Emergency medicine Flashcards
What are the symptoms and treatment of foreign body above the glottis?
Hoarseness of voice
Drooling
Gagging/ coughing
Inspiratory stridor
Tt: flexible nasal endoscopy
What are the symptoms and treatment of foreign body below the glottis?
Unilateral expiratory wheeze
Tt: bronchoscopy (flexible for detecting, rigid for extracting)
What are the symptoms of a basal skull fracture, and which bone is most likely affected?
Battle’s sign (mastoid ecchymosis)
CSF rhinorrhea (torn dura, risk of meningitis)
Seventh nerve palsy
Periorbital ecchymosis (racoon eyes)
Haemotympanum
Vertigo
This type of fracture most commonly affects the petrous portion of the temporal bone, the external auditory canal, and the eardrum.
What is the difference of the pain experienced during an MI and an aortic dissection?
MI: pain occurs slowly and gains intensity with time, usually a few hours; dull and crushing pain.
AD: sharp, tearing or ripping pain, abrupt and at its maximum from the time of onset.
What is the most appropriate action in a suspected TCA overdose, and why?
ECG monitoring.
Important ECG finding suggestive of TCA poisoning is QRS widening (>100 ms); broad complex tachycardias may occur which are life threatening.
What is the suspected diagnosis and most appropriate initial investigation?
Severe epigastric pain, referred to the right shoulder;
Rigid abdomen;
History of rheumatoid arthritis
Dx: perforated peptic ulcer
Investigation: erect chest X-ray. Air under the diaphragm gives the diagnosis of a perforation
What are the signs of heroin withdrawal?
Agitation, nervousness, abdominal cramp, sweating, shivering, arthralgia
What is the most appropriate treatment for active bleeding in a patient with liver disease and a high INR?
Fresh frozen plasma, which contains clotting factors not produced in liver disease
What are the findings of subdural haemorrhage?
Thunderclap headache;
Requires urgent CT of the brain;
Crescent-shaped hyperdensity
What are the findings of extradural haemorrhage?
Usually follow trauma;
Biconvex or lens-shaped haemorrhage
How to treat if a high amount of paracetamol has been consumed > 36 hours ago?
- Obtain paracetamol levels, INR, venous gas, renal profile, liver profile and FBC
- If jaundiced, start NAC immediately, don’t wait for blood results
How to treat if a high amount if paracetamol has been consumed > 15 hours ago or if a staggered ingestion was taken > 24 hours ago?
Start NAC within 1 hour
How to treat if a high amount of paracetamol was ingested and the timing is uncertain?
Start NAC within 1 hour
How to treat if a high dose of paracetamol was ingested < 1 hour ago and the dose was > 150 mg/kg?
Give activated charcoal orally with IV antiemetic
Take blood sample 4 hours post-ingestion
If paracetamol levels are above treatment line, star NAC
How to treat if a high dose of paracetamol was ingested < 4 hours ago?
Delay blood tests until 4 hours post-ingestion
If paracetamol levels are above treatment line, star NAC
How to treat if a high dose of paracetamol was ingested > 4 hours ago and the results would be available within 8 hours of ingestion?
Obtain paracetamol levels, INR, venous gas, renal profile, liver profile and FBC
If paracetamol levels are above treatment line, star NAC
How to treat if a high dose of paracetamol was ingested > 4 hours ago and the results would not be available within 8 hours of ingestion?
Prescribe NAC
Also do paracetamol levels and continue NAC if above treatment line
What are the “sepsis 6”?
Take 3, give 3
Take 3
- blood cultures
- FBC, urea and electrolytes, coltting, lactate
- start monitoring urine output
Give 3
- high flow oxygen
- intravenous fluid challenge
- intravenous ATB
What is the maximum daily paracetamol dose?
4g in adults
ie: 2x 500mg tablets four times a day
What is the percentage of body surface burned that requires fluid replacement in children?
10%
What are the symptoms and most commonly affected bone in an orbital blowout fracture?
Periorbital ecchymosis, enophthalmos and diplopia on upward gaze
Most common: maxilla (orbital floor)
followed by ethmoid (medial wall)
What is the consequence for rapid correction of hypernatraemia?
Cerebral oedema
“high to low your brain will blow”
What is the consequence for rapid correction of hyponatremia?
Central pontine myelinolysis
“low to high your pons will die”
Why should diabetic patients, who take insulin, take carbohydrates before going to bed if drinking alcohol?
Because during alcohol intoxication, the liver is too busy to break down glycogen, so glucagon is ineffective
What is the percentage of stage 1 blood loss?
10 - 15%
What is the percentage and symptoms of stage 2 blood loss?
15 - 30%
Postural hypotension
Slight tachycardia > 100 bpm
Increased RR > 20 ipm
Slightly restless mental status
Urine output 20-30 ml/hour
What is the percentage and symptoms of stage 3 blood loss?
30 - 40%
Hypotension
Tachycardia > 120 bpm
Tachypnoea > 30 ipm
Confused mental status
Urine output less than 20 ml/hour
What is the percentage and symptoms of stage 4 blood loss?
Over 40%
Marked hypotension
Extreme tachycardia < 140 bpm
Extreme tachypnoea
Decreased consciousness, lethargy or coma
No urine output
What solution should be prescribed for correction of hyperkalaemia with ECG changes for a patient with normal blood glucose?
10 units of short-acting (Actrapid) insulin with 50 ml dextrose 50% given over 5-15 minutes
Followed by 500ml dextrose 10% over 12 hours
What solution should be prescribed for correction of hyperkalaemia with ECG changes for a patient with high blood glucose (more than 11.1)?
10 units of short-acting (Actrapid) insulin with 50 ml sodium chloride 0.9% given over 5-15 minutes
Only once glucose levels normalise, give 500ml dextrose 10% over 12 hours
How to manage > 5% and > 10% burns in children?
> 5% refer to burn unit
10% start IV + refer
How to manage > 5% and > 10% burns in adults?
> 10% refer to burn unit
15% start IV + refer
What are the symptoms of heroin withdrawal?
Flu like syndrome: muscle cramps, watering eyes, runny nose
Oter symptoms like agitation, sweating and insomnia
How to proceed with a clinically stable patient with a trauma associated fracture?
Splint it
Hip - Thomas’ splint
What is the normal lab value for glucose?
3.5 to 5.5
What are the appropriate tests to determine the severity of asthma exacerbation in urgent care, and in A&E?
Urgent care: peak flow meter
- moderate: PEFR 50 to 75% best or predicted
- acute: PEFR 33 to 50% best or predicted ( admit if any features of severe asthma remain after initial management)
- life-threatening: PEFR < 33% best or predicted (admit immediately)
A&E: arterial blood gas
How to treat major bleeding in patients who are using warfarin?
- stop warfarin
- vitamin K
- PCC
- FFP
How to differentiate between the 4 stages of shock?
Stage 1
- 10-15% blood loss
- normal BP
- normal HR
Stage 2
- 15-30% blood loss
- postural hypotension
- slight tachycardia > 100 bpm
Stage 3
- 30-40% blood loss
- hypotension
- tachycardia < 120 bpm
Stage 4
- > 40% blood loss
- marked hypotension
- severe tachycardia > 140 bpm
