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4th Year ACC > Emergency Medicine (2) > Flashcards

Emergency Medicine (2) Flashcards

1
Q

Definitive management of AAA?

A

Aortic cross clamping + dacron graft insertion

EVAR (elective) if not ruptured

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2
Q

Triad in appendicitis?

A

Raised WCC
Neutrophils >75%
Raised CRP

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3
Q

Small bowel obstruction on AXR?

A

Central, valvulae coniventes, gas

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4
Q

Large bowel obstruction on AXR?

A

Big

Haustra

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5
Q

Volvulus on AXR?

A

Coffee bean sign

Differentiate by where ‘line’ of coffee bean points

Sigmoid = right
Caecal = left
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6
Q

Immediate management of bowel obstruction?

A

Drip and suck (decompresses bowel)

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7
Q

Causes of acute pancreatitis?

A

I GET SMASHHHED

Idiopathic
Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune
Scorpion bites
Hyperlipidaemia
Hypercalcaemia
Hypothermia
ERCP
Drugs (thiazides)
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8
Q

Diagnosis of acute pancreatitis?

A

really high amylase (or lipase)

ABG for glasgow score

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9
Q

Prognostic score for acute pancreatitis?

A

Glasgow score - PANCREAS

PaO2
Age
Neutrophils
Ca2+
Raised urea
Enzymes
Albumin
Sugars

> 3 = HDU

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10
Q

Presentation of renal colic?

A

Unilateral colicky pain - loin to groin

Frequent painful passage of small volumes of urine with sensation of incomplete emptying.

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11
Q

Analgesia for renal colic?

A

NSAIDs - diclofenac

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12
Q

6 Ps of ischaemia?

A 
Pain
Paraesthesia
Pallor
Pulselessness
Paralysis
Perishingly cold
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13
Q

Risk factors for gout?

A 
Age
Male sex
Thiazides
Red meat
Alcohol
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14
Q

Management of gout (acute)

A

NSAIDs (diclofenac)
or
Steroids (pred)

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15
Q

Management of gout (long term)

A

Allopurinol

Lose weight, avoid starvation, avoid fatty foods, avoid XS alcohol

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16
Q

What do S3 and S4 heart sounds mean?

A

S3 = kentucky (sloshing in)

S4 = tennessee (a stiff wall)

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17
Q

Management of acute pulmonary oedema?

A

PODMAN

Position (sit up)
Oxygen
Diuretic (furosemide) + fluid resuscitation
Morphine
Antiemetic
Nitrates
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18
Q

SIgns of basal skull fracture?

A

Panda eyes
Battle’s sign
Haemotympanum

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19
Q

Indications for CT within 1 hour in head injury?

A 
GCS < 13 on initial assessment in ED
GCS < 15 2 hours after injury
Suspected open or depressed skull fracture
Post traumatic seizure
Any sign of basal skull fracture
Focal neurological deficit
>1 episode of vomiting
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20
Q

Indications for CT within 8 hours in head injury?

A

Current warfarin treatment = AUTOMATIC

IF LOC or AMNESIA as well…
>65 years old
>30 mins retrograde amnesia of events immediately before injury
Any history of bleeding/clotting disorders
Dangerous mechanism of injury

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21
Q

Diagnostic criteria for HHS?

A

Raised plasma osmolarity (>320 mOsmol/kg)
High glucose (>33.3 mmol/L)
No ketones in blood or urine

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22
Q

Signs of amphetamine overdose?

A 
Thirst
Confusion
Agitation
Tremor
Dilated pupils
High HR/BP/Temp
Ataxia, tachyarrhythmias, hyperthermia, water intoxiciation, DIC, hyperkalaemia, hepatocellular/muscle necrosis, cardiovascular collapse, ARDS
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23
Q

Supportive management in amphetamine overdose?

