Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

causes of shock?

A

CHOD

Cardiogenic:

MI, arrhythmia

hypovolaemic:

haemorrhage- internal/ external

endocrine- addisionian crisis, DKA

excess loss- burns, diarrhoea, vomiting

third-spacing- pancreatitis

obstructive:

PE, tension pneumothorax, cardiac tamponade

distributive:

sepsis, anaphylaxis, neurogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

mx of shocked patient?

A

if ECG unrecordable, mx as a cardiac arrest

->

ABCDE approach

->

raise foot of bed (unless cardiogenic)

->

IV access: 2 wide bore cannula in each Antecubital fossa

->

fast infusion of crystalloid to raise BP (unless cardiogenic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

initial monitoring of a shocked patient?

A

catheter to measure urine output

(>30ml/hr)

arterial line- monitor blood pressure directly and in real-time

central venous pressure line-

blood pressure in the venae cavae, near the right atrium of the heart. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood back into the arterial system.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is anaphylactic shock?

A

type 1 IgE mediated hypersensitivity reaction

TH2 driven IgE production following primary allergen exposure

re exposure -> biphasic inflammatory response

early phase: mast cell degranulation -> histamine release

late phase: amplify and sustain the initial response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

presentation of anaphylactic shock?

A

skin: urticaria, itching, oedema
breathing: wheeze, laryngeal obstruction, cyanosis

GI: D+V, abdo pain

sweating

CVS: tachycardia, hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

mx of anaphylactic shock

A

secure airway: give 100% O2

  • consider intubation if respiratory obstruction

elevate the feet

IM adrenaline 0.5ml of 1:1000 (0.5mg)

  • repeat every 5 min if needed

Secure IV access: IV 0.9% saline (500ml over 15 min)

IV 10mg chlorphenamine

IV 200mg hydrocortisone

Salbutamol nebs if wheeze

  • 5mg salbutamol + 0.5mg ipratropium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

discharge advice for anaphylaxis patient

A

teach adrenaline self-injection and ensure pt has at least 2 epipens

advise wearing medic alert bracelet

advice re recognition and avoidance

arrange outpatient followup: skin prick tests, RAST to identify antigens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the definition of a supraventricular tachycardia?

A

rate > 100 beats/min

QRS width < 120 ms

start from atria/ AV node

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

types of SVT

A

Sinus tachycardia

Atrial:

AF, Atrial flutter, atrial tachycardia

AV nodal re-entry tachycardia (AVNRT)

AV re-entry tachycardia (AVRT): e.g. Wolff-Parkinson-White

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is AVRT?

Atrioventricular re-entrant tachycardia

A

a type of SVT

e.g. WPW

electrical signal passes in the normal manner from the AV node into the ventricles

the electrical impulse pathologically passes back into the atria via the accessory pathway (e.g. bundle of Kent), causing atrial contraction, and returns to the AV node to complete the reentrant circuit

-> may cause heart to beat faster

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SVT Mx

if patient is compromised?

A

sedate + DC cardioversion

otherwise ID rhythm and treat accordingly

pt compromised

ie. MI, syncope, hypotension (shock), heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SVT Mx?

A

ID rhythm ?

irregular -> treat as AF

regular?

SVT = Start with Vagal Treatment

(e.g. carotid sinus massage, valsalva)

if unsuccessful,

ABCD

adenosine while recording continuous rhythm strip

-> 6mg IV bolus, then 12mg, 12mg

then

choose from:

Beta Blockers: e.g. atenolol

CCB e.g. Verapamil

Digoxin

Amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SVT mx if all medical treatment fails?

A

DC cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

SVT mx if adverse signs develop

ie. BP <90, heart failure, decreased consciousness, HR> 200?

A

Sedation

Synchronised Cardioversion

then

Amiodarone: 300 mg over 20-60 min

then 900mg over next 23 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are vagal manoeuvres meant to do in SVT mx?

A

decreases HR by stimulating vagus nerve

transiently increases AV block and may unmask underlying atrial rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Giving adenosine in SVT mx?

what would it do

A

transient AV block -> unmasking atrial rhythm

cardioverts AVRT/AVNRT to sinus rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Mode of action of adenosine?

A

temporary AV node block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Side effects of adenosine?

A

transient chest tightness, dyspnoea, flushing, headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

relative contraindications of adenosine?

A

asthma,

2nd/3rd degree heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

in what type of SVT will you avoid the usual treatment pathway?

ie. Adenosine, CCB, BB

A

WPW

hx of WPW or AF/flutter with WPW

-> may lead to VF

Use amiodarone or flecainide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

mx of AF?

A

onset <48h consider cardioversion w amiodarone or DC shock

Rate control: BB e.g. metoprolol or digoxin

Anticoagulation with heparin/ warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

prophylaxis of SVTs?

A

BB

AVRT: Flecainide

AVNRT: verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Definition of broad complex tachycardias?

A

rate > 100bpm

QRS width >120 ms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

types of broad complex tachycardias?

A

VT

Torsades de pointes

SVT w BBB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Causes of VT?

A

IM QVICK

Infarction (esp w ventricular aneurysm)

Myocarditis

QT interval prolonged

Valve abnormality: mitral prolapse, AS

Iatrogenic: digoxin, antiarrhythmics

Cardiomyopathy esp dilated

K low, low Mg, low O2, acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Mx of broad complex tachycardia if pt is compromised?

ie. BP <90

Heart failure

chest pain (MI)

decreased consciousness / syncope

HR >150

A

Sedation

->

Synchronised cardioversion

(200->300->360)

->

Amiodarone:

300mg over 20-60 min

900 mg over next 23h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Mx of stable VT?

after O2 + IV access

A

Correct electrolyte problems:

ie. Low K+: max 60 mM KCl @ 20mmol/h

Low Mg2+: 4ml 50% MgSo4 in 30 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

mx of stable VT

if no electrolyte problems?

