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Final Med > emergency medicine > Flashcards

emergency medicine Flashcards

1
Q

indications for a CT scan

A 
immediate:
1. GCS less than 13 on arrival 
if the GCS is less than 15 2 h post arrival 
if there was a seizure after trauma
FNDeficiet
vomiting more than 1
suspected skull fracture 
with 8 hour CT 
head injury and on warfarin
LOC or amnesia 
plus age greater than 65, fall greater than 1 meter, fall greater than 5 steps, pedestrian vs vehicle 
bike vs vehicle 
more than 30 min amnesia of before injury events
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2
Q

what is likely to cause a lateral neck lump in an adult?

A

75% chance of malignancy
80% mets and the rest lymphomas
in absence of systemic illness a lateral neck mass is due to metastatic carcinoma until proven otherwise

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3
Q

lump in neck there for less than a few weeks

A

most likely infective or inflammatory but can be malignancy

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4
Q

lump in the neck for a few weeks

A

malignancy until proven otherwise

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5
Q

is the lump in the neck going bigger?

A

if yes rule out malignancy

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6
Q

B symptoms of lymphoma

A

fever night sweats and weight loss

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7
Q

what blood pressure is considered shock?

A

less than 90/60

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8
Q

what gauge is a large bore cannula

A

14G-16G

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9
Q

elevated urea can tell you

A

kidney functions but also can tell you if upper GI bleed

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10
Q

fluid resuscitation

A

2 L of warmed crystalloid solution (hartmanns normal saline)

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11
Q

pre endoscopy procedure magagement for heamatemsis

A

terlipressin 1-2 mg 4-6 hourly (splachnic vasoconstriction)

prophylactic abx

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12
Q

What is the Blatchford score?

A

classifies patients coming into the hospital with heamatemsis into either high risk requiring urgent intervention or low risk being able to be taken care of as a outpatient.

components: urea, HB in men, HB in women, systolic BP, and other markers: pulse (less 100) melaena or syncope, hepatic disease cardiac disease

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13
Q

What is the Rockwell score?

A

The rockwell score predicts the patient’s risk of rebleeding and mortality of patients with an upper Gi heamorrage.
The rockwell score is separated into pre endoscopic and endoscopic scoring.
Initial is age less than 60 (0) over 80 is 2
shock heart rate is over 100 bpm, (1) systolic BP less than 100 (2)
comorbities 1 point if heart disease or failure 2 points if liver or renal disease
post endo
stigmata of recent heamorrhage 2 points in the upper GI tract clot visible spurting blood vessels
diagnosis Mallory Weiss or normal(0) 1 all other ddx 2 malignancy of the upper GI tract

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14
Q

indications for emergency endoscopy in a patient with suspected upper GI bleed?

A

continuance of upper GI bleed, and also a blatchford score of greater than 6

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15
Q

if a patient with a known recent aortic graft comes in with heamatemsis what do you order to outrule?

A

contrast angiogram to rule out an aorto-enteric fistula.

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16
Q

management for a bleeding oesophageal varix

A
  1. band ligation
  2. sclerotherapy
  3. balloon tamponade
  4. TIPPS transjugular intrahepaticportosystemic shunt(catheter down jugular vein and creating a shunt from hepatic vein to portal vein)
  5. portcaval (portsystemic) shunt
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17
Q

indications for red cell blood transfusion

A

heamorrahage major trauma and amputations
hb less than 70 g/L with signs of compromise (tachycardia, syncope, dyspnoea)
Hb less than 80 g/L plus signs of compromise in patients greater than 65 or who have ischemic heart disease or severe respiratory distress.

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18
Q

risks associated with blood transfusion

A 
immune 
active transfusion reaction
anaphylaxis 
heamolytic transfusion reaction
transfusion related lung injury 
delayed heamolytic reaction
alloimmunization 
post transfusion purpura 
non immune 
transfusion associated circulatory overload 
coagulopathy 
transfusion related infection
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19
Q

what are the five things you must outrule in your history exam and investigations with a patient presenting with chest pain?

