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Emergency Medicine Flashcards

1
Q

DDx of life threatening chest injuries:

A

HOT and FAT CHEST

  • Hemothorax
  • Open pneumo
  • Tension pneumothorax
  • Flail chest
  • Airway obstruction
  • Tamponade
  • Contusion: myocardial or pulmonary
  • Hernia: traumatic, diaphragmatic
  • ESophageal performation
  • Tracheobronchial disruption
  • Traumatic/Thoracic Aortic Rupture
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2
Q

Management of anaphylaxis/allergic reaction

A
  1. ABC’s
  2. Secure airway and IV access
    Give 100% O2
    Intubate if obstruction
    Raise feet to help restore circulation
3.  IM epinephrine
     Adult:  0.5mL of 1:1000
     Child:  0.01mL/kg/dose up to 0.4mL 
     1:1000.
     Repeat every 5min if needed
  1. Chlorphenamine 10mg IV
    Hydrocortisone 200mg IV
    0.9% saline
  2. If wheeze - treat using asthma protocol
    Nebulized salbutamol
  3. If still hypotensive - IV adrenalin in ICU
  4. Patient should be monitored for atleast
    4-6hrs.
    FU with GP 24-48hrs later - risk of 2nd
    phase response up to 48 hrs later.
    Suggest medical alert bracelet
    Teach self injection of epipen
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3
Q

Definition of shock

A

Circulatory failure resulting in inadequate organ perfusion.

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4
Q

List the types of shock

A
  1. Cardiogenic shock
  2. Hypovolemic shock
  3. Neurogenic shock
  4. Anaphylactic shock
  5. Sepsis
  6. Endocrine causes - Addison’s, hypothyroid
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5
Q

Management of shock

A 
1.  If BP is unrecordable - call the cardiac 
     arrest team immediately.
2.  ABC
3.  Start high flow oxygen
4.  Raise the foot of the bed 
     **unless cardiogenic shock**
5.  IV access x2
6.  Try to identify and treat the underlying 
     cause.
7.  Infuse crystalloid fast to raise BP
     **Unless cardiogenic shock**
8.  Get help
9.  Investigations
     -  FBC, U&E, glucose, CRP
     -  Group and cross match
     -  Check clotting
     -  Blood cultures, urine cultures, ECG
     -  Chest XRY
10.  Consider putting in an arterial line, 
       CVL, urinary catheter.
11.   Aim for urine flow > 30cc/h
12.   Goals:
        -  Fluid replacement as per BP/vitals
        -  Don't over load
        -  If still hypotensive = ionotropes
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6
Q

SIRS

A 
Systemic inflammatory response syndrome
1.  Temp > 38 or < 36
2.  Tachy > 90
3.  RR > 20 or PaCO2 < 4.3 kPa
4.  WBC > 12 or < 4 or > 10% immature 
     bands.
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7
Q

Define sepsis

A

SIRS in the presence of an infection

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8
Q

Severe sepsis

A

Sepsis with evidence of organ hypoperfusion

e.g lactic acidosis, oliguria, altered cerebral function.

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9
Q

Septic shock

A

Severe sepsis with hypotension despite fluid rescusitation.

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10
Q

Cause of upper GI bleed

A
  1. Peptic ulcer 40%
  2. Mallory Weiss tear 15%
  3. Gastroduodenal ulceration
  4. Esophagitis
  5. Varies
  6. Others: malignancy, vascular
    malformations, nose bleed, trauma.
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11
Q

Management of Upper GI Bleed

A
  1. Protect airway
  2. Insert two large IV cannula
  3. Draw bloods - FBC, U&E, clotting
    screen, cross match 6 units of blood.
  4. Give high flow oxygen
  5. Rapid IV crystalloid infusion up to 1L
  6. If remain shocked - give blood group
    specific or O Rh-ve.
  7. Give slow saline infusion to keep lines
    open.
  8. Transfuse according to hemodynamic
  9. CVP line - aim for > 5cm H20
    Swan Ganz catheter
  10. Catheterize - aim for > 30mL/hr
  11. Urgent endoscopy when stable.
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12
Q

Management of variceal bleeding

A
  1. Resuscitate
  2. Urgent endoscopy for banding or
    sclerotherapy.
  3. Give terlipressin 2mg sc
  4. If massive bleed - Sengstaken-
    Blakemore
  5. Omeprazole 40mg PO
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13
Q

Empiric management of meningitis

A
  1. Prior to hospital - give 1.2g IM/IV
    benzypenicillin.
  2. While in hospital - 2g cefotaxime IV
    + Dexamethasone 4-10mg/6hr IV
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14
Q