A

assess rhythm

regular ie. VT:

amiodarone

or lignocaine 50mg over 2min

irregular:

usually AF w BBB: flecainide/ amiodarone

or Torsades de pointes: MgSO4 2g IV over 10 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

mx of stable VT if medical treatment failed?

A

synchronised cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

mx of Torsades de pointes?

A

MgSO4 2g IV over 10 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Mx of recurrent/ paroxysmal VT?

A

Medical:

Amiodarone

BB

Implantable cardiac defibrillator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Acute Mx of STEMI?

A

12 lead ECG

O2 2-4L: aim for SpO2 94-98%

IV access: bloods for troponin, FBC, U+E, glucose, lipids

brief assessment: hx of CVD/ RFs, thrombolysis CIs, ABCDE

anti-platelets:

aspirin 300mg PO (then 75mg/d) + clopidogrel 300mg PO (then 75mg/d)

analgesia: morphine 5-10mg IV, metoclopramide 10mg IV

anti-ischaemia: GTN 2 puffs or 1 tablet sublingual, BB atenolol 5mg IV (CI asthma, LVF)

DVT prophylaxis: enoxaparin 40mg SC OD

admit to CCU for monitoring: arrhythmias, continue meds except CCBs

-> consider primary PCI / thrombolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

when is Percutaneous coronary intervention inndicated in STEMI?

A

usually tx of choice if <12h

angioplasty and stenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

complications of primary PCI for STEMI?

A

bleeding

emboli

arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

if high risk patient

e.g. delayed PCI, Diabetes mellitus, complex procedure,

what medication is given alongside primary PCI for STEMI

A

GpIIb/IIIa antagonist

eg. tirofiban

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

DVT prophylaxis in STEMI mx

if pt is not receiving any reperfusion therapy?

if pt is receiving PCI?

A

not receiving any form of reperfusion therapy:

fondaparinux

otherwise:

enoxaparin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

ECG criteria for thrombolysis?

A

ST elevation > 1mm in 2+ limbs or >2mm in 2+ chest leads

new LBBB

posterior: deep ST depression and tall R waves in V1- V3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

when is thrombolysis for STEMI contraindicated?

A

beyond 24h of onset

AGAINST

aortic dissection

gi bleeding

allergic reaction previously

iatrogenic: major surgery <14d prior

neuro: cerebral neoplasm/ CVA hx

severe HTN (200/120)

trauma inc CPR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what are the agents used in thrombolysis in STEMI?

A

1st line:

streptokinase

alteplase

tenecteplase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

complications of thrombolysis

A

bleeding

stroke

arrhythmia

allergic reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

continuing therapy (long term) for STEMI?

lifestyle advice

A

Stop smoking

Diet: oily fish, fruit, veg, ↓ sat fats

Exercise: 30min OD

Work: return in 2mo

Sex: avoid for 1mo

Driving :avoid for 1mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

continuing therapy (long term) for STEMI?

medications

A

address risk factors

ACEi: start within 24h of MI (e.g. lisinopril 2.5mg)

BB: e.g. bisoprolol 1.25 mg OD (or CCB)

Cardiac rehabilitation: group exercise and info/ heart manual

DVT prophylaxis until fully mobile

(cont for 3 mo if large anterior MI)

Statin: regardless of basal lipids e.g. atorvastatin 80mg

Continue clopidogrel for 1mo following STEMI

Continue aspirin indefinitely.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

NSTEMI mx?

A

exactly same as STEMI

assess CV risk

if low risk: no further pain, flat or inverted T waves or normal ECG, -ve troponins

may discharge + outpatient tests: angio, perfusion scan, stress echo

intermediate to high risk: persistent/ recurrent ischaemia, ST depression, + trops

GpIIb/IIIa antagonist - tirofiban

Angiography with PCI within 96 h

clopidogrel 75mg/d for one year + aspirin indefinitely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

causes of severe pulmonary oedema?

A

cardiogenic:

MI, arrhythmia, fluid overload: renal/ iatrogenic

non-cardiogenic:

ARDS: sepsis, post op, trauma

upper airway obstruction

neurogenic- head injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

symptoms of severe pulmonary oedema

A

SOB

orthopnoea

pink frothy sputum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

signs of severe pulmonary oedema

A

Distressed, pale, sweaty, cyanosed

↑HR, ↑RR

↑JVP

S3 / gallop rhythm

Bibasal creps

Pleural effusions

Wheeze (cardiac asthma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

monitoring of severe pulmonary oedema?

A

BP

HR, RR

JVP

urine output

ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Mx of severe pulmonary oedema

A

Sit pt up

give O2 15L via non-rebreather mask for SpO2 to be 94-98%

IV access + monitor ECG

  • take bloods for FBC, U+E, troponin, BNP, ABG
  • tx any arrhythmias

IV furosemide 40-80mg (if pt on oral diuretics, use double dose)

IV GTN 0.5mg / hr (only if systolic BP >90)

Consider slow IV diamorphine 2.5-5mg + metoclopramide (for severe chest pain/ distress)

if SBP <100: tx as cardiogenic shock

(ie. consider inotropes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

indications for diamorphine in acute pulmonary oedema?

A

analgesia and sedation may be appropriate where the patient is in pain or distressed - eg, diamorphine 2.5-5 mg intravenously slowly

+ pulmonary venodilators -> decreases preload -> reduces SOB

opiates should not be given to patients with acute decompensated heart failure, or if drowsy, exhausted or hypotensive.

not used routinely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

mx of acute pulmonary oedema if poor response to nitrates and furosemide?

