Emergency Medicine Flashcards
What are the components of Sepsis 6?
3 in - oxygen, antibiotics, fluids
3 out - blood cultures, lactate, urine
What is the tennis score system of hypovolaemic shock?
Class I - 0-15% blood loss, increase RR
Class II - 15-30% blood loss, increase in RR and HR
Class III - 30-40% blood loss, increase in RR and HR, decrease in BP
Class IV - >40% blood loss, decreased perfusion to kidneys and brain manifesting as low urine output and LOC
What are the diagnostic features of DKA?
Diabetic - hyperglycaemia: BM > 30 mmol/L
Ketotic - positive for ketones in urine and blood
Acidotic - low pH on ABG + hyperkalaemia
What are the diagnostic features of HONK
Hyperglycaemia - BM > 35 mmol/L
Hyperosmolar - pOsm > 340 mmol/L
Non-ketotic - negative for ketones in urine and blood
Outline the management of hyperglycaemia in the acute setting
1) ABC approach
2) IV fluids (0.9% saline) - if in DKA and BP < 90 systolic, give bolus
3) IV insulin - 0.1 unit / kg / hour
4) Look for trigger (infection, missed insulin etc.)
5) Monitor BM, pH and K - give dextrose and potassium after first hour
Outline the acute management of ischaemic stroke
1) ABC approach
2) CT head
3) If no evidence of bleeding + within 4.5 hours of symptom onset - thrombolysis
4) Aspirin (300mg PO)
5) Transfer to stroke unit
Outline the management of status epilepticus
1) ABC approach
2) Place patient in recovery position + O2
3) Lorazepam (2-4mg IV) or Diazepam (10mg IV) or midazolam (10mg buccal)
4) Repeat if still fitting at 2 mins
5) Call for anaesthetic support
6) Phenytoin infusion
7) RSI - intubation + propofol
What is the Rx of bacterial meningitis in hospital?
2g cefotaxime IV
Outline the management of acute GI bleeds (HINT: think 8 Cs)
1) ABC approach
2) 15 L O2 (non re-breather)
3) Cannulae - 2x large bore
4) Catheter - strict fluid monitoring
5) Crystalloid
6) Cross match - 6 units of blood
7) Correct clotting abnormalities
8) Camera - endoscopy
9) Culprit - stop culprit drugs (eg NSAIDs, aspirin, warfarin, heparin)
10) Call the surgeons
Outline the management of PE
1) ABC approach
2) 15 L O2 (non-rebreather)
3) Morphine 5-10 mg IV + metoclopramide 10mg IV
3) LMWH (eg: tinzaparin 175 U/kg SC)
What is the treatment for tension pneumothorax?
1) Emergency aspiration (i.e. needle decompression)
2) Insertion of chest drain
Outline the management of acute exacerbation of asthma
1) ABC approach
2) 15 L O2 (non re-breather)
3) Salbutamol: 2 puffs every 10 minutes up to 10 puffs
4) Salbutamol neb (5mg with O2)
5) Prednisolone (40-50 mg PO) or Hydrocortisone (100 mg IV)
6) Ipratropium bromide neb (500 ug)
7) Magnesium sulfate (1-2 g IV)
8) Theophylline (5mg/kg IV loading dose then 0.5mg/kg/hr IV)
Outline the management of anaphylaxis
1) ABC approach
2) 15 L O2 (non re-breather)
3) Remove cause
4) Adrenaline 500 ug 1:1000 IM
5) Chlorpehnamine 10 mg IV
6) Hydrocortisone 200 mg IV
7) Bronchodilators if wheeze
Define cardiogenic shock
inadequate tissue perfusion due to cardiac dysfunction (i.e. low cardiac output)
List the causes cardiogenic shock (HINT: think MI HEART)
MI
Hyperkalaemia Endocarditis / PE Aortic dissection Rhythm (arrhythmias) Tamponade / Tension pneumothorax
List the causes of VT (HINT: think IM QVICK)
Infarction
Myocarditis
QT interval - long Valve abnormality - esp prolapse Iatrogenic - esp digoxin Cardiomyopathy - esp dilated K low / Mg low / O2 low / pH low
What do you monitor at the following intervals in patients in DKA:
- every hour
- every two hours
- every four hours
Every hour - blood glucose, blood ketones
Every two hours - VBG (K, bicarb)
Every four hours - U&Es
If suspecting renal colic, when should you perform a CT KUB?
Tender renal angle
What is the typical presentation of renal colic?
Colicky/wave pain from loin to groin
What is the atypical presentation of renal colic?
Constant loin to groin pain
Outline the analgesia given to renal colic patients
PO paracetamol, codeine
PR diclofenac
IV morphine w/ ondansetron
List the criteria for CT within 1 hour following head injury
GCS < 13 or deteriorating Evidence of base of skull fracture Any evidence of depressed skull fracture Seizure Focal neurology Vomiting
What is the indication for CT within 8 hours of a head injury?
Anticoagulated patients
Name the two types of chest drain - what is the difference between them and when is each used?
Narrow bore / seldinger drain - inserted into the “safe triangle” using the seldinger technique, used for drainage of air and fluid (not blood)
Wide bore / surgical drain - inserted into the “safe triangle” by scalpel incision, used for drainage of blood (clots can obstruct narrow bore
What is Beck’s Triad?
Triad of symptoms present with cardiac tamponade - raised JVP, hypotension, muffled heart sounds
What is the Cushing Reflex and what does it signify?
Hypertension + Bradycardia + Irregular Breathing - suggestive of imminent herniation (in the presence of brain injury)
