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Finals > Emergency medicine > Flashcards

Emergency medicine Flashcards

1
Q

Airway signs of anaphylaxis

A

Swelling of the throat -> stridor and hoarse voice

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2
Q

Breathing signs of anaphylaxis

A

Respiratory wheeze, dyspnoea

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3
Q

Circulation signs of anaphylaxis

A

Tachycardia, hypotension

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4
Q

Adrenaline for anaphylaxis under 6 months

A

100-150 micrograms (0.1-0.15ml 1 in 1000)

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5
Q

Adrenaline for anaphylaxis 6 months to 6 years

A

150 micrograms (0.15ml 1 in 1000)

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6
Q

Adrenaline for anaphylaxis 6-12 years

A

300 micrograms (0.3 ml 1 in 1000)

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7
Q

Adrenaline for anaphylaxis over age 12

A

500 micrograms (0.5ml 1 in 1000)

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8
Q

After how many minutes can you repeat adrenaline in anaphylaxis?

A

5 minutes

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9
Q

Site IM adrenaline injection

A

Anterolateral aspect of middle third of the thigh

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10
Q

What is refractory anaphylaxis?

A

Respiratory or cardiovascular problems despite two doses of IM adrenaline

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11
Q

Management of refractory anaphylaxis

A
  • IV fluids for shock
  • consideration of IV adrenaline infusion
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12
Q

Management of anaphylaxis after stabilisation

A
  • non sedating anti-histamines if continuing skin rash/urticaria
  • serum tryptase to see if anaphylaxis
  • if new episode of anaphylaxis refer to specialist allergy clinic
  • prescribe and show patient how to use 2 adrenaline auto injectors
  • WHO risk stratified approach to discharge
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13
Q

Who can be discharged after 2 hours from anaphylaxis?

A
  • good response to a single dose of adrenaline
  • complete resolution of symptoms
  • given adrenaline auto-injector and trained how to use it
  • adequate supervision following dishcarge
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14
Q

Discharge 6 hours after anaphylaxis

A
  • 2 doses of IM adrenaline required
  • or previous biphasic reaction
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15
Q

Discharge minimum of 12 hours from anaphylaxis

A
  • severe reaction requiring >2 doses of IM adrenaline
  • possibility of ongoing reaction e.g. modified slow release
  • severe asthma
  • difficult access to emergency care
  • late at night
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16
Q

Rate of compressions to ventilation in an adult

A

30:2

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17
Q

What are the shockable rhythms?

A
  • pulseless VT
  • ventricular fibrillation
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18
Q

What are the non shockable rhythms

A
  • asystole
  • PEA
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19
Q

Shocks in a witnessed cardiac arrest of a monitored patient

A

stacked shocks: 3 successive quick shocks

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20
Q

Drugs in cardiac arrest for a non shockable rhythm

A
  • give adrenaline 1mg as soon as possible
  • repeat every 3-5 minutes
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21
Q

Drugs in cardiac arrest for a shockable rhythm

A
  • give adrenaline 1mg after third shock
  • give amiodarone 300mg after 3 shocks then 150mg after 5 shocks
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22
Q

When should thrombolytic drugs be given in the context of cardiac arrest

A

if pulmonary embolus is suspected

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23
Q

If thrombolytic drugs are given in cardiac arrest, how long should cpr be continued for?

A

60-90 minutes

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24
Q

Reversible causes of cardiac arrest

A

4H’s:
- hypoxia
- hyperkalaemia
- hypothermia
- hypovolaemia

4T’s:
- toxins
- thrombus
- tamponade
- tension pneumothorax

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25
Q

Definition of sepsis

A

life-threatening organ dysfunction caused by a dysregulated host response to infection

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26
Q

qSOFA score

A
  • resp rate >22
  • Altered mentation
  • systolic BP <100mmHg

Heightened risk of mortality if score 2 or higher

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27
Q

Sepsis 6

A
  • IV antibiotics
  • oxygen
  • IV fluids (fluid challenge)
  • serum lactate
  • blood cultures
  • urine output
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28
Q

6 types of shock

A
  • haemorrhagic
  • septic
  • cardiogenic
  • neurogenic
  • anaphylactic
  • hypovolaemic
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29
Q

What is neurogenic shock?

A

Tends to occur in patients who have a transected spinal cord interrupting the autonomic nervous system resulting in decreased sympathetic tone or increased parasympathetic tone

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30
Q

What is status epilepticus?