A

Consider continuous positive airway pressure CPAP or NIV

if acidotic or poor response

! must discuss w senior

consider:

Referral to senior medical staff and intensive care for consideration of IV inotropes or invasive ventilation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

what is CPAP?

A

CPAP increases intrathoracic pressure, which reduces preload by decreasing venous return.

CPAP lowers afterload by increasing the pressure gradient between the left ventricle and the extrathoracic arteries, which may contribute to the associated increase in stroke volume.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Ix of severe acute pulmonary oedema?

A

ABG: to assess type and severity of resp failure + associated biochemical changes

CXR: ABCDE

ECG: MI, arrhythmias, pulsus alternans

consider echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

what CXR findings are assoc w Heart failure?

A

ABCDE

Alveolar oedema (bat’s wings)

kerley B lines (interstitial oedema)

Cardiomegaly

Dilated prominent upper lobe vessels

Effusion (pleural)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

long-term mx of stable pt with pulmonary oedema?

A

daily weights

DVT prophylaxis

repeat CXR

change to oral furosemide/ bumetanide

ACEi + BB if heart failure

consider spironolactone

consider digoxin +/- warfarin (esp in AF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

definition of cardiogenic shock?

A

inadequate tissue perfusion (and oxygenation) to suit body’s metabolic needs primarily due to cardiac dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

causes of cardiogenic shock?

A

MI

HyperK (+ other electrolytes)

Endocarditis

Aortic dissection

Rhythm disturbance

Tamponade

Obstructive: tension pneumothorax, massive PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

presentation of cardiogenic shock

A

unwell: cyanosed, pale, distressed

cold clammy peripheries

high RR, HR

pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

signs of cardiac tamponade?

A

Beck’s triad: low BP, raised JVP, muffled heart sounds

pulsus paradoxus: (pulse fades on inspiration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Mx of cardiac tamponade?

A

pericardiocentesis

(preferably under US guidance)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

what is Kussmaul’s sign?

A

assoc with constrictive pericarditis

raised JVP on inspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

what is Beck’s triad?

A

assoc w Cardiac tamponade

low BP, raised JVP, muffled heart sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Ix of Cardiac tamponade?

A

echo: diagnostic

CXR: globular heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

mx of cardiogenic shock?

A

ABCDE approach

O2

monitor ECG

diamorphine + metoclopramide for pain/ anxiety

correct any arrhythmias, electrolyte disturbances, acid-base abnormalities

Ix: CXR, Echo, CT depending on cause

consider need for dobutamine (sympathomimetic)

tx underlying cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

what mx B1 receptor stimulant is used for HF and cardiogenic shock?

A

dobutamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what is kernig’s sign?

A

flex both legs at hip to 90

-> pt will be unable to fully straighten one leg down

lumbar spine tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

what is Brudzinski’s sign?

A

neck flexion would cause flexion of legs at hip

discomfort at c spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

mx of meningitis in the community before transfer to hospital?

A

benzylpenicillin 1.2g IV/IM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

tx of meningitis?

A

<50 yo: ceftriaxone 2g IVI/IM BD

>50 yo: ceftriaxone + ampicillin (to cover listeria)

if viral suspected: add aciclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

ix of suspected meningitis pt?

A

Bloods: FBC, U+E, clotting, glucose, ABG

blood cultures

LP: MCS, glucose, virology/ PCR, lactate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

contraindications to LP?

A

raised ICP

cardio/ resp instability

thrombocytopenia

coagulation disorder (DIC)

infection at LP site

focal neuro signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

acute mx of meningitis pt?

A

A to E approach

O2 15L - SpO2 94-98%

IVI fluid resus

if mainly meningitic: do LP if no CIs, dexamethasone + ceftriaxone

mainly septicaemic: ceftriaxone

+ maintenance fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what prophylaxis is available for household contacts of meningitic patients?

A

Rifampicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

mx of encephalitis?

A

aciclovir stat

supportive measures in HDU/ITU

phenytoin for seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

risk factors for cerebral abscess?

A

infection: ear, sinus, dental

skull #

congenital heart disease

endocarditis

bronchiectasis

immunosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

ix of cerebral abscess?

A

CT/ MRI head- ring enhancing lesion

Bloods: high WCC, high ESR/CRP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

tx of cerebral abscess?

A

neurosurgical referral

abx- e.g. ceftriaxone

treat the raised ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

definition of status epilepticus?

A

seizure lasting > 5 min

or

repeated seizures w/o recovery of consciousness in between

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

ix in status epilepticus?

A

Blood glucose levels

Bloods: infection markers (WCC, CRP), U+E, Ca/Mg, FBC

ECG, EEG

Consider AED levels, tox screen, LP, CT head, BHCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

1st line mx of status epilepticus?

A

Lorazepam IV 2-4mg bolus over 30s

2nd dose if no response within 2 min

alternatives:

buccal midazolam 10mg

rectal diazepam 10mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

mx of status epilepticus after 1st line tx (e.g. lorazepam) has failed?

A

phenytoin 18mg/kg IVI @ 50mg/ min

monitor ECG and BP

CI: bradycardia or heart block

alternative: diazepam infusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

what medication will be considered if cerebral oedema may be the cause of status epilepticus?

A

dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Important things to remember in status epilepticus?

A

Get anaesthetist early - may need to intubate

treat early with 100ml 20% glucose unless glucose known to be normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

GCS eyes criteria?

A

4 – Spontaneous eye opening

3 – Open to voice
2 – Open to pain
1 – No opening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

GCS verbal criteria?

