Emergency medicine Flashcards
AAA
signs?
size monitoring
treatment
cullens sign above and below umbilicus grey turners on both flanks <3 is not normal <5.5 cm watch and wait - 5.5 = surgery >5.5 cm / rupture - IV morphine, surgery clamping
Treatment: If ruptered = prophylactic abx metronidzole and cefuroxime
APPENDICITIS
diagnosis + signs
treatment
- bloods WCC up and CRP up
- urinalysis to exclude UTI + pregnancy test
- rigid abdomen + rebound tenderness
- rosvigs sign = pain in RIF when pressing LIF
- TX = IV fluids, analgesia,
IV ABX = Co-amoxiclav/ cerfuroxime /metronidazole
laparoscopic appendectomy
CHOLECYSTITIS = inflammation of gall bladder often due to stone
CHOLANGITIS = INFECTION of billiary tract due to obstruction
–> pain RUQ, colicky, radiated to shoulder, worse eating fatty foods,
–> CHARCOTS TRIAD
- RUQ pain
- jaundice (obstructive post hepatic
- FEVER - septic
TX = IV abs co-amoxiclav or cephalosporin
bowel obstruction treatment
Vomiting early indicates high level obstruction
- DRIP + SUCK
- NG tube
- IV FLUIDS
- antiemetric cyclizine
- surgical resection
diverticulitis
syx
TREATMENT
infection and inflammation of pouches in descending or sigmoid colon
RF: low fibre diet, obesity
syx –> localised abdo pain in LEFT LOWER q relieved by opening bowels
fever, malaise, anorexia, nausea, achy,,
TREATMENT
- IV abx = cerfuroxime + metronidazole
- IV analgesics - avoid opiates as constipation
- IV fluids NBM
ectopic pregnancy
syx
ivx
treatement
severe lower abdo pain + shoulder tip if perforated as diaphragm irritation
MISSED PERIOD, cervical motion tenderness on bimanul
hx of ammenorhea and vaginal bleeding
IVX - pregnancy test
bloods BHCG , cross match, FBC, rh status
Transvaginal ultrasound is DIAGNOSTIC
BHCG lower than expected
treatment: A-E, iv access, fluid resuscitations
methotrexate then refer to gynaecologist!!
surgery = salpingectomy
miscarriage
- syx
- ivx
- treatment
foetus is <24 weeks gestation (peak 12 weeks)
affects > 20% pregnancies
- pelvic pain
- vaginal bleeding
- offensive vaginal discharge (septic abortion)
IVX - bloods BCHG, crossmatch, usss, speculum
TREATMENT: IM OXYTOCIN or ERGOMETRINE if continued vaginal bleeding
- Anti D Rhesus prophylaxis
- Vaginal Misoprostol for incomplete/missed miscarriage
- Antiemetic and analgesia
ovarian cyst
syx
ivx
tx
- lower abdo /pelvic pain
- may be worse in sex
- Bloating
- torsion can cause severe intermittent pain
- urinary symptoms if pressing on bladder
(usually underlying endometriosis) - ivx- bloods fbc for infection,
CA125
urinalysis and uss abdoment to confirm diagnosis
tx -> most resolve but if persisent >5cm then laporoscopic cystectomy
URGENT RESUS IF TORSION
pancreatits
syx
ivx
tx
- severe constant epigastric pain raidiates to back
- worse with alchohol + relieved by sitting forwards
anorexia, N+V, guarding, janice
cullens + grey turner may develop
ivx- INCREASED amylase, Lipase, uWCC, CRP, + UREA, Decreased Calcium.
USS detect gallstones
cxr to exclude small bowel perf
treatment: oxygen 15 NRB, BP. IV ACCSS, fluids, abx, catheter
iv analgesic = pethidine
iv antiemetic
Cause = igetsmashed = ethanol + gallstones + steroids
pelvic inflammatory disease
- syx
- ivx
- treatment
sexual active women hx of STI and many sexual partners
- painful sex
- bilateral lower abdo tenderness
- painful and irregular periods
- vaginal discharge, dysuria
- fever!!!
