Emergency Medicine

Question 1

What are the components of Sepsis 6?

Answer 1

3 in - oxygen, antibiotics, fluids

3 out - blood cultures, lactate, urine

Question 2

What is the tennis score system of hypovolaemic shock?

Answer 2

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

Question 3

What are the diagnostic features of DKA?

Answer 3

Diabetic - hyperglycaemia: BM > 30 mmol/L
Ketotic - positive for ketones in urine and blood
Acidotic - low pH on ABG + hyperkalaemia

Question 4

What are the diagnostic features of HONK

Answer 4

Hyperglycaemia - BM > 35 mmol/L
Hyperosmolar - pOsm > 340 mmol/L
Non-ketotic - negative for ketones in urine and blood

Question 5

Outline the management of hyperglycaemia in the acute setting

Answer 5

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

Question 6

Outline the acute management of ischaemic stroke

Answer 6

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

Question 7

Outline the management of status epilepticus

Answer 7

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

Question 8

What is the Rx of bacterial meningitis in hospital?

Answer 8

2g cefotaxime IV

Question 9

Outline the management of acute GI bleeds (HINT: think 8 Cs)

Answer 9

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

Question 10

Outline the management of PE

Answer 10

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)

Question 11

What is the treatment for tension pneumothorax?

Answer 11

1) Emergency aspiration (i.e. needle decompression)

2) Insertion of chest drain

Question 12

Outline the management of acute exacerbation of asthma

Answer 12

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)

Question 13

Outline the management of anaphylaxis

Answer 13

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

Question 14

Define cardiogenic shock

Answer 14

inadequate tissue perfusion due to cardiac dysfunction (i.e. low cardiac output)

Question 15

List the causes cardiogenic shock (HINT: think MI HEART)

Answer 15

MI

Hyperkalaemia
Endocarditis / PE
Aortic dissection
Rhythm (arrhythmias)
Tamponade / Tension pneumothorax

Question 16

List the causes of VT (HINT: think IM QVICK)

Answer 16

Infarction
Myocarditis

QT interval - long
Valve abnormality - esp prolapse
Iatrogenic - esp digoxin
Cardiomyopathy - esp dilated
K low / Mg low / O2 low / pH low

Question 17

What do you monitor at the following intervals in patients in DKA:

• every hour
• every two hours
• every four hours

Answer 17

Every hour - blood glucose, blood ketones

Every two hours - VBG (K, bicarb)

Every four hours - U&Es

Question 18

If suspecting renal colic, when should you perform a CT KUB?

Answer 18

Tender renal angle

Question 19

What is the typical presentation of renal colic?

Answer 19

Colicky/wave pain from loin to groin

Question 20

What is the atypical presentation of renal colic?

Answer 20

Constant loin to groin pain

Question 21

Outline the analgesia given to renal colic patients

Answer 21

PO paracetamol, codeine
PR diclofenac
IV morphine w/ ondansetron

Question 22

List the criteria for CT within 1 hour following head injury

Answer 22

GCS < 13 or deteriorating 
Evidence of base of skull fracture
Any evidence of depressed skull fracture
Seizure
Focal neurology 
Vomiting

Question 23

What is the indication for CT within 8 hours of a head injury?

Answer 23

Anticoagulated patients

Question 24

Name the two types of chest drain - what is the difference between them and when is each used?

Answer 24

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

Question 25

What is Beck’s Triad?

Answer 25

Triad of symptoms present with cardiac tamponade - raised JVP, hypotension, muffled heart sounds

Question 26

What is the Cushing Reflex and what does it signify?

Answer 26

Hypertension + Bradycardia + Irregular Breathing - suggestive of imminent herniation (in the presence of brain injury)