A

5 – Orientated conversation

4 – Confused conversation
3 – Inappropriate speech
2 – Incomprehensible sounds

1 – No speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

GCS motor criteria?

A

6 – Obeys commands
5 – Localises pain
4 – Withdraws to pain
3 – Decorticate posturing to pain (flexor)
2 – Decerebrate posturing to pain (extensor)

1 – No movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

initial primary survey of head injury pt?

A

A: ? intubation, immobilise C-spine

B: 100%O2, RR

C: IV access, BP, HR

D: GCS, pupils

Treat seizures

E: expose pt and look for other obvious injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

secondary survey of head injury patient?

A

Look for:
Lacerations

Obvious facial/skull deformity

CSF leak from nose or ears

Battle’s sign, Racoon eyes
Blood behind TM

C-spine tenderness ± deformity

Head-to-toe examination for other injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

ix of head injury patient?

A

CT head + c spine

Bloods: FBC, U+E, glucose, clotting, ABG, EtOH level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

mx of head injury patient?

A

Neurosurgical opinion if signs of ↑ICP, CT evidence of intracranial bleed significant skull #

Admit if:
Abnormalities on imaging
Difficult to assess: EtOH, post-ictal
Not returned to GCS 15 after imaging

CNS signs: vomiting, severe headache

Neuro-obs half-hrly until GCS 15:

GCS, pupils, HR, BP, RR, SpO2, temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

discharge advice for someone who had received a head injury?

A

Stay with someone for first 48hrs

Give advice card advising return on:

Confusion, drowsiness, unconsciousness

Visual problems
Weakness
Deafness

V. painful headache that won’t go away

Vomiting
Fits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

when to intubate after head injury?

A

GCS ≤ 8

Respiratory irregularity

Spontaneous hyperventilation: PCO2 <4KPa

PaO2 <9KPa on air / <13KPa on O2 or PCO2 >6KPa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

cerebral oedema may cause which false localising sign?

A

6th CN palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what is Cushing’s reflex?

A

raised BP

bradycardia

irregular breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Acute Mx of cerebral oedema?

A

A-> E approach

treat seizures and correct hypotension

elevate bed to 40 degrees

neuroprotective ventilation: PaO2: > 13kPa, PCO2: 4.5 kPa, good sedation

Mannitol or hypertonic saline -> can decrease ICP in the short term but may cause rebound raised ICP later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

ix of acute severe asthma

A

PEFR

ABG: Co2 should be low, if normal or rising: send to ITU for ventilation

FBC, U+E, CRP, blood cultures

96
Q

what is severe asthma?

presentation

A

PEFR <50%

RR>25

HR>110

cant complete sentence in one breath

97
Q

what is life threatening asthma?

A

PEFR< 33%

SpO2 <92%

PCO2> 4.6 kPa

cyanosis

exhaustion

silent chest, poor respiratory effort

98
Q

mx of acute severe asthma?

A
  1. sit up
  2. 100% O2 via non-rebreathe mask (aim for 94-98%)
  3. Nebulised salbutamol (5mg) and ipratropium bromide(0.5mg)
  4. Hydrocortisone 100mg IV or pred 50mg PO (or both)
  5. Write “no sedation” on drug chart
99
Q

mx of life threatening asthma attack

A

same as severe: O2, nebs, steroids

Inform ITU

MgSO4 2g IVI over 20 min

back to back nebulised salbutamol with cardiac monitoring

Salbutamol 2g IVI

Consider Aminophylline

100
Q

monitoring of patient experiencing severe acute asthma?

A

PEFR every 15-30 min

pre and post B agonist

SpO2: keep > 92%

ABG if initial PaCO2 normal or high

101
Q

medications upon discharge after severe asthma attack?

A

PO steroids for 5d

102
Q

management of acute exacerbation of COPD?

A

controlled O2 therapy:

sit up, Target SpO2 88-92%, 24% O2 via venturi mask

nebulised bronchodilators:

salbutamol, ipratropium

steroids:

hydrocortisone IV, prednisolone PO 40mg for 7-14d

ABx:

if evidence of infection. doxycycline

NIV if no response:

BiPAP if pH<7.35 / RR>30

consider invasive ventilation if pH <7.26

103
Q

Mx of PE

A

Sit up

O2

Analgesia: Morphine + metoclopramide

if massive PE: consider thrombolysis with alteplase or surgical/interventional embolectomy

LMWH heparin - enoxaparin SC

if BP low: consider fluids

104
Q

long term mx after PE?

A

TEDS stocking

graduated compression stockings for 2 years if DVT: prevent post-phlebitic syndrome

continue LMWH until INR>2

Target INR 2-3

for 3 mo if remedial cause, 6 mo if no identifiable cause

Warfarin

105
Q

definition of pneumothorax?

A

accumulation of air in the pleural space with secondary lung collapse

106
Q

causes of primary pneumothorax?

A

no underlying lung disease

usually young, thin men with ruptured subpleural bulla

smokers

107
Q

causes of secondary spontaneous pneumothorax?

A

underlying lung disease present

  • COPD
  • Marfan’s, Ehler-Danlos
  • Pulmonary fibrosis, sarcoidosis
108
Q

iatrogenic causes of pneumothorax?

A

subclavian CVP line insertion

positive pressure ventilation

transbronchial biopsy

liver biopsy

109
Q

what sorts of trauma can cause pneumothorax?

A

penetrating chest wound

blunt trauma +/- rib #s

110
Q

signs of pneumothorax?

A

reduced expansion,

hyperresonant percussion

decreased breath sounds

decreased vocal resonance

surgical emphysema

111
Q

signs of tension pneumothorax?