A

Anxiety/seizures - diazepam
Tachyarrhythmias - metoprolol
Hypertension - nifedipine/nitrates
Hyperthermia - active cooling, dantrolene if rectal temp >39

24
Q

Causes of hypocalcaemia?

A 
Vitamin D deficiency 
Hypoparathyroid
Acute pancreatitis
Alkalosis
Low Mg
Alcoholism
25
Q

Signs of hypocalcaemia?

A

Hyperreflexia
Tetany
Low BP/Low HR
Arrhythmias

Trousseau’s sign = spasm of hand from inflated BP cuff
Chvostek’s sign = unilateral twitching of face from tapping facial nerve 2cm anterior to auditory meatus

26
Q

What is the Cushing response?

A

Hypertension
Bradycardia
Irregular breathing

Sign of impending coning

27
Q

Investigations in temporal arteritis?

A

Bloods - ESR raised, CRP raised

Biopsy

28
Q

Management of temporal arteritis?

A

IV steroids
Strong analgeisa
Biopsy
Ophthalmology to exclude visual complications

29
Q

Complications of temporal arteritis?

A

Blindness (10-50%)

TIA/Stroke

30
Q

Red flag symptoms for acute back pain? (PAIN 6, NEUROLOGY 4, PMH/SYMPTOMS 5, AGE 2)

A

AGE
Age <20 or >55
Acute onset in elderly

PAIN
Constant or progressive pain
Nocturnal pain
Worse pain on being supine
Thoracic pain
Morning stiffness
Bilateral or alternating leg pain

NEUROLOGY
Bladder/bowel changes
Neurological disturbance
Perianal anaesthesia/sphincter disturbance
Leg claudication or exercise related weakness/numbness

PMH/SYMPTOMS
Fever, weight loss, night sweats
History of malignancy
Pulsatile abdominal mass
Current or recent infection
Immunosuppression (steroids/HIV)
31
Q

Causes of acute back pain?

A

Serious = cord compression, cauda equina, metastases, myeloma, infection, fracture, aortic aneurysm

Common = mechanical back pain, renal colic

32
Q

Management of mechanical back pain?

A

Early mobilisation, avoid lifting, maintain good posture

Analgesia (consider tricyclic or strong opioids if PCM, NSAIDs and weak opioids ineffective)

Diazepam for muscular spasm

Safety net - if bilateral symptoms or incontinence

33
Q

Ottawa ankle rules?

A

DONT APPLY TO CHILDREN UNDER 6

  1. Unable to walk 4 steps in ED or immediately after injury
  2. Bony tenderness at any of the points described
  3. Pain in midfoot (foot x-ray) or malleolar zone (ankle x-ray)

Posterior edge or tip of lateral/medial malleolus - 6cm
Base of 5th metatarsal
Navicular

34
Q

Management of ankle injury?

A

For 72 hours - PRICE

Protection - from further injury
Rest - for 48/72 hours. Use of crutches + controlled weight bearing
Ice - as soon as possible after injury for 10-30 mins
Compression - with bandage will limit swelling
Elevation - limits and reduces swelling

35
Q

Two types of distal radius fracture?

A

Colle’s fracture - dorsal displacement of fracture fragments - results from fall onto outstretched hand –> forced dorsiflexion of wrist
DINNER FORK

Smith’s fracture = reverse colle’s - anterior displacement of fracture fragments. Falling backwards with arm pronating as body falls.
GARDEN SPADE

36
Q

Presentation of hip fracture?

A

Shortened, adducted and externally rotated

Exacerbation of pain on palpation of greater trochanter and by rotation of the hip

37
Q

What is garden classification?

A

Femur fracture classification

I - IV

III and IV is bad because avascular necrosis of femoral head

38
Q

Most common type of shoulder dislocation?

A

Anterior (98%)

39
Q

Presentation of anterior shoulder dislocation?

A

Arm at side of body in external rotation
Shoulder loses its usual roundness
Humeral head palpable anteriorly

40
Q

Neurovascular things in anterior shoulder dislocation?

