Emergency medicine Flashcards
How do you do an A & E assessment?
C ABCDE Control catastrohic haemorrhage Airway with C-spine protection Breathing with ventilation Circulation with haemorrhage control Disability with neurological status Exposure/environment
How do you do a handover in emergency medicine?
Age, time, mechanism, injuries, signs, treatment
Where are the junctional haemorrhage areas?
femoral, axillary, neck
What is a drug you can do to limit bleeding?
traexamic acid 1g 10 minute then 1g infusion
What are the 4 types of blast injury?
Primary - blast wave disrupts gas filled structures
Secondary - impact airborne debris
Tertiary - transmission of body
Quaternary - all other forces
Name 6 things measured in the NEWS2 score
respiratory rate oxygenation pulse and BP level of consiousness temperature
When would you consider a patient hypotensive?
BP <90, or a difference of 40 from their normal blood pressure
What are non-cardiac ways to measure circulation?
colour, capillary refill, saturations, decreased consiousness (brain perfusion), urine output (kidney perfusion)
What are the 3 broad categories of shock? [plumber]
Fluid - hypovolaemic, haemorrhagic
Pump - obstructive, cardiogenic
Pipes - distributive, septic, anaphylactic
What are some types of obstructive shock?
tension, pneumothorax, PE, tamponade
What are some types of cardiogenic shock?
ischaemic, arrhythmia
What are some types of distrubtive shock?
neurogenic, endocrine
Which three types of shock are you more likely to give fluids and vasopressor for?
hypovolaemic, septic, anaphylactic
What are the 3 things you should do if you see a patient in shock?
ask for help
O2
ABCDE
What are 5 potential causes of a coma?
seizure, infection, hypoxia, hypercapnia, CO poisoning, uraemia, hepatic encephalopathy, hypoglycaemia, hypothyroidism, hypothermia, opiates, benzos, tricyclics, alcohol
How would you score a GCS?
Eye open 4 - spontaneously 3- verbal 2- pain 1- none verbal response 5 - orientated 4- confused 3 - inappropriate 2 - incomprehensible 1 - none motor response 6 - obeys 5 - purposeful to pain 4 - withdraws (clavicle) 3 - flexes to pain 2 - extends to pain 1 - none
Give 3 indications for intubation
failure to maintain airway
insecure airway e.g. GCS<9
poor ventilation
impeding herniation
What is Cushing’s reflex?
ICP > 30mmHg
ischaemia in medullary vasomotor centre
hypertension
bradycardia
What is a score to measure sepsis risk?
SOFA score - sequential organ failure assessment
- resp, cardio, hepatic, coagulation, renal, neuro
What is a drug that can falsely raise lactate?
metformin
How would you manage sepsis?
BUFALO
What fracture do you need to look out for when elderly people have head injuries?
cervical fracture
What are some RF for elderly falls?
meds (gliclizide, benzodiazepines, antihypertensives)
UTIs
What is a FAST scan?
focused assessment with sonography in trauma - takes 15 mins
- low negative predictive value (can only see >250 ml blood in abdo)
What is included in trauma series of XR?
AP chesst, pelvis, c-spine
What type of hip fracture is a pelvic binder used to treat?
AP compression fracture
What are C-spine views?
lateral, AP, odontoid peg view (open mouth)
How would you interpret CT head?
basic overview, brain tissue (grey), CSF (dark grey), gas (black), bone (white)
When would you do a CT in trauma?
if haemodynamically unstable
mechanism of injury - more than one system
findings of XR/FAST scan are inconclusive or suggest injury
obvious severe injury
What does AVPU stand for?
alert, voice, pain, unresponsive
What is included in neuro secondary survey?
general motor
reflexes
tone
cranial nerve and brainstem
What are indications to intubate?
absent gag, GCS <9, AVPU < 9
failure to maintain airway
poor ventilation
impending herniation
How would you optimise cerbral perfusion?
optomise BP to reduce ICP
cerebral dehydration with mannitol or hypertonic saline
reduce cerebral blood volume - head to 30 degrees, avoid hypoxia
What is Cushing’s reflex?
ICP >30mmHg
ischaemia medually vasomotor centre
hypertension
bradycardia
What approach do you take in major trauma?
C ABCDE Control catasrophic haemorrhage airway - c spine protection breathing with ventilation circulation with haemorrhage control disability - neuro status exposure/environment - do not move from one system to another
What is the difference between incision and laceration?
incision - blade
laceration - tear
How do you assess A on emergency approach?
How would you treat it if a problem was found?
Look - accessory, breathing?
Listen - gurgling, snoring, stridor etc.
Feel - airflow?
Treat - jawthrust, guedel, recovery position, nasal airway, intubation, gentle suction
How do you assess B on emergency approach?
Look - expansion, cyanosis, tachypnoea, saturations
Listen - absent or added sound
Feel - central trachea, symmetry, percussion, feel before listening
How do you assess C on emergency approach?
Look - colour, cap refil, sats, bleeding, decreased consiousness
Listen - heart sounds
Feel - pulse, BP
What is the dose of adrenaline in anaphylactic shock?
adult 500 micrograms (0.5mL)
child (6-12) 300 micrograms
Child <6 150 micrograms
What drugs do you give in anaphylaxis?
adrenaline
IV fluid challenge
chlorphenamine
hydrocortisone
How would you treat ethylene glycol poisoning?
IV fomepizole or ethanol
supportive measures