A

mediastinal shift

raised JVP

raised HR, low BP

112
Q

mx of tension pneumothorax?

A

large bore cannula into 2nd ICS, mid clavicular line

then chest drain

113
Q

mx of traumatic pneumothorax with open wound?

A

3-sided wet dressing if sucking

chest drain

114
Q

what is the Rockall score for?

A

prediction of re-bleeding and mortality

final score post endoscopy

(initial score >3) >6 indication for surgery

115
Q

causes of cardiogenic shock?

A

MI

arrhythmia

116
Q

causes of hypovolaemic shock?

A

haemorrhage: internal and external

Diarrhoea and vomiting, burns

Third spacing: pancreatitis

Endocrine: addisonian crisis, DKA

117
Q

causes of obstructive shock?

A

PE

Tension pneumothorax

118
Q

causes of distributive shock

A

sepsis

anaphylaxis

neurogenic

119
Q

specific mx of anaphylactic shock?

A

adrenaline IM 0.5mg

Hydrocortisone IV 200mg

Chlorphenamine 10 mg

Salbutamol

120
Q

Specific Mx of cardiogenic shock?

A

Dobutamine (B1 agonist)

or

dopamine (B1 agonist)

to increase heart contractility

121
Q

specific mx of septic shock?

A

IV ABx

Fluids

Vasopressors e.g. norad

122
Q

specific mx of hypovolaemic shock?

A

Fluid replacement: crystalloid, colloid, blood

titrate to: urine output, CVP, BP

haemodialysis if ATN

123
Q

use of noradrenaline in septic shock?

A

potently stimulates alpha and b1 receptors

main effect = peripheral vasoconstriction to non essential organs e.g. gut

useful in septic shock to maintain BP

124
Q

if pt doesnt get better after tx for septic shock?

A

Get culture results back -> may be organism resistant to abx used

Prep for possible ITU transfer

125
Q

specific mx of upper GI bleed?

due to varices

A

IV terlipressin (splanchnic vasopressor)

Prophylactic Abx e.g. ciprofloxacin 1g/ 24h

Fluids/ blood

correct coagulopathy: Vit K, FFP, platelets

Thiamine if alcohol cause

notify surgeons of severe bleeds

126
Q

specific mx of upper GI bleed due to ulcer?

A

O2, Large bore cannulae: fluids, blood resus

Correct coagulopathy: Vit K, FFP, platelets

Notify surgeons of severe bleeds

URGENT endoscopy:

haemostasis of vessel or ulcer-

adrenaline injection, thermal/ laser coagulation, fibrin glue, endoclips

127
Q

Endoscopic mx of upper GI bleed due to varices?

A

urgent endoscopy:

1st line: Banding, sclerotherapy, adrenaline

2nd: balloon tamponade w Sengstaken-Blakemore tube

(only used if exsanguinating haemorrhage or failure of endoscopic tx)

2nd: TIPSS if bleeding cant be stopped endoscopically (to decrease portal pressure)

128
Q

indications for surgery in upper GI bleeding?

A

rebleeding

bleeding despite transfusing 6u

uncontrollable bleeding at endoscopy

initial rockall score ≥3, or final >6.

open stomach, find bleeder and underrun vessel.

129
Q

causes of acute renal failure?

A

pre renal:

shock e.g. sepsis, hypovolaemia

renal:

ATN, GN

Post renal:

stone, catheter, neoplasm

130
Q

presentation of acute renal failure?

A

usually presents in the context of critical illness

uraemia

hyperK

acidosis

oedema and raised BP

131
Q

Ix of acute renal failure?

A

Bloods: FBC, U+E, LFT, Glucose, Clotting, Ca, ESR

ABG: hypoxia (oedema), acidosis, raised K+

GN screen: if cause unclear

Urine: Dip, MCS, chemistry (e.g. osmolality)

ECG: HyperK

CXR: pulmonary oedema

Renal US: renal size, hydronephrosis

132
Q

ECG features of Hyper K?

A

peaked T waves

flattened P waves

increased PR interval

widened QRS

Sine wave pattern -> VF

133
Q

Mx of HyperK?

A

10ml 10% calcium gluconate

100ml 20% glucose + 10 u insulin (Actrapid)

Salbutamol 5mg nebulizer

Calcium Resonium 15g PO or 30g PR or Haemofiltration

134
Q

indications for acute dialysis?

A

AEIOU

Acidosis:

Severe metabolic acidosis (pH <7.2)

Electrolytes:

Persistent hyperK (>7 mM)

Intoxicants:

Poisons e.g. aspirin

Oedema:

refractory pulmonary oedema

Uraemia:

Symptomatic- encephalopathy, pericarditis

135
Q

Mx of pulmonary oedema?

A

Sit up and give high flow O2

morphine 2.5mg IV + metoclopramide 10mg IV

Frusemide IV 120-250mg over 1h

GTN spray +/- ISMN IVI (unless SBP <90)

if no response consider:

CPAP

haemofiltration/ haemodialysis +/- venesection

136
Q

Mx of Acute Renal Failure?

A

Resus and assess fluid status

ABC

A: ↓GCS may need airway Mx

B: Pulmonary oedema. - sit up, high flow O2

C: assess fluid status: CRT, urine output, BP

tx any lifethreatening complications: hyperK, pulmonary oedema, consider need for rapid dialysis

137
Q

monitoring in acute renal failure?

A

cardiac monitor: hyperK

urinary catheter

consider CVP

start fluid balance chart

138
Q

features of benzodiazepine poisoning?

A

reduced GCS

respiratory depression

139
Q

mx of benzodiazepine overdose?

A

Flumazenil

140
Q

features of BB overdose?

