly shifting
treatment for torsades des pointes
magnesium sulphate
causes of torsades de pointes
MI
mitral valve prolapse
ischaemia
management of unstable and stable torsades des pointes
unstable: DC cardio version
stable: Magnesium sulphate
what is given to treat severe hyperkalaemia
calcium gluconate
- potassium is intracellular
- calcium is extracellular
calcium is given to push the potassium back inside the cells
treatments for hyperkalaemia
- insulin with dextrose - pushes K into the cells
- salbutamol
- sodium bicarbonate - works on collecting duct to push the K into the urine
- potassium resin bond
or dialysis
what is a lucid interval
after an injury for a period of time the person looks fine but isn’t
what bleed in the brain presents immediately after injury
arterial
what bleed in the brain presents slowly after an injury
venous bleed
what type of bleed is an extradural bleed
arteriall
what type of bleed is subdural
venous
treatment anagram for MI
Morphine
Oxygen
Nitrate GTN
Aspirin
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?
pericarditis and given NSAIDS
What is given in management of paracetamol overdose
Activated charcoal if OD was taken within an hour
Or
N-acetylcysteine
Halitosis
Bad smelling breath
Schatzi ring
Narrowing of lower oesophagus
Optic neuritis
Painful loss of vision
Abnormal perception of colours
Epigastric hernia
Protusionod the fat
Advise weight loss
Reverse tick in ST depression with first degree heart block
Dizziness
Nausea
What is it
Digoxin overdose
What is the antidote for digoxin overdose
Digibind
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?
within one hour
anaphalaxsis attack treatment
adrenaline IM 0.5ml of 1:1000
numbness in hand and wrist
inability to straighten fingers
wrist drop due to direct pressure on upper medial arm
Saturday night palsy
vomiting
abdo pain
breathing fast and high blood glucose
diabetic keto acidosis
what is acute coronary syndrome
also called coronary artery disease
causes a cessation in the blood supply to the myocardium
ischaemic heart disease
symptoms of ACS
chest pain
SOB
sweating
palpitations
pain radiating to the jaw and arms
light headedness
what comes under ACS
unstable angina
NSTEMI
STEMI
stable angina presentation
pain on exertion
unstable angina presentation
pain all the time
NSTEMI presentation
troponin levels are increased but no changes on ECG
t wave inversion
STEMI presentation
ECG will show ST elevation
when is troponin best tested
when the pain is there
as this is when the troponin is released
what is MONA - in management for ACS
morphine
oxygen
nitrates
aspirin
when should PCI be done for STEMI
within 2 hours
If the patient cannot be given PCI in 2 hours then?
give them fibrinolysis - shouldn’t give if there’s a risk of bleeding then clopidogrel and low molecular weight heparin and then PCI after
NSTEMI management
Beta blockers (not to give to asthmatics)
A - aspirin
T - ticagreolor
M- morphine
A - anticoags
N- nitrates
ACS secondary prevention
aspirin 75mg daily
another Antiplatelet
atrovastatin
ACE inhibs
atenolol
aldosterone antagonist
ACS prevention
stop smoking
reduce alcohol
then rehab
Cardiac Tamponade - what is it
fluid of blood fills in the pericardial sac
pericardium cannot stretch
pressure increases and compresses the heart
causes of cardiac tamponade
trauma
pericarditis
TB
malignancy
becks triad
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
what is kussumauls sign
JVP rises on every inhale and produces a wheeze
what is pulses paradoxus
systolic BP just goes up and down and not constant
investigation for cardiac tamponade
ECHO
chest x ray
ECG - tachycardia and electrical alternanas
management for cardiac tamponade
urgent needle pericardiocentresis
cardiac surgery
what is SHOCK
acute failure of the CVS to perfuse the tissues enough
not enough oxygen
what is cardiac output
HR x Stroke volume
what is stroke volume
how much blood pumped out in each ejection
different types of shock
cardiogenic
hypovalemic
obstructive
distributive
hypovalaemic
Due to blood of fluid loss
low BP
low CO2
high HR
management for hypovalaemic shock
IV fluids
cariogenic shock
low CO2
low cardiac output
due to MI
low BP
high HR
management for cariogenic shock
obstructive shock
due to tension pneumothorax
cardiac tamponade
PE
low BP
high HR
what is distributive shock
septic
anaphylactic
neurogenic
septic shock
low SVR
caused by peripheral vasodilation
due to infection
low BP
high HR