A
  • single seizure lasting over 5 minutes
  • 2 seizures within 5 minutes, without the person returning to normal in between them
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31
Q

Management of status epilepticus

A
  • ABC: airway adjunct, oxygen, check blood glucose
  • PR diazapam or buccal midazolam if not in hospital
  • IV lorazepam if in hospital, can be repeated after 5-10 minutes
  • If ongoing give levetiricetam
  • if no resolution after 45 minutes then consider general anaesthesia or phenobarbital
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32
Q

Pre renal causes of AKI

A
  • hypovolaemia
  • renal artery stenosis
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33
Q

Renal causes of AKI

A
  • glomerulonephritis
  • Acute tubular necrosis
  • acute interstitial necrosis
  • rhabdomyolysis
  • tumour lysis syndrome
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34
Q

Post renal causes of AKI

A
  • kidney stone in ureter or bladder
  • BPH
  • external compression of the ureter
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35
Q

Nephrotoxic drugs

A
  • NAIDs
  • aminoglycosides
  • ACEi
  • ARB
  • diuretics
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36
Q

Definition of AKI

A
  • <0.5ml per kg per hour urine output
  • rise in creatinine of 26mmol in the past 48 hours
  • 50% or greater rise in serum creatinine over the past 7 days
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37
Q

Which drugs may have to be stopped in AKI because of risk of toxicity

A
  • metformin
  • lithium
  • digoxin
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38
Q

Signs of lower GI bleed

A
  • bright red blood or dark red per rectum
39
Q

Causes of lower GI bleed

A
  • colitis
  • divertiucular disease
  • haemorrhoids
  • cancer
  • angiodysplasia
40
Q

Management of lower GI bleed

A
  • history, abdo exam, PR, proctoscopy
  • consider admisson if over 60, hameodynamic instability, aspirin/NSAID, significant co-morbidity
  • outpatient colonoscopy if stable
  • if unstable then angiogram
41
Q

Features of upper GI bleed

A
  • haematemesis (coffee ground)
  • melena
  • raised urea
42
Q

oesophageal causes of upper GI bleed

A
  • oesophagitis
  • oesophageal cancer
  • mallory-weiss tear
  • oesophageal varices
43
Q

Gastric causes of upper GI bleed

A
  • gastric ulcer
  • gastric cancer
44
Q

Duodenal causes of upper GI bleed?

A
  • duodenal ulcer
  • aorto-enteric fistula
45
Q

When do you use the glasgow blatchford score vs rockall score

A

Rockall score is used after endoscopy

46
Q

What is the glasgow score used to calculate?

A

If the patient can be treated as an outpatient

47
Q

What is the rockall score used to calculate?

A

Percentage risk of rebleeding and mortality

48
Q

Management of variceal bleed

A
  • terlipressin and antibiotics at presentation (before endoscopy)
  • band ligation for oesophageal varices
  • N-butyl- 2-cyanoacrylate for gastric varices
  • transjugular intrahepatic portosystemic shunts if bleeding not controlled after above measures
49
Q

immediate first aid for burns

A
  • ABCDE
  • Heat: remove the person from the source, within 20 minutes irrigate with cool water for 10-30 minutes, cover with clingfilm (layered not wrapped)
  • electric: switch off power supply, remove person
  • chemical: brush off any powder, irrigate with water
50
Q

3 ways to assess extent of burn

A
  • Wallace rule of 9s : Head and neck=9%, each arm=9%, each anterior part of leg=9%, each posterior part of leg = 9%, anterior chest=9, posterior chest=9, anterior abdomen=9, posterior abdomen=9
  • Lund and browder chart
  • palmar surface is roughly 1%
51
Q

categories of depths of burn

A
  • superficial epidermal
  • partial thickness (superficial dermal)
  • partial thickness (deep dermal)
  • full thickness
52
Q

Superficial epidermal burn

A
  • red and painful
  • dry
  • no blister
53
Q

Partial thickness superficial dermal

A
  • pale pink
  • painful
  • blistered
  • slow capillary refill
54
Q

Partial thickness deep dermal

A
  • typically white
  • patches of non blanching erythema
  • reduced sensation
  • painful to deep pressure
55
Q

Full thickness burn

A
  • white (waxy), brown/black
  • no blisters
  • no pain
56
Q

Who should be referred to secondary care for a burn

A
  • any deep dermal or full thickness burn
  • superficial dermal affecting over 3% adult or 2% child
  • superficial dermal burn affecting the face, perineum, hands, feet, genitalia, any flexure, or circumferential burns on limb or torso or neck
  • inhalation injury
  • chemical or electrical burn
  • suspected non accidental injury
57
Q

management of superficial dermal burn

A
  • clean wound
  • leave the blister intact
  • non-adherent dressing
  • avoid topical creams
  • review in 24 hours
58
Q

For burns, who requires IV fluids?

