Emergency Medicine Flashcards
Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, extrapyramidal symptoms?
Antipsychotic (neuroleptic malignant syndrome)
Side effects of corticosteroids
Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies
Treatment of DTs
Benzodiazepines
Treatment for acetaminophen overdose
N-acetylcysteine
Treatment for opioid overdose
Naloxone
Treatment for benzodiazepine overdose
Flumazenil (monitor for withdrawal and seizures)
Treatment for neuroleptic malignant syndrome & malignant hyperthermia
Nitroprusside
Treatment for atrial fibrillation
Rate control, rhythm conversion & anti coagulation
Treatment for SVT
Stable –> carotid massage (rate control), other vagal stimulation
Unsuccessful –> consider adenosine
Causes of drug induced SLE
INH, penicillamine,hydralazine, procainamide, chlorpromazine, methyl dopa, quinidine
Macrocytic,megaloblastic anaemia with neurological symptoms
B12 deficiency
Microcytic, megaloblastic anaemia without neurological symptoms
Folate deficiency
A burn patient presents with cherry red, flushed skin & coma. SaO2 normal, but carboxyHb is elevated. Treatment?
CO poisoning –> 100% O2, or hyperbaric O2 if severe poisoning or pregnant
Blood in the urethral meatus or high riding prostate
Bladder rupture or urethral injury
Test to rule out urethral injury
Retrograde cystourethrogram
Radiographic evidence of aortic disruption or dissection
Widened mediastinum (>8cm), Loss of aortic knob Pleural cap Tracheal deviation to the right Depression of left main bronchus
Radiographic indications for surgery in acute abdomen
Free air under diaphragm Extravasation of contrast Severe bowel distension Space occupying lesion (on CT) Mesenteric occlusion (angiography)
Most common organism in burns related infections
Pseudomonas
Method of calculating fluid repletion in burn patients
Parkland formula:
24hr fluids = 4 x kg x %BSA
Acceptable urine output in trauma patient
50cc/hr
Acceptable urine output in a stable patient
30cc/hr
Signs of neurogenic shock
Hypotension & bradycardia
Cushings triad (signs of raised ICP)
HTN, bradycardia & abnormal respirations
Low cardiac output
Low PCWP
High peripheral vascular resistance
Hypovolaemic shock
Low cardiac output
High PCWP
High PVR
Cardiogenic (or obstructive) shock
High cardiac output
Low PCWP
Low PVR
Distributive (e.g. septic or anaphylactic) shock
Treatment of septic shock
Fluid & antibiotics
Treatment of cardiogenic shock
Identify cause –> inotropes (e.g. Dopamine)
Treatment of hypovolaemic shock
Identify cause –> fluid and blood repletion
Treatment of anaphylactic shock
Epinephrine 1:1000 & diphenhydramine
Supportive treatment for ARDS
Low tidal volume ventilation
Signs of air embolism
A patient with chest trauma who was previously stable suddenly dies
Signs of cardiac tamponade
Beck triad:
- distended neck veins
- hypotension
- diminishes heart sounds
Pulsus paradoxus
Absent breath sounds, dullness to percussion, shock, flat neck veins
Massive haemothorax
Absent breath sounds, tracheal deviation, shock, distended neck veins
Tension pneumothorax
Treatment for blunt or penetrating abdominal trauma in haemodynamically unstable patients
Immediate exploratory laparotomy
Raised ICP in alcoholics or the elderly following heat trauma. Can be acute or chronic
Crescent shape on CT
Subdural haematoma
Head trauma with immediate LOC followed by lucid interval and then rapid deterioration
Convex shape on CT
Extradural (epidural) haematoma
Patient with singed nasal hairs, facial burns, hoarseness, wheezing, soot in posterior oropharynx or carbonaceous sputum. Suspect?
Thermal or inhalational injury to the airway
When to intubate?
GCS < 8 = intubate!
Immediately evaluate trauma patients for? (6)
Open pneumothorax Tension pneumothorax Flail chest Massive haemothorax Cardiac tamponade Airway obstruction
ABCDE assessment airways
- ability to speak
- look for airway obstruction
- give O2
Intubate if compromised airway (jaw thrust or cricothyroidotomy)
ABCDE breathing assessment
- auscultation breath sounds
- if suspect tension pneumo —> needle decompression
- CXR (rule out trauma)
- if suspect pneumo or haemo —> chest drain
ABCDE circulation assessment
- assess pulses
- control active bleeding ; splint long-bone deformity/fractures
- secure IV access
- fluids & bloods if unstable
ABCDE disability assessment
- GCS
- gross motor/sensory function in extremities
ABCDE assessment exposure
- disrobe & inspect for more injuries
- cover patient to prevent hypothermia
19 yo man gunshot wound to chest bp 60/30, no BS on left, raised JVP, tracheal deviation to right. Management?
- IV 14G cannula to 2nd ICS MCL
- chest drain
Syndrome associated with weak aortic wall
Marfans
Syphillis
Ehlers Danlos
25yo man stabbed in neck, calm and vital signs stable.
O/E cut extends through platysma muscle.
Management?
Admit for surgical exploration of wound
All penetrating trauma that violates the platysma muscle mandates admission and surgical consultation for surgery or further diagnostic evaluation
