Emergency Medicine Flashcards
What is Wellen’s syndrome
An abnormal ECG pattern:
- Deeply inverted/biphasic T waves in leads V2 + V3
+ history of revent chest pain now resolved
Due to LAD stenosis
Features of isolated posterior MI on ECG
ST depression leads V1-V3
Upright Rs + T waves
Cause of isolated ST-depression in AVL
Inferior STEMI is a common cause
Requirements for coronary angiography with follow-on PCI, if indicated
In acute STEMI
Presentation within 12 hours of symptom onset
Primary PCI can be delivered within 120 minutes of time when fibrinolysis could have been given
Can be considered after more than 12 hours onset if there is evidence of continuing myocardial ischaemia/cardiogenic shock
When is fibrinolysis offered
Acute STEMI
Presenting within 12 hours of symptom onset
Primary PCI can NOT be delivered within 120 minutes
Features of acute upper GI bleed
Haematemesis - often bright red, may be coffee-ground
Malaena
Raised urea
Features of other diagnosis e.g. oesophageal varices –> stigmata of liver diseae
Oesophageal causes of acute upper GI bleed
Oesophageal varices
Oesophagitis
Cancer
Mallory-Weiss tear
Gastric causes of acute upper GI bleed
Gastric ulcer
Gastric cancer
Dieulafoy lesion
Diffuse erosive gastritis
Duodenal causes of acute upper GI bleed
Duodenal ulcer
Aorto-enteric fistula
Risk assessment for acute upper GI bleed
Glasgow-Blatchford score at first assessment
Rockall score - used after endoscopy
Factors in Glasgow-Blatchord score
Urea (high levels = worse)
Haemoglobin (low levels = worse)
Systolic BP (lower = worse)
Pulse
Melaena
Syncope
Hepatic disease
Cardiac failure
Commonest sites for IO access
Proximal tibia (anteromedial aspect)
Distal femur <6yrs
Proximal humerus >6yrs
Organophosphate poisoning features
DUMBELS:
Defecation + diaphoresis
Urinary incontinence
Miosis
Bradycardia
Emesis
Lacrimation
Salivation
Pathophysiology behind features of organophosphate poisoning
Predominance of overstimulation of parasympathetic nervous system