A

Severe bradycardia or hypotension

141
Q

mx of Beta Blocker overdose?

A

Atropine

142
Q

Cyanide overdose features?

A

inhibits the cytochrome system

almond smell

phase 1: anxiety +/- confusion

phase 2: increased/ decreased pulse

phase 3: fits, coma

143
Q

mx of cyanide overdose?

A

Dicobalt edentate

144
Q

Carbon monoxide overdose features?

A

headache, dizziness, nausea

hypoxaemia (SpO2 may be normal)

metabolic acidosis

145
Q

Mx of Carbon Monoxide overdose?

A

Hyperbaric O2

146
Q

Features of digoxin overdose?

A

reduced GCS

yellow green visual haloes

arrhythmias

147
Q

mx of digoxin overdose?

A

Anti-digoxin antibodies (Digibind)

148
Q

Features of ethanol overdose?

A

reduced GCS

respiratory depression

149
Q

Features of ethylene glycol poisoning?

A

Found in antifreeze

High anion gap metabolic acidosis with high osmolar gap

Intoxication with no visual disturbance

150
Q

mx of ethylene glycol poisoning?

A

Ethanol

Haemodialysis

151
Q

Features of heparin overdose?

A

bleeding

152
Q

Mx of heparin overdose?

A

Protamine sulphate

153
Q

features of iron overload?

A

n+v

abdo pain

154
Q

mx of iron overload?

A

desferrioxamine

155
Q

Features of methanol overdose?

A

high anion gap metabolic acidosis with high osmolar gap

intoxication with visual disturbance

156
Q

mx of methanol overdose?

A

ethanol

haemodialysis

157
Q

features of Lithium overdose?

A

N+V

ataxia, coarse tremor

Confusion

polyuria and renal failure

158
Q

mx of lithium ovferdose?

A

IV fluids, haemodialysis

159
Q

features of opiate overdose?

A

respiratory depression

reduced GCS

pin point pupils

160
Q

mx of opiate overdose?

A

Naloxone

161
Q

mx of warfarin overdose?

A

Vit K

Prothrombin complex

162
Q

features of warfarin overdose?

A

major bleed

163
Q

features of tricyclic antidepressant overdose?

A

Prolonged QT interval -> Torsade de pointes

Metabolic acidosis

anticholinergic effects

164
Q

mx of tricyclic antidepressants overdose?

A

activated charcoal

NaHCO3 IV

165
Q

mx of organophosphate overdose?

A

atropine + pralidoxime

166
Q

effects of aspirin overdose?

A

respiratory stimulant -> respiratory alkalosis

uncouples oxidative phosphorylation -> met acidosis

vomiting and dehydration

hyperventilation

tinnitus, vertigo

hyper/ hypoglycaemia

respiratory alkalosis initially then lactic acidosis

167
Q

mx of aspirin overdose?

A

activated charcoal if <1h since ingestion

Bloods: paracetamol and salicylate levels, Glucose, U+E, LFTs, INR,

ABG: met acidosis

alkalinise urine: NaHCO3 +/- KCl

haemodialysis may be needed

168
Q

pathophysiology of paracetamol overdose?

A

normal metabolism overloaded and paracetamol -> highly toxic NAPQI by cytP450

NAPQI can be detoxified by glutathione conjugation (overwhelmed in Overdose)

169
Q

presentation of Paracetamol overdose?

A

vomiting, RUQ pain

jaundice and encephalopathy +/- liver failure

cerebral oedema -> raised ICP

170
Q

mx of paracetamol overdose?

A

activated charcoal if <1 h since ingestion

Bloods: paracetamol level 4h post ingestion

Glucose, U+E, LFTs, INR, ABG

N-acetyl cysteine: if levels are above treatment line on graph

171
Q

pathophysiology of diabetic ketoacidosis?

A

Ketogenesis:

↓ insulin → ↑ stress hormones and ↑ glucagon

→ ↓ glucose utilisation + ↑ fat β-oxidation

↑ fatty acids → ↑ ATP + generation of ketone bodies

Dehydration:

↓ insulin → ↓ glucose utilisation + ↑ gluconeogenesis →severe hyperglycaemia

→ osmotic diuresis → dehydration

Also, ↑ ketones → vomiting

Acidosis:

Dehydration -> renal perfusion

HyperK

172
Q

presentation of DKA?

A

abdo pain, vomiting

gradual drowsiness

Dehydration

sighing “kussmaul” hyperventilation

ketotic breath

173
Q

diagnosis of diabetic ketoacidosis?

A

Acidosis (high anion gap): pH < 7.3

Hyperglycaemia: ≥11.1mM

Ketonaemia: ≥3mM (≥2+ on dipstix)

174
Q

Ix of diabetic ketoacidosis?

A

Urine: dip for ketones and glucose, MCS

Capillary glucose and ketones

VBG: acidosis + high K

Bloods: U+E, FBC, glucose, cultures

CXR: ?infection

175
Q

complications of diabetic ketoacidosis?

A

cerebral oedema: excess fluid administration

aspiration pneumonia (vomiting)

hypoK

Hypophosphataemia -> resp and skeletal muscle weakness

Thromboembolism

176
Q

Mx of Diabetic Ketoacidosis?

A

Fluids:

0.9% Normal saline infusion

(SBP > 90 -> 1L over 1h)

(SBP < 90 -> IL stat + more until SBP >90)

Start K replacement in 2nd bag of fluids

3.5-5.5 mM -> 40 mM/L

Add 10% dextrose 1L/ 8h when glucose <14mM

Insulin infusion

0.1u/kg/h Actrapid

find an treat precipitating factors

177
Q

monitoring during tx of diabetic ketoacidosis?