Management of status epilepticus

A

Seizures lasting > 30min or repeated seizures without intervening consciousness

  1. Open airway, lay person in recovery
    position, remove false teeth, insert
    oral/nasal airway.
  2. 100% oxygen + suction
  3. IV access + take bloods
    • FBC, LFT, glucose, Ca++
    • Toxicology screen
    • Anticonvulsant levels
  4. Thiamine 250mg IV if alcoholic or
    malnourished.
    Glucose 50mL of 50% unless normal
  5. Hypotensive - give fluids
  6. Lorazepam 2-4mg
    Second dose if no response in 2min
  7. If seizure continues - phenytoin
    • 18mg/kg IV = infusion
    • 100mg/6-8hr = maintenance
    • Check levels
  8. Alternative: IV diazepam infusion
  9. Call for anesthesia - if still seizing.
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15
Q

Raised ICP: Management

A
  1. ABC
  2. Correct hypotension and treat seizures
    or identifiable cause.
  3. Elevate the head of the bed to 30-40deg
  4. If intubated hyperventilate the patient.
  5. Mannitol - 20% sol 1-2g/kg IV
  6. Dexamethasone 10mg IV
    Only useful for cerebral edema due to
    tumor
  7. Fluid restrict to < 1.5L/d
  8. Monitor patient & try to find cause.
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16
Q

Diagnosis of DKA

A
  1. Acidosis < 7.3
  2. Hyperglycemia
  3. Ketosis
17
Q

Investigations carried out in patient with DKA

A 
-  Test urine for ketones, glucose + perform 
   MSU
-  Blood glucose, FBC, blood cultures
-  U&E, HCO3-, amylase, osmolality
-  ABG
18
Q

Management of DKA

A
  1. Check plasma glucose Usually >
    20mmol/L
  2. Give 4-8U insulin IV
  3. Insulin pump:
    • Dilute to 1unit/mL
    • Start at 6U/h for adult
    • Expect blood glucose to drop by
      5mmol/L
    • If poor response double rate.
    • When glucose < 10mmol = decrease
      rate to 3U/h
  4. If there is no pump:
    • Load with 20U IM
    • Then 4-6U/hr IM while glucose >
      10mmol/L.
  5. Check glucose, U&E, HCO3 regularly
    • *hourly initially**
  6. Fluid replacement
    • Give 1L 0/9% saline stat
    • 1L over the next hour
    • 1L over 2hr
    • 1L over 4hr
    • 1L over 6hr
    • Adjust according to urine output
  7. Start LMWH SC until mobile
  8. K+ replacement
    • Don’t add K+ to first bag.
    • Monitor urine output and add K+ when
      it’s > 30mL/h.
    • Serum K+ < 3mmol = Add 40mmol
      K+
    • Serum K+ 3-4mmol = Add 30 mmol
    • Serum K+ 4-5mmol = Add 20 mmol
  9. Change to SC insulin when ketones are
    < 1+ and eating.
19
Q

Management of HONK

A

No acidosis present

  1. Rehydrate with 9L of 0.9% saline IVI
    over 48 hours.
  2. Replace K+ when urine starts to flow.
  3. Wait 1hr before using insulin - it may not
    be needed.
  4. If insulin needed = 1U/hr
20
Q

Myxoedema coma: Presentation & management

A

Cause: Severe hypothyroid state

Presentation:

  • Looks hypothyroid
  • Age usually 65 years
  • Hypothermia
  • Hyporeflexia
  • Decreased glucose
  • Bradycardia
  • Seizures
  • Coma
Management:
1.  High flow oxygen
2.  Give T3 IV:  5-20ug/12 hr IV slowly
3.  Hydrocortisone IV:  100mg/8hrs IV
3.  Fluids:  0.9% saline
4.  If infection:  Cefuroxime 1.5g/8h IV
5.  Hypothermia:  warm blankets 
6.  When improved - start PO Levothyroxine 
     50ug/24 hrs.
21
Q

Hyperthyroid crisis: Presentation

A
  • Increased temperature
  • Agitation
  • Confusion
  • Confusion/coma
  • Tachycardia
  • AF
  • Acute abdomen
  • Heart failure
  • Circulatory collapse
22
Q

Management of hyperthyroid crisis

A
  1. Saline 0.9% IV 500mL/4hr
  2. NG tube if vomiting
  3. Take bloods: T3, T4, TSH, culture
  4. If good heart function:
    • Propranolol 40mg/8hr PO
  5. If asthma or poor heart function:
    • Short acting BB = IV esmolol
  6. High dose digoxin to slow the heart.
  7. Anti-thyroid drugs:
    • Carbimazole 15-25mg/6hr PO
    • After give Lugol’s solution 0.3mL/8hr
      PO for 1 week to block thyroid.
  8. Hydrocortisone 100mg/6hrs IV
  9. If infection: cefuroxime 1.5g/8hr IVI
  10. Hyperthermia: cool with sponging +
    paracetamol.
23
Q

Treatment of phaeochromocytoma crisis

A
  1. Phentolamine 2.5mg IV
  2. When BP well controlled - give
    phenoxybenzamine 10mg/24hrs
  3. BB can now be given at this stage to
    control tachycardia.
  4. Surgery 4-6 weeks after full alpha
    blockade.

Medicine (6 decks)

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