A
  • Adults with greater than 15% BS
  • children with greater than 10%
59
Q

Management of more severe burns

A
  • IV fluids
  • urinary catheter
  • if circumferential may need escharotomy
  • early intubation should be considered if deep burns to face or neck, or blisters, or oedema of oropharynx
60
Q

Which head injury patients should get a head CT within an hour?

A
  • GCS<13
  • GCS<15 after 2 hours post injury
  • suspected open or depressed skull fracture
  • post injury seizure
  • 2 or more episodes of vomiting
  • focal neurological deficit
  • any sign of basal skull fracture
61
Q

What are the signs of a basal skull fracture?

A
  • panda eyes
  • battle sign
62
Q

Which head injury patients should receive a head CT within 8 hours

A

For adults who have experienced some kind of loss of consciousness or amnesia since the injury
- anyone aged 65 or older
- on anticoagulants or history of a bleeding disorder
- dangerous mechanism of injury
- more than 30 minutes of retrograde amnesia of events preceding the injury

63
Q

Presentation of extra dural haematoma

A
  • lucid interval
  • raised ICP
64
Q

What type of injury classically causes extra dural haematoma

A
  • acceleration deceleration injury
  • blow to the side of the head
65
Q

Which artery is most commonly associated with an extra dural head injury?

A

Middle meningeal

66
Q

Risk factors for subdural haemorrhage

A
  • older age
  • alcoholism
67
Q

Shape extra dural haematoma

A

lemon

68
Q

Shape subdural haematoma

A

Crescent

69
Q

What type of head bleed sudden collapse and loss of consciousness?

A

Sub arachnoid haemorrhage

70
Q

Which scans are most sensitive to diffuse axonal injury?

A

MRI

71
Q

Sub dural haematoma vessels

A

Bridging veins

72
Q

Management of mass effect in head injury

A

IV mannitol

73
Q

Signs of opiate overdose

A
  • pin point pupils
  • respiratory depression
  • drowsy
  • hypotensive
74
Q

Signs of anti-cholinergic overdose

A
  • blind as a bat, pupils dilated
  • mad as a hatter, confused and agitated
  • dry as a bone, dry mouth and urinary retention
  • red as a beet
  • hot as hell
  • tachycardia
75
Q

Management of amitriptyline overdose causing broad complex tachycardia or hypotension

A

NaHCO3 8.4%

76
Q

Benzodiazepine overdose

A
  • decreased heart rate
  • decreased resp rate
  • decreased bowel sounds
  • decreased temp
77
Q

When should you start NAC immediately?

A
  • staggered overdose
  • if presenting 8-24 hours after single ingestion and over 150mg/kg
  • if presenting over 24 hours since ingestion and showing signs of jaundice or hepatic tenderness
78
Q

In the context of paracetamol overdose, when should you check the paracetamol levels?

A

4 hours after ingestion

79
Q

Adverse NAC reaction

A
  • nausea/vomiting
  • flushing/pruritis
  • hypotension/bronchospasm
  • angioedema
80
Q

Management of adverse NAC reaction

A
  • stop NAC
  • antihistamine
  • bronchodilators
  • adrenaline
  • once treated can re-start NAC
81
Q

How do you calculate anion gap?

A

(Na+K) - (HCO3 + CL)

82
Q

Causes of high anion gap

A
  • Methanol
  • Uraemia
  • DKA
  • Paraldehyde
  • Iron, Isoniazid
  • Lactic acidosis
  • Ethanol
  • Salicylate
  • Carbon monoxide
  • Aminoglycosides
  • Theophylline
83
Q

Signs of cholinergic overdose

A
  • constricted pupils
  • increased bowel sounds
  • increased secretions
84
Q

Blood gas salicylate

A
  • respiratory alkalosis due to stimulation of the respiratory centre
  • then acidosis
85
Q

paracetamol overdose ingested less than an hour ago

A

activated charcoal

86
Q

Management of benzo overdose

A

Can use flumazenil but this can cause seizures which you then wouldnt be bale to treat with benzos so mainly just supportive management

87
Q

Lithium overdose management

A
  • IV saline
  • haemodialysis in severe toxicity
88
Q

heparin reversal agent

A

protamine sulphate

89
Q

management of beta blocker overdose

A
  • if bradycardic then atropine
  • in resistant cases can try glucagon
90
Q

Iron poisoning

A

desferrioxamine

91
Q

Lead poisoning

A

Dimercaprol, calcium edetate

92
Q

Criteria for liver transplant following paracetamol overdose

A
  • arterial pH less than 7.3 24 hours after ingestion

OR ALL of the following:
- PT>100 seconds
- creatinine >300
- grade III or IV encephalopathy

93
Q
A

Finals (37 decks)

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