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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
Signs of hypocalcaemia?
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
What is the Cushing response?
Hypertension Bradycardia Irregular breathing Sign of impending coning
27
Investigations in temporal arteritis?
Bloods - ESR raised, CRP raised Biopsy
28
Management of temporal arteritis?
IV steroids Strong analgeisa Biopsy Ophthalmology to exclude visual complications
29
Complications of temporal arteritis?
Blindness (10-50%) | TIA/Stroke
30
Red flag symptoms for acute back pain? (PAIN 6, NEUROLOGY 4, PMH/SYMPTOMS 5, AGE 2)
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
Causes of acute back pain?
Serious = cord compression, cauda equina, metastases, myeloma, infection, fracture, aortic aneurysm Common = mechanical back pain, renal colic
32
Management of mechanical back pain?
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
Ottawa ankle rules?
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
Management of ankle injury?
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
Two types of distal radius fracture?
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
Presentation of hip fracture?
Shortened, adducted and externally rotated Exacerbation of pain on palpation of greater trochanter and by rotation of the hip
37
What is garden classification?
Femur fracture classification I - IV III and IV is bad because avascular necrosis of femoral head
38
Most common type of shoulder dislocation?
Anterior (98%)
39
Presentation of anterior shoulder dislocation?
Arm at side of body in external rotation Shoulder loses its usual roundness Humeral head palpable anteriorly
40
Neurovascular things in anterior shoulder dislocation?
Radial pulse Radial nerve function - extension and sensation Axillary nerve - regimental badge area
41
Presentation or posterior shoulder dislocation?
Abducted and internally rotated Nerve/vascular injury not common
42
X-ray in anterior shoulder dislocation?
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
X-ray in posterior shoulder dislocation?
AP - lightbulb sign (due to rotation) and widened GH joint Y-view - humeral head posteriorly positioned in relation to glenoid
44
Adverse features in dysrhythmias?
Shock Syncope (usually brady) HF MI (usually tachy)
45
Tachyarrhythmias - what to do if adverse features?
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
Regular narrow complex tachycardia?
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
Irregular narrow complex tachycardia?
Probable AF Control rate with beta blocker or diltiazem In HF consider digoxin or amiodarone Assess thromboembolic risk and consider anticoagulation
48
Regular broad complex tachycardia?
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
Irregular broad complex tachycardia?
AF + BBB or Pre-excited AF SEEK EXPERT HELP If AF + BBB - treat as for narrow complex If pre-excited AF - consider amiodarone
50
Examples of vagal manoeuvres?
10s of carotid sinus massage Straining down as if passing a stool Blowing plunger out of clean syringe Immersing face in icy water
51
Bradycardias - what to do if adverse features?
Atropine 500 mcg IV
52
What to do if adverse features in bradycardia but no response to atropine?
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
Alternative drugs in bradycardia?
Aminophylline Dopamine Glucagon (if brady caused by B blocker or CCB) Glycopyrrolate (anti muscarinic)
54
What are the conditions that cause risk of asystole in bradycardia?
Recent asystole Mobitz II AV block Complete heart block with broad QRS Ventricular pause >3 s
55
What are the different types of heart block?
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
Management of testicular torsion?
Emergency surgical exploration USS can confirm diagnosis but should not delay management

4th Year ACC (9 decks)

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