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FOP/TAS > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

shockable side of the algorithm - initial energy value for shock

A

4J per kg

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2
Q

shockable side of the algorithm - after how many shocks do u give drugs

A

3 shocks

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3
Q

drugs given on shockable side of algorithm - doses and timing interval

A

ADRENALINE
10 mcg per kg
give after 3rd shock and every alternate cycle thereafter

AMIODARONE
5 mg per kg
give after 3rd shock and after 5th shock and that’s it!

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4
Q

max single dose of adrenaline during cpr

A

1 mg

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5
Q

max single dose of amiodarone during cpr

A

300 mg

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6
Q

non-shockable side of the rhythm, when do you give drugs and what are they

A

ADRENALINE
give as soon as possible

10 mcg per kg
and then give every 3-5 mins

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7
Q

4 H’s and 4 T’s

A

hypothermia
hypovolaemia
hypoxia
hyperkalaemia / electrolyte abnormalities

tension penumothorax
tamponade
thrombosis
toxic agents

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8
Q

classification of bradycardia

A

< 80 if < 1 year
< 60 if > 1 year

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9
Q

dose of atropine for bradycardia

A

up to 11y:
20 mcg / kg

12-17y:
300 - 600 mcg

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10
Q

if atropine doesn’t work for bradycardia, what should you consider giving

A

adrenaline

10 mcg/kg and repeat if necessary

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11
Q

shocks for synchronised cardioversion for SVT

A

1st shock 1J / kg

2nd shock 2J/kg, consider up to 4 J/kg

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12
Q

Rx torsades de pointes VT

A

magnesium

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13
Q

dose of IM adrenaline for <6m

A

100 - 150 micrograms (0.1 - 0.15mL)

of 1: 1000

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14
Q

dose of IM adrenaline for 6m - 6 years

A

150 micrograms (0.15mL)

of 1: 1000

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15
Q

dose of IM adrenaline for 6 - 12 years

A

300 micrograms (0.3mL)

of 1 :1000

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16
Q

dose of IM adrenaline for 12 years and above

A

500 micrograms (0.5mL)

of 1: 1000

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17
Q

why does the HR not increase appropriately in neurogenic shock

A

there is loss of sympathetic tone

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18
Q

Rx for choking in infant

A

5 back blows then 5 chest thrusts

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19
Q

Rx for choking in child

A

5 back blows then 5 abdominal thrusts

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20
Q

skin layers involved in 1st degree burn

A

epidermis only

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21
Q

blistering in 1st degree burns - Y or N

A

No

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22
Q

skin layers involved in 2nd degree burn

A

epidermis + papillary and reticular layers of dermis

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23
Q

blistering in 2nd degree burns - Y or N

A

Yes

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24
Q

skin layers involved in 3rd degree burns

A

entire epidermis and dermis (ie full thickness)

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25
Q

why are 3rd degree burns not painful

A

loss of nerve endings

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26
Q

what areas should nto be included in total % area calculation of burns

A

areas of erythema

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27
Q

Ix for burns

A

laser doppler to measure depth of the burns

carboxyhaemoglobin level

reflectance confocal microscopy + OCT to visualise tissue subcellularly

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28
Q

what do the colours in laser doppler mean

A

yellow = 2nd degree

blue = 3 rd degree

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29
Q

timings of when laser doppler is valid after burns

A

48h - 5d

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30
Q

how to calculate fluid resuscitaiton in burns

A

% burn x weight x 3

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31
Q

timings of giving fluid resus in burns

A

give 1/2 in the first 8h from time of onset of injury and then the next 1/2 given over the next 16h

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32
Q

fluid replacement on day 2 of burns

A

50% of the volume from day 1 due to reabsorption of oedema

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33
Q

what are infantile spasms also known as

A

west syndrome

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34
Q

what is the most prevalent epilepsy syndrome in infancy

A

west syndrome aka infantile spasms

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35
Q

pathophysiology of west syndrome

A

an insult to the brain during a critical period of dendritic spine formation, which causes a structural or functional disturbance in subcortical neurotransmitter pathways