A

Hourly cap glucose and ketones

VBG @ 60 min, 2h then 2 hrly

Plasma electrolytes 4 hrly

178
Q

When to restart Subcut insulin in DKA?

A

when pt is biochemically resolved, eating and drinking

start long acting insulin night before and short acting insulin before breakfast

179
Q

metabolic derangement in hyperosmolar non ketotic coma?

A

marked dehydration and glucose > 35mM

no acidosis (no ketogenesis)

osmolality > 340 mosmol/kg

180
Q

complications of hyperosmolar non-ketotic coma?

A

occlusive events are common: DVT, stroke

give LMWH

181
Q

mx of hyperosmolar non ketotic coma?

A

Rehydrate with 0.9% NS over 48h

  • may need ~9L

wait 1 h before starting insulin

(may not be needed) - start low to avoid rapid changes in osmolality

Look for precipitant

e.g. MI, infection, bowel infarct

LMWH

182
Q

cause of hypoglycaemia?

A

usually exogenous: insulin, gliclazide

pituitary insufficiency

Liver failure

Addison’s

Insulinomas

183
Q

Symptoms of hypoglycaemia?

A

Autonomic:

sweating, anxiety, hunger, tremor, palpitations

neuroglycopaenic:

confusion, drowsiness, seizures, coma, personality change

184
Q

Mx of hypoglycaemia?

if pt still able to swallow

A

oral carbs

rapid acting: lucozade

long acting: sandwich

185
Q

Mx of hypoglycaemia

if pt is unconscious/ unsafe swallow?

A

IV dextrose 100ml 20%

186
Q

mx of hypoglycaemia if pt is drowsy / confused but swallow still intact?

A

Buccal glucogel/ hypostop

consider gaining IV access

187
Q

Mx of hypoglycaemia with no IV access?

A

1mg Glucagon IM

(insulin release may cause rebound hypoglycaemia)

188
Q

presentation of thyroid storm?

A

high temp

agitation, confusion, coma

tachycardia, AF

acute abdomen

heart failure

189
Q

precipitants of thyroid storm?

A

Recent thyroid surgery or radioiodine

infection

MI

trauma

190
Q

Mx of thyroid storm?

A

Fluid resus + NGT

Bloods: TFTs + cultures if infection suspected

Propranolol (symptomatic control)

Digoxin may be needed

Carbimazole then Lugol’s iodine 4h later to inhibit thyroid

Hydrocortisone

Tx cause

191
Q

Presentation of myxoedema coma?

A

looks hypothyroid

hypothermia

hypoglycaemia

heart failure: bradycardia and low BP

coma and seizures

192
Q

mx of myxoedema coma?

A

Bloods: TFTs, FBC, U+E, glucose, cortisol

correct any hypoglycaemia

T3/T4 IV slowly (may precipitate MI)

hydrocortisone 100mg IV

tx hypothermia and heart failure

193
Q

precipitants of myxoedema coma?

A

radioiodine

thyroidectomy

Pituitary surgery

Infection, trauma, MI, stroke

194
Q

presentation of addisonian crisis?

A

shocked: high HR, postural drop, oliguria, confused

hypoglycaemia

usually known addisonian or chronic steroid user

195
Q

precipitants of addisonian crisis?

A

infection

trauma

surgery

stopping long-term steroids

196
Q

Mx of addisonian crisis?

A

Check cap glugose: glucose may be needed

Hydrocortisone 100mg IV 6hrly

IV crystalloid

septic screen

tx underlying cause

197
Q

cause of hypertensive crisis?

A

phaeochromocytoma

198
Q

presentation of hypertensive crisis?

A

pallor

pulsating headache

feeling of impending doom

raised BP

Cardiogenic shock

199
Q

mx of hypertensive crisis?

A

alpha blocker

e.g. phentolamine or labetalol

phenoxybenzamine when BP controlled

BBs AFTER to control tachycardia/ arrhythmia

elective surgery after 4-6 wks to allow full a-blockade and volume expansion

200
Q

risk factors for burns

A

age: children + elderly
comorbidities: epilepsy, CVA, dementia, mental illness

occupation

201
Q

classification of burns?

A

superficial:

erythema, painful e.g. sunburn

partial thickness:

heal within 2-3 wks if not complicated

superficial: no loss of dermis, painful, blisters

deep: loss of dermis but adnexae remain

healing from adnexae e.g. follicles

v painful

full thickness:

complete loss of dermis

charred, waxy, white skin

anaesthetic

heal from the edges -> scar

202
Q

early complications of burns?

A
  • Infection: loss of barrier function, necrotic tissue, SIRS, hospital
  • Hypovolaemia: loss of fluid in skin + ↑ cap permeability
  • Metabolic disturbance: ↑↑K, ↑↑myoglobin, ↑Hb → AKI
  • Compartment syndrome: circumferential burns
  • Peptic ulcers: Curling’s ulcers
  • Pulmonary: CO poisoning, ARDS
203
Q

what metabolic disturbances may result from burns?

A

High K+

high myoglobin

raised Hb -> AKI

204
Q

What peptic ulcers results from burns?

A

Curling’s Ulcers

205
Q

late complications of burns?

A

scarring

contractures

psychological problems

206
Q

intermediate complications of burns?

A

VTE

pressure sores

207
Q

assessment of % body surface area burnt?

A

Wallace rule of 9s

Head and neck: 9%

arms: 9% each
torso: 18% front and back
legs: 18% each
perineum: 1%
palm: 1%

208
Q

Mx of Burns?

