Emergency Medicine Flashcards
What is the target oxygen saturation for acutely ill patients at risk of hypercapnoeic respiratory failure due to chronic respiratory disease?
88-92%
What is the target oxygen saturation for most acutely I’ll patients?
94-98%
What is the max flow rate of nasal cannulae?
Up to six litres, but consider changing to simple face mask at 5-6l
What test should be performed within in one hour of a patient requiring an increased oxygen dose?
ABG
What is hypoxic hypoxia?
When O2 content in the blood is low due to reduces partial pressure of oxygen
Occurs naturally at altitude, in emphysema etc
What is anaemic hypoxia?
When there is a reduced level of haemoglobin available for oxygen transport
For example, carbon monoxide poisoning
What is stagnant hypoxia?
Low level oxygen due to inadequate blood flow, either globally or regionally
May occur in low cardiac output, peripheral vascular disease
What is histotoxic hypoxia?
When cellular metabolic pathways are disrupted so that cells are unable to use oxygen
Eg cyanide poisoning
How is major trauma defined?
Patients with an injury severity score of >15
How is the size of a cervical collar measured?
From the top of the trapezius to the point of the chin, measured in fingers
This is then measured against the sizing posts on the cervical collar
This is adjusted to the correct size
What is a helpful mnemonic for life threatening thoracic injuries?
ATOM FC
Airway obstruction Tension pneumothorax Open chest wound Massive haemorrhage Flail chest Cardiac tamponade
What interventions may improve inadequate ventilation in the case of life threatening thoracic injury?
Optimise oxygenation Needle tube/thoracocentesis Pericardiocentesis Resuscitative thoracotomy Consider the need for intubation
What is a useful mnemonic for assessing for signs of shock?
Hands - temp, sweating, cap refill
End organ perfusion - gcs, urine output
Pulse - rate, quality, regularity
Blood pressure - hypotension
What is a useful mnemonic for identifying the site of blood loss?
On the floor and four more
External wounds Chests cavity Abdominal cavity Pelvic cavity Long bone fractures
What steps may be taken to manage inadequate circulation?
Optimise oxygenation Splints/tourniquet/direct pressure for active haemorrhage 2x large bore IV access in antecubital Fluid resus - warm crystalloid, blood IV tranexamic acid if bleeding Consider massive transfusion protocol Definitive haemostasis
How is brain injury classified according to the gcs!
Minor - 13-15
Moderate - 9-12
Severe - 3-8
Coma - <8
How should neuro disability be managed?
Optimise oxygenation Maintain cerebral perfusion - BP >90 Avoid hypoglycaemia Avoid pyrexia Definitive imaging and treatment
Where should hands be positioned in a log roll?
Two to stabilise the neck on the shoulder on top of the hip on top of the upper thigh Between the lower thighs Between the knees Between the ankles
How can spinal injury be managed?
Optimise oxygenation Ensure adequate ventilation Maintain spinal cord perfusion by avoiding hypotension Maintain immobilisation Document thorough spinal cord examination Urinary catheterisation Definitive imaging Early specialist advice
What can be used to stabilise a fractured pelvis and prevent haematoma!
A pelvic binder
Usually applied pre hospital
How can musculoskeletal injury be managed?
Optimise oxygenation
Maintain tissue perfusion - avoid hypotension
Apply splints
Analgesia
IV antibiotics
Monitor for complications - compartment syndrome, skin necrosis, nerve compression
What are commonly used trauma scores?
Abbreviated injury severity scale (AIS)
Injury severity scale (ISS)
Revised trauma score (RTS)
Trauma score- injury severity score (TRISS)
What causes anterior cord syndrome?
Direct anterior cord compression
Flexion injuries of the cervical spine
Thrombosis of the anterior spinal artery
How does anterior cord syndrome present?
Variable paralysis below level
Loss of pain and temperature perception
Proprioception and vibration sense are preserved
Has a poor prognosis
What causes brown Sequard syndrome?
Hemitransection or unilateral compression of the cord
Usually due to trauma
How does brown Sequard syndrome present?
Ipsilateral spastic paresis and loss of proprioception and vibration sense
Contralateral loss of pain and temperature perception
Moderately good prognosis
What causes central cord syndrome?
Hyperextension injuries
Spinal cord ischaemia
Cervical spinal stenosis
Usually syrinx, tumours in central spinal cord, trauma
How does central cord syndrome present?
Greater motor weakness in the upper extremities than the lower extremities
Greater distal weakness than proximal weakness
Sensory loss is variable