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36
Q

presentation of infantile spasms

A

4-8mths

bilateral symmetrical brief contractions

repetitive head bobbing or nodding

occur in clusters with 5-30s between spells

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37
Q

what conditions are infantile spasms associated with

A

tuberose sclerosis
neurofibromatosis

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38
Q

EEG in infantile spasms

A

hypsarrhythmia -

no discernable pattern with disorganised electrical activity

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39
Q

what phase of sleep do infantile spasms NOT occur in

A

REM sleep

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40
Q

Rx for infantile spasms if cause unknown

A
  1. ACTH
  2. High dose pred
41
Q

Rx for infantile spasms if cause is tuberose sclerosis

A

Vigabatrin

42
Q

how does a febrile seizure normally present

A

generalised tonic clonic seizure followed by post ictal drowsiness

43
Q

1st line agents in seizure Rx

A

buccal midazolam 0.3-0.5mg/kg

OR

IV/IO lorazepam 0.1mg/kg

44
Q

timing of when to give 1st line seizure agent

A

after 5 min if seizure hasn’t self resolved

45
Q

what to give if seizure hasn’t terminated with buccal midaz or lorazepam

A

2nd dose of lorazepam 0.1mg/kg

46
Q

timing of when to give 2nd line agents in seizure

A

15-35 min

47
Q

2nd line seizure agents

A

Levetiracetam

OR

Phenytoin

OR

Phenobarbital

48
Q

what does the treatment algorithm recommend if 2nd line seizure agents havent worked and timing of doing this

A

20-40 min

can either give another alternative 2nd line drug, or if prepping to intubate and ventilate at this point then mvoe to 3rd line agents

49
Q

3rd line seizure agents

A

thiopental

or

propofol

50
Q

equation for cpp

A

CPP = MAP - ICP

51
Q

what does the CPP need to be maintained above to prevent brain ischaemia

A

> 400 mmHg

52
Q

Rx cushings triad

A

head up at 20 degrees in midline to aid venous drainage

mannitol 20%
- osmotic diuretic

53
Q

changes to resus protocol when temp <30C

A

limit defibrillation to 3 shocks

dont give antiarrhytmic and inotropic drugs

54
Q

changes to resus protocol when temp 30-35 C

A

double the dose interval for drugs

55
Q

pathophysiology of carbon monoxide poisoning

A

CO binds to Hb to form carboxyhaemoglobin (250x higher affinity for Hb than O2)

This reduces the oxygen carrying capacity of the blood

56
Q

how does CO poisoning affect the oxygen dissociation curve

A

shifts it to the left

57
Q

how does the % of carboxyhaemoglobin concentration in the blood affect symps

A

10% - rarely associated with symps

10-60% - headache and dyspnoea

60% - coma, convulsions, death

58
Q

Ix for CO poisoning

A

exhaled breath test

  • converts carbon monoxide concentrations into carboxyhaemoglobin levels
59
Q

Rx CO poisoning

A

100% O2

60
Q

what factors are associated with a worse prognosis in CO poisoning

A

exposure during pregnancy

coexisting CVS disease

pre-existing anaemia

acidotic on blood gas

61
Q

which solitary features necessitate a CT within 1h

A

NAI suspicion

GCS <14 (or <15 if <1y) on initial ED assessment

GCS <15 2h post injury

any sign of BOS

focal neurological deficit

bruising or laceration <5cm on the head (for children <1y)

62
Q

which features if > 1 present necessitate a CT within 1h

A

LOC > 5 mins

Abnormal drowsiness

3 or more discrete eps of vomiting

dangerous mechanism of injury

amnesia > 5min

N.B. if only has one of the above then observe for min 4h. If goes on to develop any in addition get CT within 1h

63
Q

timing of CT for head injury in a child on anticoagulant

A

8h

64
Q

criteria for CT C spine

A

GCS <13 on initial assessment

inutbated

focal peripheral neurological signs

paraesthesia in upper or lower limbs

definitive diagnosis of c-spine injury needed urgently

strong clinical suspicion despite normal xrays

plain xray suggests bony injury

65
Q

what is decorticate posturing and what causes it

A

bent arms, clenched fists, utstretched legs

caused by brain lesions above the red nucleus, affecting the corticospinal tracts

66
Q

what causes decerebrate posturing

A

a brain lesion below the red nucelus

67
Q

what is opisthotonus posturing

A

rigid and arching back and head thrown backwards

68
Q

cause of opisthotonus posturing

A

extrapyramidal effect from spamming of the axial muscles along the spinal column

69
Q

CT finding of epidural haematoma

A

lentilucar hyperlucency

70
Q

CT finding of subdural haematoma

A

biconcave hyperlucency

71
Q

blood film appareance in lead poisoning

A

basophilic stippling

72
Q

xray appearance in lead poisoning

A

increased metaphyseal density

73
Q

what blood lead level necessitates Rx

A

45 and above

74
Q

thresholds for different lead poisoning Rx

A

45-70 single agent

> 70 dual agent

75
Q

oral agents for Rx of lead poisoning

A

DMSA
penicillamine

76
Q

parenteral agents for Rx of lead poisoning

A

versenate

dimercaprol

77
Q

what doses of paracetamol cause serious toxciity

A

> 150mg/kg if < 6 years

> 75mg/kg if > 6 years

78
Q

two normal metabolites of pcm

A

glucuronide & sulphate

79
Q

pathophysiology of pcm overdose

A

in overdose there is overwhelming of the normal pcm metabolism procress, so it is metabolised by an alternative pathway

this produces NAPQI

this is normally inactivated by glutathione, but if the glutathione stores are overwhelmed then NAPQI induces necrosis of the liver and kidney

80
Q

acute vs staggered overdose of pcm

A

acute - ingestion over 1h or less

staggered - ingestion over >1h

81
Q

timing of pcm level testing

A

acute - do at 4h

if staggered ingestion or ingestion >4h before presentation then take level at time of presentation

82
Q

blood gas in pcm overdose

A

metabolic acidosis

83
Q

how does n-acetylcysteine work

A

replaces glutathione stores

84
Q

dose regimen of n-acetylcysteine

A

standard 21h regimen
total 300mg/kg

150mg/kg over 1h
50mg/kg over next 4h
100mg/kg over next 16h

85
Q

pathophysiology of salicylate OD

A

high doses of salicylate > stimualte respiratory centre in medulla > hyperventilation > respiratory alkalosis

disruption of kreb’s cycle > accumulation of lactate & pyruvic acid > metabolic acidosis

hyperpyrexia due to uncoupling of oxidase phosphorylase

86
Q

presentation salicylate poisoning

A

mild (125mg/kg)
- n&v/deafness/tinnitus/dizziness/lethargy

moderate (250mg/kg)
- sweaty/restless/bounding pulses/warm extremities/tachypnoea

severe (500mg/kg)
- pulm oedema/cerebral oedema/hyperpyrexia/seizures

87
Q

when to measure salicylate concentrations in OD

A

at 2h if symptomatic

at 4h if asymptomatic

88
Q

blood gas n salicylate OD

A

mixed metabolic acidosis and respiratory alkalosis

89
Q

Rx salicylate OD

A

Urinary alkalinisation
- sodabic
- need to correct hypokalaemia prior to this

activated charcoal if taken <1h previous and ingestion is >125mg/kg

Gastric lavage within 1h if ingestion is >500mg/kg

90
Q

Rx iron overdose

A

desferrioxamine

91
Q

complication of iron overdose

A

pyloric stenosis - iron causes scarring of the gut mucosa

92
Q

ECG changes in digoxin overdose

A

T wave flattening, short QT interval, prominent U waves

93
Q

blood gas in ethylene gylcol OD

A

severe metabolic acidosis with significant base deficit

94
Q

Rx ethylene glycol OD

A

IV fomepizole
Then sodabic to correct the acidosis

95
Q

Rx TCA OD

A

activated charcoal every 2-4 aiming to prevent reabsorption

96
Q

which substance causes unpleasant smell of rotting eggs in OD

A

hydrogen sulphide

97
Q

which substance causes unpleasant smell of garlic in OD

A

arsenic
selenium

98
Q

which substance causes unpleasant smell of bitter almonds in OD

A

cyanide

FOP/TAS (25 decks)

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