A

specific concerns w burns: secure airway, manage fluid loss, prevent infection

Airway: examine for respiratory burns, consider early intubation + dexamethasone (to decrease inflammation)

Breathing: 100% O2, look for signs of CO poisoning,

ABG: COHb level, SpO2 unreliable if CO poisoning

Circulation: 2 large bore cannulae, take bloods, start 2L warmed Hartmann’s immediately

+ Analgesia: morphine + metoclopramide

209
Q

what signs may suggest respiratory burns?

A

soot in oral or nasal cavity

burnt nasal hairs

hoarse voice, stridor

210
Q

signs of CO poisoning?

A

headache

n/v

confusion

cherry red appearance

211
Q

What are some formulas to guide fluid replacement in burns?

A

parkland formula in 1st 24h

4 x weight (Kg) x % burn = mL of Hartmanns in 24h

give half in 1st 8h

Muir and Barclay formula

(weight x % burn) /2 = mL of Colloid per unit time

time units: 4, 4, 4, 6, 6, 12 = 36 hrs total

212
Q

definition of hypothermia?

A

core (rectal) temperature < 35

213
Q

pathophysiology of hypothermia?

A
  1. Radiation: 60%

Infra-red emissions

  1. Conduction: 15%

Direct contact

1O means in cold water immersion

  1. Convection: 15%

Removes warmed air from around the body

↑d in windy environments

  1. Evaporation: 10%

Removal of warmed water

↑ in dry, windy environments

214
Q

primary vs secondary causes of hypothermia?

A

primary: environmental exposure
secondary: change in temp set point
e. g. age related, hypothyroidism, autonomic neuropathy

215
Q

presentation of mild hypotension?

32.2-35

A

shivering

tachycardia

vasoconstriction

apathy

216
Q

presentation of moderate hypothermia?

28-32.2

A

dysrhythmia, bradycardia, hypotension

J waves

decreased reflexes, dilated pupils, reduced GCS

217
Q

presentation of severe hypotension??

<28 degrees

A

VT -> VF -> cardiogenic shock

apnoea

non reactive pupils

coagulopathy

oliguria

pulmonary oedema

218
Q

Ix of hypothermia?

A

rectal temperature

FBC, U+E, glucose

TFTs, blood gas

ECG: J waves (between QRS and T wave) , arrhythmias

219
Q

mx of hypothermia?

A

slowly rewarm (0.5 degrees/ hr)

(reheating too quickly -> peripheral vasodilation -> shock)

passive external: blankets, warm drinks

active external: warm water or warmed air

active internal: mediastinal lavage and CPB

(severe hypothermia only)

warm IVI 0.9% NS

consider abx for prevention of pneumonia (routine if temp < 32 and age > 65)

220
Q

complications of hypothermia?

A

arrhythmias

pneumonia

coagulopathy

acute renal failure

221
Q

what is the rate of Chest compressions to breaths in adult CPR?

A

30:2

222
Q

If non shockable rhythm is identified on defibrillator?

A

PEA/ Asystole.

Immediately resume CPR for 2 min then assess rhythm again

adrenaline 1 mg as soon as IV access obtained

repeat adrenaline every other cycle

223
Q

if shockable rhythm is identified on defibrillator?

A

VF/ pulseless VT

1 shock

then immediately resume CPR for 2 min

+ adrenaline 1 mg

amiodarone 300mg after 3rd shock

repeat adrenaline every other cycle

224
Q

reversible causes of cardiac arrest?

A

Hypoxia

Hypovolaemia

Hypo/HyperK/ metabolic

Hypothermia

Thrombosis - coronary or pulmonary

Tamponade - cardiac

Toxins

Tension pneumothorax

225
Q

Adrenaline given how often in cardiac arrest?

A

every 3- 5 min

226
Q

what adverse features would suggest pt is unstable and requires synchronised DC shock?

A

tachycardia/ arrhythmia

+

shock

syncope

myocardial ischaemia

heart failure

227
Q

How to carry out synchronised DC shock?

A

up to 3 attempts

then

amiodarone 300mg IV o ver 10-20. min and repeat shock

followed by amiodarone 900 mg over 24h

228
Q

narrow complex tachycardia mx?

A

vagal manoeuvres

then

adenosine 6mg rapid IV bolus (then 12, 12 mg)

monitor ECG continuously

if sinus rhythm not restored -> seek expert help

if restored -> probable re entry paroxysmal SVT

  • record 12 lead ECG in sinus rhythm
229
Q

AF Mx?

A

rate control

  • BB or diltiazem
  • consider digoxin or amiodarone if evidence of heart failure
230
Q

VT mx?

A

amiodarone 300mg IV over 20-60 min

then 900 mg over 24h

231
Q

Torsades de pointes mx?

A

Mg 2g over 10 min

232
Q

SVT w BBB mx?

A

give adenosine as for regular narrow complex tachycardia

233
Q

Bradycardia general mx?

A

ABCDE approach

O2, IV access

Monitor ECG, BP, SpO2

identify and treat reversible causes (e.g. electrolytes)

234
Q

bradycardia with no adverse features (shock, syncope, MI, HF) + no risk of asystole

Mx?

A

Observe

235
Q

what suggests increased risk of asystole in bradycardia pt?

A

recent asystole

mobitz II AV block

Complete Heart block w broad QRS

ventricular pause > 3s

236
Q

mx of bradycardia w adverse features (e.g. shock, syncope, HF, MI)?

A

atropine 500mcg IV

237
Q

mx of bradycardia if no satisfactory response to atropine or risk of asystole?

A

Atropine 500mcg IV repeat to max 3mg

Isoprenaline 5 mcg/ min IV

Adrenaline 2 -10 mcg/ min IV

OR

Transcutaneous pacing

Medicine (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions