Emergency Medicine Flashcards
1
Q
AED
A
Advanced external defibrillators
2
Q
ROSC
A
Return of systemic circulation.
3
Q
Mouth to mouth ventilation
A
3000BC
4
Q
First attempt of newborn resuscitation by blowing
A
1780
5
Q
First experimental direct cardiac massage
A
1874
6
Q
First successful direct cardiac manage in man
A
1901
7
Q
First experimental indirect cardiac massage and defibrillation
A
1946
8
Q
Developmental of cardiopulmonary resuscitation due to the works of Peter safar
A
1980
9
Q
First CPR guidelines
A
1966
10
Q
Comprehensive review
A
2010AHA guidelines
11
Q
Update of 2010 was at
A
2015 AHA guidelines
12
Q
Pathogenesis of cardiac arrest
A
1) loss of blood flow
2) the failure of the heart to effectively pump
13
Q
Causes of cardiac arrest
A
1) Cardiac
2) extracardiac
14
Q
Cardiac
A
Primary lesion of cardiac muscle leading to the progressive decline of contractility ,conductivity disorders and mechanical factors
15
Q
Extra cardiac
A
All cases accompanied with hypoxia
16
Q
Signs and symptoms of cardiac arrest
A
1) sudden loss of responsiveness
2) unconsciousness
3) no pulse in the carotid and femoral arteries
4) apnea or gasping ,no breathing
5) death like appearance
17
Q
Symptoms of cardiac arrest
A
1) absence of pulse on carotid arteries
2) respiratory arrest may be in 30sec aft Cardiac arrest
3) enlargement of pupils -90sec aft CA
18
Q
Chances of living
A
Reduce to 7-10%
19
Q
Bystanders intervene
A
1/3
20
Q
In hospital survival rate for cardiac arrest
A
Lower than 20%
21
Q
Out of hospital in cardiac arrest
A
Lower than 10%
22
Q
Imp reason for tragic consequences
A
1)rapidity and efficacy resuscitation interventions
23
Q
Chain of survival
A
1) recognition and activation of the emergency response system
2) immediate high quality CPR
3) rapid defibrillation
4) basic and advanced emergency medical services
5) advanced life support and post arrest care
24
Q
Order of CPR
A
CAB
Circulation -chief
Airway
Breathing
25
Pulse should be checked in case of cardiac arrest
Carotid artery and brachial artery
26
Primary cardiac arrest due to
1) ventricular fibrillation
| 2) asystole
27
Secondary cardiac arrest results from
1) asphyxia
| 2) exsanguination (loss of blood - artham )
28
Mechanical asystole with electrocardiogram complexes continuing in form of pulseless electric activity (PEA)
Electromechanical dissociation (EMD)
29
During CPR patient should be in which position
Supine and placed on the hard surface
30
During CPR,heel of one hand on
Lower half of the sternum
31
How the elbow should be and how much cm should the depression be
Elbow should be extended ,5-6cm depression
32
How many compression should be done
100-120/min and 2 intial breath aft every 30compression 30:2
33
How should the airway be maintained
1) tilting the head backward
2) the jaw thrust or chin lift
3) supplemental oxygen should be administered
34
In case of insufficient oxygen what should be done
Bag mask assisted ventilation,needle or surgical cricothyrotomy and rapid endotracheal and nasotracheal intubation should be done
35
How many sec for 1breath
6 to 8 sec (abt 8 to 10 breaths per min)
36
Mostly used Intravenous access Bt which is not used
Common peripheral vein and should avoid central venous access
37
How much time will it take for medication admin peripheral site to reach the heart
1-2mins
38
Therapy medication in case of ALs(advance life support )
1) epinephrine -1mg 3-5min /70kg body weight
2) lidocaine- 1 to 1.5 mg /kg iV push should repeat ones in 3-5 min to reach 3mg /kg
3) alkaline buffers -1mmol/kg IV during CPR
39
If venous is unobtainable then Wat should be done
Should be given endotracheal app 2-2.5 times the recommended dose,dilated in 10ml of saline
Beyond the tip of endotracheal
40
How many joules in case of use of defibrillators
1) 360 joules (monophasic)
| 2) 200vjoules (biphasic)
41
Where the pads should be positioned
Negative pad - right inferior infraclavicular chest
| Positive pad -lateral left chest
42
Total number of CPR should be
5 cycles
43
Mechanism of restoration of circulation by external cardiac massage
1) cardiac pump
| 2) thoracic pump
44
What is compression equal to
Systole
45
Which reaction mimic the feature of an anaphylactic reaction by mast cell/basophil activation is not IgE dependent
Anaphylactoid
46
Anaphylaxis not necessarily
Type 1 hypersensitivity/IgE mediated
47
Anaphylactic reaction of Systemic ingested (IV drugs) leads to
Cardiovascular (hypotension / syncope)
48
Anaphylactic reaction of ingested (food allergens) leads to
Respiratory (laryngeal oedma/bronchocontriction)
49
Anaphylactic reaction of percutaneous insect stings
| Leads to
Respiratory or cardiovascular problems equally likely