- risk of abscess formation
ivx- bloods up WCC, chlamydia + gonnorhea test endocervical/vulvogainal swab,
urinalysis exclude UTI
PREGNANCY TEST
treatment: fluids if shocked
- PO abx 14 days
Low risk gonorrhoea = ofloxacin + metronidazole
High risk gonnorrhea = ceftiroxime IM and doxyclcline and metronidazole.
peptic ulcer risk syx ivx treattment
elderly male smoker
- severe epigastric pain may radiate to shoulder/ abdomen
- worse on movement/ coughing
- GASTRIC worse on eating
- duodenal relieved by eating + 4X commoner
- hx of indigestion anorexia and bloating
if severe + perf –> haematemesis, fatigue, sob, Anaemia
IVX- h.pyloria- breath or stool, upper gi endoscopy repeat at 6 weeks and bloods, check FBC for anaemia
treatment: acute if perf a-e triple therapy: BD 7 DAYS- PPI 4 weeks clarithromyic + amoxicillin or metronidazole alc + smoking sessation
Renal colic
SYX
ivx
treatment
elder male
SYX- pain dull ache in loin = stone in renal pelvis
severe clicky worse pain ever felt = ureteric stone
N+V, sweating and restlessness
urinary symptoms: dribbling, anuria, macroscopic haematruia
syx of hypercalcamiea, palpable kidney
ivx- increased urea, creatinine + ca. kidney xr and contrast ct kidney urethrea bladder
treatment- analgesic, NSAIDS 1st line! DICLOFENAC PR abx for any infection - metoclopramide - tamsulosin a blocker relaxes smooth muscle of bladder and ureter - high freq US to break up stones surgery for 1/5 - larger stones
UTI
syx
upper + lower
ivx
tx
E.COLI
lower - cystitis
- dysura, freq, urgency, suprapubic pain and smelly wee
upper- pyleonephritis - loin/back pain - fever, nausea, vomiting shock/sepsis hx preceeding cystitis
ivx- urinalysis, MSU, dipstick, bloods, sepsis screen
treatment: LOWER
trimethoprim, nitrofurantoin for 3-6 days
catheterised = ciprofloxacin
UPPER -
A-E and cefuroxime 10 days
analgesia
acute ischamic leg
6ps
causes
treatment
pallor pulselessness pain paraesthesia paralysis perishingly cold cause: thrombus, embolus, dm, SMOKING, alcohol, obesity, HTN
treatment: urgent angioplasty within 6hrs
emboli may be thrombolysed with TISSUE PLASMINOGEN ACTIVATOR - most effective when given via local arterial catheter.
- anticoagulate with heparin after thrombolysis and angioplasty
cellulitis
syx
treatment
- painful swollen red warm unilateral leg + systemic fever sometimes
treatment: ABX 7 days
- flucloxacillin (if prep give pen V)
- Clarithromycin in pen allergic
DVT
syx
ivx
treatment
pain and tenderness in calf / limb
red warm swollen
distension of superficial veins
pitting oedema
ivx - well score more than 2 = do USS and give LMWH if positive
less than 2- d dimer and if positive USS if negative discharge
screen for thrombophilia / cancer
tx- LMWH - tinziparin / enoxaparin
Warfarin for 3 months
MOa: heparin bind to antithrombin
compression stockings
GOUT
syx
KNEE OR MTP 1st toe
rapid onset warm swollen
shiny skin - deposition of urate crystals
ivx- serum urate up and wcc up
joint aspiration = exclude septic arthritis
treatment: NSAIDs, Colchine = acute
Allopurinol = Chronic
Septic arthritis
- syx
- causes
- ivx
- treatment
one joint- normally knee
IVDU more unusual joints affected
painful tender joint with hot red swollen
systemic fever and rigours
70% causes by staph areas
- ivx joint aspiration = yellow, purulent wcc up
treatment= joint aspirate until DRY - ABX- BENZYLPENICILLIN AND FLUCLOX iv for 2 weeks po for 4 weeks nsaid analgesia
ASTHMA
severe
severe= 33, 92 sats CHEST Cyanosis Hypotension Exhaustion Silent chest Tachycardia
Treatment: Oxygen Salbutamol Hydrocortisone 100mg/Pred 40mg Ipratropium Theophyline Magnesium sulfate Escalate
COPD exacerbation
syx
COSICAARR