anaphylactic shock
low SVR
severe allergic reaction
SOB
hives
angioedema
low BP
high HR
management of septic shock
iv antibiotics
management of anaphylactic shock
adrenaline 500mg 1:1000
neurogenic shock
due to CNS injury
can be due to trauma to head and spine
mgt of neurogenic shock
corticosteroids
sepsis vs septic shock
sepsis - consistent hypotension
it is the infection that can then go onto causing shock
what is sepsis
life threatening organ dysfunction caused by an infection
sepsis is more common in:
very young children
very old
immunosuppressed
recent surgery
IV drug use
clinical sigs of sepsis
temperature >38 degrees
high RR
blood pressure is <90
confusion
>9 HR
urine output is <0.5 Ml/Kg/hour
clammy skin
cyanosis
management of sepsis
take 3:
blood cultures, urine output and lactates
give 3:
high flow oxygen
IV fluids
antibiotics
golden hour of treatment for sepsis
1 hour
target for oxygen for patients with COPD
89-92%
what is neutropenic sepsis
sepsis
fever >38 degrees
neutrophil count will be less that <0.5x10^9
due to treatment related toxicity
features of neutrogenic sepsis
same as sepsis
additional: on chemo
had a recent UTI
pneumonia
management of neutrogenic sepsis
antibiotics immediately - don’t wait for WBC count
give piperacillin and tazebactum
Steven John syndrome and toxic epidermal necrolysis
immune response causes epidermal necrosis
blistering and shedding of the skin
SJS important fact
affects less that 10% of the body
TEN (toxic epidermal necrolysis) important fact
affects more than 10% of the body
Steven John syndrome and toxic epidermal necrolysis common cause
medications
management for Steven John syndrome and toxic epidermal necrolysis
emergency!
supportive care - fluids
infection control
painkillers
causes of burns
thermal
electrical
chemical
friction
different types of thermal burns
contact
flame
scald - wet heat
different types of electrical burns
high and low voltage
worse if done for a long period of time
different types of chemical burns
acid and alkali
burns are the most common type of injury
true of false
true
what is the most common cause of burns in children
scald burns
common cause of burns in adults
flames
classification of burns - first degree
red and painful
superficial epidermal
second degree burn 1
partial thickness superficial dermal
blistered
red
painful
second degree 2
partial thickness
deep dermal
white and non blanching
reduced sensation
third degree
white/brown or black
no blisters
no pain - all tissue is dead
treatment fir burns
A-E approach - management of airways is important - smoke inhalation can cause narrowing of airways
iv fluids
wound care
management for burns FATT
fluids
analgesia
tests
tubes
burns can cause what shock?
hypovolaemic shock - as they can lose fluids
burns on the back and chest can cause?
it can cause obstructive shock -
what is a nilkolisky sign
when you apply pressure to a blister and it peels - looks like a burn
seen in SJS or TEN
paracetamol OD management
give charcoal within an hour
then N-acetyl cisitine
radial nerve injury at the humerous would cause?
wrist drop
radial nerve injury at forearm would cause?
finger drop
patient is unable to extend 4th and 5th digits of his hand
weakness in finger abduction and adduction
what nerve is damaged?
ulnar
radial nerve injury at axilla would cause
wrist drop and tricep weakness
median nerve injury would cause?
reduced finger flexion
reduced sensation - in median distribution of the hand
flumazenil is the antidote for?
benzodiazepine
naloze is the antidote for?
opioid
IV glucagon is an antidote for?
beta blocker overdose
terlipressin is given when?
in an oesophageal bleed to reduce portal hypertension
how much glucose is a good amount to give IV
10%
as 50% can irritate the veins
management for diabetic ketoacidosis
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
methadone overdose symptoms
pinpoint pupils
decreased heart rate
decreased rest rate
drowsiness
what are the risks of referring syndrome
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
where is an inguinal canal placed
it is superior and medial to the pubic tubercle
where is a femoral canal placed
it is below and lateral to the pubic tubercle
how long do you take medication for PE
unprovoked - 6 months
provoked - 3 months
PE management
LMWH and apixaban for 5 days
and in an unstable patient give alteplase
what are the visual symptoms for COPD poisoning
cherry pink and flushed skin