50
What are the feature which are suggesting severe anaphylactic reaction will be
```
Wheeze
Stridor
Cyanosis
Skin pallor
Prominent tachycardia
```
51
How many percentage of fatal food related anaphylactic reaction have no skin signs
Compared to bradycardia in vasovagal attack
80%
52
Which histamine produces the classical triple response
Intradermal histamine
53
What are all the classical triple response
Central red spot (vasodilatation)
Flare
Wheal(odema overlying initial red spot)
54
Which histamine causes 1)vasodilatation 2)increased capillary leak
Intravenous histamine
55
What kind of categorisation is made for anaphylaxis condition
Odema/itch -good
Hypotension - modest
Bronchoconstriction - negligible
56
What does DCAP BTLS used in case of abdominal trauma
D- deformity
C-contusion
A-abrasion
P-puncture or penetration
B-burns
T-tenderness
L-laceration
S-swelling
57
Destruction of the surface layer on body by dry heat(fire)
Burns
58
Destruction of the surface layer on body by moist heat(hot water,oil)
Scalds
59
What is most common causes of accidental death
Burns
60
What causes the burns
Heat,radiation,harmful chemicals,sunlight or electrical shock
61
The immediate threat to the life results from
Fluid loss,infection and effects of burned,dead tissue
62
How are burns classified
According to the depth of the tissue
63
Classification of burns
1st and 2nd degree burns
| Third degree burns
64
1st and 2nd degree burn is also called
Partial thickness burns
65
Third degree burns are called
full thickness burn
66
What does the first degree burn characterised by
Redness
Pain
Slight edema
67
What does the first and sec degree burn involve
1st only epidermis
| 2nd epidermis And part of dermis
68
What are the characteristics of second degree burn
Red,tan,white,blistered,painful
69
What does the third degree burn involve
Epidermis,dermis,subcutaneous layer which are often destroyed
70
Characteristic of 3rd degree burn
Painless due to loss of nerve endings,no blanching,contracture and deformity are common
71
Urinary catheter is also called
Foleys catheter
72
Ng tube is also known as
Ryles tube
73
Parklands formula
Fluid required = 4ml * wt* % of burn
74
Muir and barclay formula
1 ration = (% of burn * wt)/2
75
What is fluid of choice for burn
Ringer lactate
76
What is the stage 1 hypertension
140-159/90-99
77
Stage 2 hypertension will be
>160/100
78
Hypertensive urgency
SBp >180 or DBP >120 in the ab of end organ damage
79
Hypertensive emergency
SBp > 180 or DBP >120 in the presence of end organ damage
80
GI bleeding arising from esophagus,stomach,proximal duodenum
Upper GI bleeding
81
GI bleeding arising from the distal duodenum to illeocecal valve
Mid intestinal bleed
82
GI bleeding arises from colon/rectum
Lower intestinal bleed
83
Ocult blood in stool
Guaiac positive stool
84
Very dark,tarry,pungent stool
Melena
85
Bright red blood,dark red,maroon bleeding
Hematochezia
86
Most common differential diagnosis of upper GI bleeding
Peptic ulcer disease
| Gastroesophageal varices
87
Most common differential diagnosis of lower GI bleeding will be
Diverticulosis
88
Vit k
Slow acting ,long lived
89
FFP
Fast acting ,short lived and give 1U FFP for every 4U PRBCs
90
IV drip for hypertensive emergency
Nitroprusside,nicardipine,labetalol
91
Antiseptic and cream used
Iodine ,silver sulfadiazine
92
Should adrenaline be give IM or SC
IM
93
How should not given in arrhythmogenic in high dose
1:2000 adrenaline IV
If patient in shock -dilute 0.5ml of 1:1000 adrenaline in 50ml of normal saline infuse at o.1-2ml/min till stable
94
If adrenaline should be give IVI what should be done
Must be diluted and should not be delayed administration to set up IVI and gain IV access given 5-10mins
95
Fluid volume over time
Volume* drip factor /time in min =gtts/min
500cc*10gtt/ml/60 mins =83.3gtts/min
96
The effect of adrenalin are markedly potentiated in patients taking concurrent
Tricyclic antidepressants,MAOIs or cocaine
97
The b-effect of adrenaline may also be antagonised if patient taking
B -blocker
98
What are the potent Alpha blocker
Phenothiazine
99
First generation of histamine receptor antagonist
Chlopheniramine(only for systemic use)
| Diphenhydramine
100
Sec generation of histamine receptor antagonist
Terfenadine and cetrizine
101
Other drugs in anaphylaxis
Nebulised or IV beta agonist (eg salbutamol)-useful where bronchospasm
IV glucocorticoid (hydrocortisone )-response to biphasic and ashtmatic features
IV glucagon -refractory hypotension
H2 antagonist -systemic mastocytosis clearer
102
Investigation for anaphylaxis
Mast cell tryptase assay
Allergen specific IgE levels(RAST)
Within 1hr and not >6hr,10ml of clotted blood