A
  1. acute coronary syndrome
  2. aortic dissection
  3. pneumothorax
  4. PE
  5. boerhaaves perforation
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20
Q

risk factors of CVD?

A

angina on exertion, previous MI

smoking hypertension hypercholesterolemia, DM family history of CVD

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21
Q

what is SIRS

A

this is the body’s response to pro inflammatory processes
two or more of the following criteria
1. temperature greater than 38 or less than 36
2. heart rate greater than 90
3. RR greater than 20 or PCO2 less than 4.3
4. white cell count grater than 12 or less than 4 or greater than 10% immature forms

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22
Q

what is sepsis

A

sepsis is SIRS *systemic inflammatory response syndrome

caused by suspected or proven infection

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23
Q

What is severe sepsis?

A

sepsis causing hypotension (systolic bp less than 90 or greater than 40
drop compared to normal for that patient
and end organ hypo-perfusion (lactic acidosis on VBG)

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24
Q

septic shock

A

severe sepsis that is refractory to fluid resus (and therefore in need of vasopressors like debutamin)

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25
multiorgan dysfunction syndrome
evidence of two or more organs failing (confusion due to cerbral hypoperfusion, renal failure, respiratory failure, liver failure)
26
why is it important to ask about a aortic graft in patients who present with GI bleeding?
because if they do it is an aortenteric shunt until proven otherwise.
27
indications for emergency dialysis
refractory severe acidosis less than 7.1 hyperkalemia 6.5 fluid overload- pulmonary oedema uremic signs *encephalopathy, pericarditis urea greater than 30 creatinine greater than 1000
28
What are the five symptoms of TTP
TTP (thrombotic thrombocytopenia purpura) 1. fever 2. microangiopathic haemolytic anemia 3. thrombocytopenia 4. neurological symptoms 5. renal failure
29
three things to remember in hyperkalemia
10ml of 10% calcium gluconate over 2 minutes 10 units of actrapid insulin in 250 ml of 50% glucose solution over 30 minutes salbutamol 5 mg nebs
30
So for seizures what are the four important time intervals
0-5 minutes 5-20 minutes 20-40 minutes greater than 40 minutes
31
what do you need to do in a patient who is convulsing at 0-5 minutes
start the timer, make sure the scene around the patient is safe, put the patient into recovery positions monitor the HR, O2 sats, BP cardiac trace and temp establish venous abcess check the blood glucose if less than 3.5 mmol/l give 100,l of 20% glucose stat
32
what to do when the patient is continuing to seize at 5-20 minutes
important to stop the seizure call for senior help consider airway adjunct if IV abcess established lorazepam 4 mg IV over 2 minutes repeat 10 minutes no IV abcess PR diazepam 10 mg If history of alcohol abuse than pabrinex
33
If the seizure is laying more than 20-40 minutes
call the anaesthetic and senior help | start the phenytoin 20 mg/kg IV at less than 50 mg per min
34
If greater than 40 minutes the seizure is lasting
thiopentol or propofol on the ICU | transfer to the ICU for GA EEG monitoring
35
So what are the medications to give in the 5-20 minutes of a seizure
lorazepam 4 mg IV/ 2 minutes peat at 10 minutes | PR diazepam 10mg
36
what are he important medications to remember in a patient seizing for over 20 minutes
phenytoin 20 mg/kg IV at less than 50 mg per minute
37
What are three things that are important to give in anaphylaxis
1. adrenaline 1:100 solution 0.5 ml IM repeat in 5 minutes if no improvement IV fluids 1 L of 0.9% normal saline consider salbutamol 5 mg for bronchospasm reassess
38
What do you give if your top three therapies in anaphylaxis are given?
adjuncts antihistamine chlorphenamine 10 mg slow IV hydrocortisone 200mg slow IV
39
Medication given in a bradyarrhythmia
atropine IV 500 micrograms repeat every 2-3 minutes (max 3 mg) if this not working consider transcutaneous pacing
40
What four features on the ECG have an increased risk of asystole?