- acute dyspnoea chest tightness productive cough green sputum confusion/ cyanosis pursled lip breathing /- accessory muscles IVX- abg, perf, cxr, ecg
treatment COSICAARR Controlled Oxygen Salbutamol 5mg neb Ipratropium 0.5mg neb Corticosteroids pred 30mg Antibiotics Aminiphyline Radiography Resp support - BIPAP + refer
PNEUMONIA
syx
signs:
CURB-65
ivx
tx
breathlessness + cough + purulent sputum + hamoptysis
pleuritic chest pain
fevers + rigors
signs: dull percussion, decreased breath sounds, crackles
Confusion Urea >7 Resp rate >30 Blood pressure 90/60 >65 yrs score of 2 = admission in hosptial
ivx- cxr, BLOODS ^wcc, ^esr/crp, sputum culture
treatment: A-E, sepsis screen, BUFALO iv fluids abx CAP guided by curb score mild- 7 day amoxicillin mod- amoicicillin and clarityrhomycin severe- iv co-amoxiclav and clarithromycin
HAP = trust guidelines = genatamicin and cephalosporin
pneumothorax
types
syx-
ivx-
tx-
primary = young tall men
secondary = underlying disease
syx- asymptomatic or ^hr ^rr decreased chest expansion, hyperresonant, decreased breath sounds, deviated trachea if tension
ivx- abg (resp alkalosis as blowing off co2)
cxr- not if acute!!!
tx = if not tension but bigger than 2cm = CHEST DRAIN 5TH ICS MIX AXILLIARY LINE
if tension:
A-E
aspirate 16/18g cannula 2nd ICS MID CLAVICULAR LINE
continue until 2.5L aspirated
then chest drain 5TH ICS MID AXILLARY LINE
PE
syx
ivx + score
treament;
unless massive pe, has vague syx and dyspnoea
MASSIVE: sudden onset SOB
pleuritic chest pain, worse on inspiration, haemoptysis, ^Hr, ^rr, down bp. raised JVP and hypoxia.
WELLS SCORE + 4 = CTPA
wells score under 4 d dimer- if +ve do CTPa
If negative = discharge
TX: troponin, ecg, abg, echocardiography
15l nrm, iv fluids, cardiac monitor
ANTICOAGULATE: LMWH
- start warfrin until INR 2-3 then stop LMWH
- DOAC ribaroxiban
analgesia
- consider alteplase in massive pe when haemodynamically acceptable
pulmonary oedema
syx
signs
ivx:
Treatment:
Short sentences hx of orthopnoea, PND COUGH- pink frothy anxious, sweaty, cold, pale sign: fine basal inspiratory crackles callop rhythm
ivx: BNP, FBC, LFT, ecg, odoppler, abg, Cxr CXR SIGNS: Alveolar oedema B kerley lines Cardiomegaly Dialted upper lobe vessels Effusion -pleural
TX: A-E and get patient to sit up 0MFG Oxygen 15L nrbm Morphine / diamorphine Fureoeminde diuretic GTN 2 sprays / iv nitrate \+ B blocker + Ace I Catheter + CPAP if needed "pain, pee, puff pap"
ACS
syx
ivx:
- crushing central chest pain
- sudden onset
- radiates to back/ jaw/ arm
- impending doom
- dyspnoea
- N+V, sweating and palpitations
IVX: troponin raises at 12hr and peak 24hrs.
CK increased, CXR heart failure, ECG signs
STEMI = st elevation and LBBB
NSTEMI = st depressiion and t wave inversion
IMMEDIATE MANAGEMENT for confirmed STEMI or NSTEMI (MMONACH)
ECG + blood markers + Secure IV access
Morphine 2.5-10mg (treat nausea)
Metoclopramide 10mg IV
O2 high glow if sats <94%
Nitrates - GTN spray 2 sprays + BB - Bisoprolol
Aspirin 300mg PO
Clopidogrel 300mg
Heparin (if within 12hrs of Sx onset and undergoing rimary PCI) OR Fondaparinux (NSTEMI – LMWH continue for 2-5d, CI with PCI)
Bloods: FBC, U+E, glucose, lipid profile (LDL, HDL, triglycerides)
CXR
After care for all patients with recent NSTEMI or STEMI (ABC’S):
ACEi – indefinite
BB – 12 months
anti-Coagulants X 2 (Aspirin and Anti-plat = ticagrelor or clopidogrel) 12 months
Statin
aortic dissection types syx ivx treatment - medical - surgical
type a = ascending 70%
type b desceding 30%
syx: tearing chest pain sudden onset
dyspnoea, dizziness, sweating, syncope
ivx: CT ANGIOGRAM
Ecg: rule out MI
CXr: widened medistinum - double knuckle aorta!!
tracheal deviation to right
Treatment: oxygen 15L nrbm 2X iv access iv opiate and antiemetic manage hypotension = LABETOLOL infusion + arterial line to slow heart rate and blood lost CALL CARDIOLOGY A = SURGICAL B =MEDICAL
Pericarditis
syx
sharp central retrosternal chest pain
worse on deep inspiration, swalloping and movement
low grade fever + dysphagia
IVX: ECG, ST elevation - concave upwards and present in all chest leads unlike MI, troponin, echo
Treatment: analgesia, NSAID + PPI, pericardiocentesis
alcohol withdrawal
delerium tremens
triad
treatment:
simple = after 12 hours
- anxious, restless, N+V, palpitations etc
delerium tremens = 24-72 hours MEDICAL EMERGENCCY
- hypertension, fever, hallucinations, fits, arryhtmias, hyperreflexia
if severe can lead to wernike-korsakoff syndrome (triad)
- ophthalmoplegia
- gait ataxia
- confuison
tx: supportive, bdzs, chlordiazepoxide stops seizures,
IV/IM thiamine- PABRINEX
complete heart block
exam:
treatment:
proximal block: at av node, may be asymptomatic - QRS: NARROW
distal block: chest pain, sob, confusion, syncope, sudder death QRS: broad
examination: JVP cannon A waves when atria and ventricles contract same time.
treatment: monitor heart via defibrillates lay flat legs raised oxygen 15L NRMB iv access --> 0.5mg atropine IV every 2-3 mins --> Adrenaline IV
Diabetic ketoacidosis
syx
ivx
tx
THIRST, POLYURIA, WEIGHT LOSS, DRY MOUTH,
NAUSEA, VOMITING, ABDO PAIN
altered mental state
low insulin so increased glucose but unable to enter cells = starvation and dehydration
Diagnosis = GLUCOSE >11, PH <7.3, BICARB >15 + KETONES > 3
ivx: bloods, urinalysis, ecg, cxr, ABG: METABOLIC ACIDOSIS
tx:
1. 500ml 0.9% NaCL over Fluid resus
2. IV insulin with sodium chloride 0.9% conc of 1 unit/mL; infuse at a fixed rate of 0.1 units/kg/hour e.g 60Kg = 6 units
3. Add KCl if needed
4. Add Glucose 10% when levels fallen enough
head injury
syx
basal skull fracture syx
treatment:
ivx: bloods, glucose, CT HEAD 8 HOURS if
- GCS <13, open fracture, basal skull signs, >1 vomiting episode, seizure, focal neuro signs.
ct must be interpreted within 1hour
basal skull - panda eyes- orbital bruising subconjunctival haemorrhage bleeding from ears CSF- ears or nose Battle sign: bruising over mastoid process
TX: c spine immobilisation iv opioid if skull fracture: IV CEFUROXIME tetanus immunisation treat seizures with bzs and phenytoin
HHS
hyperglyceamic hyperosmolar state
syx
ELDERLY T2DM syx- develop over days to weeks dehydration - thirst, polyiria, weight loss, dry mouth weakness and cramps altered mental state
Ivx: urinalysis UP glucose, UP ketones, UP Na.
Glucose: >30mmol/L.
Treatment: gradual saline rehydration over 24-48 hrs (risk of cerebral oedema if too fast)
replace K when urine starts to flow. start LMWH
Seizures
status epilepticus
treatment:
“tonic” = stiff - you have a stiff gin and tonic
Clonic = jerking
prodrome: change in mood etc before
Seizure: partial - aura
Generalised- LOC, tonic clonic
Post octal: headache, confusion, tiredness, todds palsy
Status epilpeticus : contiuous generalised seizures lasting >5mins.
treatment:
- recovery position
- 4mg lorazepam IV or buccal midazolam / rectal diazolam
oxygen 15l
2X iv access
RAPID S. INDUCTION if unresponsive
Stroke
treatment:
>24 hours non resolving urgent CT head within 1 hour treatment: ischamic 300mg aspirin Thrombolysis with alteplase if <4.5 hrs after onset - Clopidogrel for long term use
Haemorrhagic: prothrombin and vit K to normalise clotting
SUB ARRACHNOID HAEMORRHAGE
syx
ivx
treatment:
WORST ever headache sudden onsent blow to back of head history of preceeding exertional activity neck pain photophobia N+V Drowsiness, confusion, syncope, fits
ivx: CT head within 12 hrs LP in normal ct head - xanthacrhomic yellow due to break down of hb
treatment: A-E NIMODIPINE --> ca channel blocker reduces cerebral artery spasm maintain airway Surgical clip analgesia antiemeteic if GCS <8 contact neuro
vasovagal syncope
collapse with brief LOC self resolving 2 mins
prompt recovery
preceeding sweating, N+V, light headedness
sudden reflex bradyardia + vasodialiation
ivx: ECG,
tx: reassure and lie supise and raise legs
amphetamine overdose e.g speed
syx
treatment:
syx –> euphoria, dialtated pupils, palpitations, tach and hypertension
SYMPATHETIC OVERDRIVE
treatment: refer to toxobase consider activated charcoal if <1hr after ingestion cool down correct electrolye imbalance fluids and bicard consider symptomatic bzds
opiate overdose
syx
resp depression hypotension pinpoint pupils convulsions and coma PARASYMPATHETIC OVERDRIVE
treatment: maintain airway, bag valve mask
IV NALOXINE = TITRATE UP DOSE
paracetemol overdose
time frame of syx
ivx
treatment
<24 hrs N+v but asymptomatic
24-72 hrs N+V and Ruq pain
72hrs plus = jaundice, hepatic encephalopathy, hypoglycaemia and seizures
ivx = clotting and INR + LFTs and ABG
tx: 0-1hr activated charcoal
0-4 hours must wait to measure paracetemol level
4-8hrs measure paracetemol level and treat with
N-ACETYLCYCSTEINE = PARVOLEX
IF 15HR + or staggered dose over 1hr then treat with NAC and dont bother with pcm as uninterpretable.
consider 5’2
tricyclic antidepressant overdose
syx
ivx
syx
dry skin and mouth
dilated unreactive pupils + urinary retention
jerky limb movements/ ataxia
drowsiness and coma
arrhythmias
(anticholinergic - cant see, cant pee, cant shit cant spit)
abg:metabolic acidsos and ecg, bloods toxicology
treatment: maintain airway, give po activated charcoal if taken with hour.
IV BZD if fitting
IV NA BICARBONATE to treat acidosis and arrythmias
Meningitis
syx meningism
signs:
brundski
kernigs
ivx
treatment
Syx: headache, neck stiffness, photophobia
non blanching purpuric rash late sign
Brundski: involuntary lifting of leg when lying supine and head is raised
Kernigs: unable to extend knee when thigh is flexed to 90degrees
ivx: LP unless raised icp
bloods - wcc. raised crp.
low glucose on lumbar = bacterial
Treatment: fluids, maintain airway, send bloods off asap
viral: acyclovir
bacterial: IV dexamethasone and IV cefotaxime and amoxicillin or in community IM benzypenicillin
space occupying lesion
syx
ivx
treamtment
Signs of raised ICP
syx papilloedema, altered LOC, increased hr, decreased BP.
Headace worse when lying down/ coughing/ bending
seizuresin 50% and focal neuopathy
behavioural changes
ivx: CT head and MRI
biopsy and avoid LP risk of coning.
treament: surgery, chemo. radio and for cerebral oedema dexamethasome 4mg over 8hrs.
Temporal arteritis
syx
tx:
TX:
consider over 50 + recent onset headache
associated with jaw claudication
pain over temporal artery
low grade fever and weight loss, night sweats
visual disturbance= blindness/diplopia
ivx: bloods - UP ESR, fbc for normocytlic normochronic anaemia, UP WCC.
temporal artery biopsy = definitive diagnosis
treatment: STEROIDS
hydrocortisone 200mg IV or pred 40mg PO
refer emergency to opthal.
Venous sinus thrombosis
cohort of pts?
syx
ivx?
Presents sismilarly to SAH
THINK YOUNG WOMEN ON COMBINED ORAL CONTRACEPTIVE PILL
Syx: signs of raised ICP, papilloedema, altered LOC, hr increased, bp decreased.
seizures
Ivx: LMWH
start warfarin to reach INR 2-3
If unresolved after a few days STREPTOKINASE
bzds for seixures.
Migraine
syx
tx:
Throbbing unilateral headache
nausea, photophobia, malaise, anorexia, vomiting
tx: analgesia 1g paracetemol
Antiemetic: metoclopramide
Sumatriptan- 50mg as the migraine starts
Croup
age?
syx?
ivx? WHAT NOT TO DO?
treatment?
Barking coug aged 6m-6years - viral
hoarse voice and barking cough worse at night
mild fever, decreased air entry
dont examine throat - need to differentiate from epiglottis
treatment: resolves in 3 days
if severe: A-E and 02, intubation
DExamethasone
Diarrhoea-
UC
CD
gastroenteritis: watery diarrhoea, vomiting, fever
UC: colon + rectum only, dialated thin bowel wall crypt abscesses, red granulomatous appearance
CD: thick bowel wall, skip lesions, cobbelstone appearance
tx: predinisolone + Mesalazine
Gastro: most cases self resolving. if not - ORT and antiemetic and fluid bolus + bulk forming
otitis media
cohort?
syx?
ivx:
tx?
aged 3-6yrs following URTI
syx: earache preceeded by deafness, fever and discharge.
ivx: otoscopy- buldging TM with absent light reflex
treatment: po analgesia, abx amoxicillin
ent follow up if perforation
advise not to swim
tonsillitis
centor criteria
syx
treatment:
= Bacterial indicator age 3-14 tonsillar swelling/ exudate anterior cervical lymphadenopathy temp > 38 absence of cough monospot test if ebv and throat swab a culture
syx mild fever, prodromal coryzal and blocked nose.
Treatment: bacterial analgesia abx BENZYLPENICILLIN or clarithromycin avoid amoxicillin if suspected EBV
acute lower back pain
red flags
cauda equina
- back pain and lower limb weakness
- altered peri anal or perineal sensation
schpincter disturbance
MSSC - back pain and tenderness leg weakness and pain/sensory disturbance tx: 16g dexamethasone and PPI urgent neuro referral
ruptured AAA - central umbilical pain --> back expansile and pulsatile hypo--> collapse --> shock bruising acutey unwell tx; surgical repair
Ankle sprain
ottowa
treatment:
usually inversion
ottowa
- pain in malleolar zone + bone tendernesss at..
a) posterior edge of lateral malleolus
b) bone tenderness at posterior edge of medial malleolus
c) inability to weight bear immediately after injury and in ED
tx: rice
analgesia- ibuprofen
recovery 4 weeks
Distal radius fracture
Colles
smiths
colles: FOOSH dinner fork
smiths: falling on flexed wrist
xray + check neurovascular status!!
treatment: backslab pop cast + sling
manipulated under anaesthetic if grossly displaced fracture.
Biers block Iv regional LA
Hip fracture
syx
ivx:
tx:
Pain and tenderness around hip joint
radiates towards knee
unable to weight bear
affected leg shorter and internally rotated
intracapsular: can affect blood supply ot femoral head but extracapsular doesnt
ivx: lateral hip x ray
check if NOF- intra/extracapsular + trochanteric?
disrupted trabeculae and abnormal pelvic contours (shentons line)
Garden classicificaion = degrees of femoral displacement
Bloods: prepare for surgery cross match
tx: iv morphine, fluid resus, a-e, femoral nerve block and refer to ortho
shoulder dislocation
which most common?
syx?
Atrial fibrillation
syx
atrial flutter: regular
Irregularly irregular pulse
Syx: chest pain, palpitations, dizziness, syncope, collapse, dyspnoea.
Ivx: ecg absent p waves, narrow QRS, sawtooth in flutter with 2:1 block
Tx: tachycardia pathway oxygen 15l NRBM iv fluids if haemodynamically UNstable --> DC electrocardiovert if dosnt work IV FLECANIDE or IV AMIODARONE
if stable or flutter = rate control B blocker
in heart failure- rhythm control: digoxin, only given in sedentry patients.
if syx >48hrs then anticoagulate LMWH
Supraventricular tachycardia
QRS
causes
syx
ECG?
treatment:
Qrs = NARROW <0.12s
causes: AF, wolf parkinson white, (things above the ventricles)
Syx: palpitations, fatigue, sob tachycardia +100bmp.
ecg: wpw delta wave , st changes.
do trop!!
Treatment: TACHYCARDIA PATHWAY o2 + fluids If haem unstable 1. Amiodarone 300mg IV 2 DC shock
If Stable
- Vagal manouvres
- ADENOSINE 6mg –> 12mg
VENTRICULAR TACHYCARDIA
cohort?
syx?
ECG:
TREATMENT:
over 60 and hx of IHD
broad complex tachyarrhytmias
syx? palpitations, SOB, dizziness, syncope, collapse
>150bpm - cannon A waves in jvp
ECG: REGULAR, >012s broad qrs, absent p and t waves,
Treatment: pulseless VT- CPR HAEMODYNAMICALLY UNSTABLE 1. Syncronised DC 2.IV AMIODARONE 300mg
STABLE
1. IV AMIODARONE 300MG
electrical dc under sedation ?
ventricular FIBRILATION
syx
ivx
NO BREATHING OR PULSE
ivx: ECG: rate up to 500bpm NO P Q R ST waves
treatment: A-E call crash team CPR 30:2 ADRENALINE OR REVERSE CAUSES HHHH TTTT
anaphylaxis
syx
treatment:
syx: resp wheese, chest tightness, swelling of lips and tongue, itchy rash, hypotension, nausea and vomiting
treatment: DEFINITIVE AIRWAY IF NEEDED ARCH - ADRENALINE 0.5ML 1:1000 IM every 5 mins - RANITIDINE IV - Chloraphenamine IV 10MG - Hydrocortisone 100-200mg
-5mg SALBUTAMOL NEB
+0.5 IPRATROPIUM BROMIDE NEB
1-2L SALINE 0.9% IV
Hypovolaemia
MAP/ SYSTOLIC?
syx?
map <65, systolic <90
Tachy + 100 (those on b blockers cant do this)
syx: pallor, cool peripheries, decreased urine output, syncope
treatment: A-E
raise legs
IV ACCESS + consider giving blood
20ml.kg 0.9% NACL
sepsis
sepsis = sirs + sourse of infection
SIRS + TEMP UNDER 36/ ABOVE 38
- hr >90, RR >20, WCC HIGH
IVX: FBC, U+E, GLUCOSE, CLOTTING, URINE OUTPUT
TX = BUFALO!!! Blood cultures Urine output Fluid challenge Antibiotics broad spec Lactate 02
if non responsive to fluids give vasopressor e.g. noradrenaline
ACUTE KIDNEY INJURY
defined as
creatinine rise >26 in 48hrs
creatinine rise >1.5X baseline 7 days
urine output <0.5ml/kg for 6 hrs
treatment: stop nephrotoxic drugs + treat infection
fluids 500ml over 25 mins
give bicarb for acidosis
oedema: sit up and furosemide
Acute urinary retention
syx
exam
ivx
treatment
unable to urinate
painful distended bladder
may have delirium
exam: suprapubic tenderness and dull to percuss. screen for cauda equina.
ivx: urine dipstick and MSU
treatment: urgent decompression catheter
urethral 14g men
treat cause e.g bph tamsulosin
Testicular torsion
cohort?
syx
treatment
young adolescent boy MEDICAL EMERGENCY sudden onset severe scrotal pain may radiate to groin/ lower abdo painful walking unilateral red swollen testes
treatment: emergency surgery within 6-12 hrs
bilateral orchidoplexy!! do both so doesnt happen other side