A

Radial pulse
Radial nerve function - extension and sensation
Axillary nerve - regimental badge area

41
Q

Presentation or posterior shoulder dislocation?

A

Abducted and internally rotated

Nerve/vascular injury not common

42
Q

X-ray in anterior shoulder dislocation?

A

AP - humeral head lies under coracoid process

Axillary - shows head of humerus (golf ball) anterior to glenoid (tee)

Transscapular ‘Y’ view - humeral head seen lying anterior to ‘Y’ with glenoid at centre of ‘Y’

43
Q

X-ray in posterior shoulder dislocation?

A

AP - lightbulb sign (due to rotation) and widened GH joint

Y-view - humeral head posteriorly positioned in relation to glenoid

44
Q

Adverse features in dysrhythmias?

A

Shock
Syncope
(usually brady)

HF
MI
(usually tachy)

45
Q

Tachyarrhythmias - what to do if adverse features?

A

Synchronised DC shock (up to 3 attempts)
Seek expert help

Amiodarone 300 mg IV over 10-20 minutes
Repeat shock
Amiodarone 900 mg over 24h (in ICU - thrombophlebitis)

46
Q

Regular narrow complex tachycardia?

A

SVT

Vagal menoeuvres 
Adenosine 6mg rapid IV bolus
If no effect give 12mg
If no effect give further 12mg
Monitor ECG continuously

If sinus rhythm achieved, probable re-entry paroxysmal SVT.

If sinus rhythm not achieved - possible atrial flutter - control rate with beta blocker and SEEK EXPERT HELP

47
Q

Irregular narrow complex tachycardia?

A

Probable AF

Control rate with beta blocker or diltiazem
In HF consider digoxin or amiodarone

Assess thromboembolic risk and consider anticoagulation

48
Q

Regular broad complex tachycardia?

A

VT or SVT + BBB

If VT (or uncertain) - amiodarone 300mg IV over 20-60 mins then 900 mg over 24h

If known to be SVT w/BBB - treat as regular narrow complex tachycardia

49
Q

Irregular broad complex tachycardia?

A

AF + BBB or Pre-excited AF

SEEK EXPERT HELP

If AF + BBB - treat as for narrow complex

If pre-excited AF - consider amiodarone

50
Q

Examples of vagal manoeuvres?

A

10s of carotid sinus massage
Straining down as if passing a stool
Blowing plunger out of clean syringe
Immersing face in icy water

51
Q

Bradycardias - what to do if adverse features?

A

Atropine 500 mcg IV

52
Q

What to do if adverse features in bradycardia but no response to atropine?

A

Consider interim measures:

Atropine 500mcg IV repeat to maximum 3 mg
OR
Transcutaneous pacing
OR 
Isoprenaline 5 mcg/min IV
Adrenaline 2-10 mcg/min IV
Alternative drugs

SEEK EXPERT HELP + ARRANGE TRANSCUTANEOUS PACING

53
Q

Alternative drugs in bradycardia?

A

Aminophylline
Dopamine
Glucagon (if brady caused by B blocker or CCB)
Glycopyrrolate (anti muscarinic)

54
Q

What are the conditions that cause risk of asystole in bradycardia?

A

Recent asystole
Mobitz II AV block
Complete heart block with broad QRS
Ventricular pause >3 s

55
Q

What are the different types of heart block?

A

1st degree = lengthened PR interval

2nd degree (Wenkebach/Mobitz I) = progressive PR prolongation until dropped beat - beats dropped in regular pattern

2nd degree (Mobitz II) = intermittent non-conducted P waves. PR interval constant. Fixed no. of non-conducted P waves for every QRS (2:1/3:1)

3rd degree = no relationship between QRS and P waves

56
Q

Management of testicular torsion?

A

Emergency surgical exploration

USS can confirm diagnosis but should not delay management

4th Year ACC (9 decks)

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