recent asystole Mobitz 2 AV block complete heart block with broad QRS ventricular pause greater than 3 sec
41
what are the life threats presenting with SOB
``` asthma COPD pulmonary oedema tension pneumothorax Mi or arrthmia pneumonia pulmonary embolism pleural effusion anaphylaxis airway obstruction ```
42
What test should you do whenever a patient is acutely unwell
ABG
43
What are the life threats of chest pain
``` MI tension pneumothorax ACS pericardial effusion or cardiac tamponade aortic dissection pulmonary embolism sickle cell crisis ```
44
when do the troponin levels rise in an acute MI
sharpest rise over 1-2 days
45
troponin can rise in other states as well?
renal AKI and CKD cardiac acute MI HF arrthymia myocarditis respiratory hypoxia pulmonary embolism haematological anaemia neurological ischemia stroke haemorrhage trauma cardiac contusion electrical cardioversion
46
what should you make sure your patient gets as soon as they are ecg shows signs of stemi
Pci if can be done within 2 hours | thrombolysis if cannot
47
complications of an mi
``` dysrrhythmia LVF dresslers septal rupture ventricular aneurysm pericarditis pain ```
48
Diabetic ketoacidosis
Take the BP if less than 90 give 500 ml blous of normal saline STAT reassess and give another bonus if still low SBP greater than 90 1 L over hour fixed rate dose of insulin .1 unit per kg/hr VBG if less than 7.1 call the ICU glu and ketones hourly venous HCO3 and K at 60 minutes and then 2 hourly thereafter ECG, CXR, MSU to determine the cause
49
HHS stands for
hyperosmolar hyperglycemic state
50
key management point for HHS
1 L of 0.9% NACL over 60 minutes | start IV insulin 0.05 units/kg/h ONLY if the plasma ketones are greater than 1 mmol/L or 2 plus ketones in the urine
51
What are the life threatening cause of DKA or HHS
sepsis MI trauma or surgery acute illness
52
How can you diagnosis HHS
serum osmolality greater than 340 mOsm/kg | with a high glucose typically greater than 30
53
What are the sick day rules?
drink plenty of fluids try to drink milk soup or fruit juice if can’t hold down solids increase glucose monitoring to at least four times a day go to hospital if you can’t keep fluids down BG is less than 4 or greater than 20 continue to take the insulin
54
What are the antibodies to look for in DM
positive islet cell antibodies | glutamic acid decarboxylase antibodies
55
Hypoglycemia
quick acting carbohydrate (lucozade) or one glucose gel (can give up to three) monitor the finger prick glucose 1-2 hours until stable aim for greater than 5 mmol/L if it continues to be below 4 than IM glucagon or IV glucose *this is started right away if low GCS * 1L of 10% glucose 4-6 hourly
56
What are the causes of hypoglycemia?
``` insulin overdose medication fasting or starvation sepsis renal failure alcohol excess acute liver failure insulinoma glucocorticoid deficiency neoplasm ```
57
What is the management of an upper GI bleed?
ATLS guidelines insert an Iv line take FBC, Coag, U and E LFT CALL FOR SENIOR HELP CALL GI REG for urgent endoscopy correct coagulopathy if present- platelets APPT= FRESH FROZEN PLASMA PT = as above (1.5 x ULN) INR or WARFARIN- prothrombin complex IF hx of liver failure or disease- give terlipressin and abx band ligation or injection of sclerant TIPS procedure is definitive
58
What are the markers for HHS?
hyperglycaemic hyperosmolar syndrome ``` high glucose levels (greater than 30) high osmolarity (greater than 320) ``` hypovolemia complications cardiovascular (hypotension and tachycardia) and haematological (increased viscosity of blood)
59
How do you treat HHS?
1. normalise the osmolarity gradually 2. fluid replacement and electrolyte correction 3. normalise the glucose gradually fluid resus comes before insulin infusion
60
How do you treat a thyrotoxic storm with?
beta blockers propylthiouracil (anti-thyroid treatment) hydrocortisone
61
What are the clinical features of a thyrotoxic storm?
``` fever tachycardia confusion and agitation nausea and vomiting HTN heart failure abnormal LFT ```
62
Why do you give dexamthasone in a thyrotoxic storm?
blocks the seroconversion of T4 to the active form T3

Final Med (35 decks)

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