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Self > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

AED

A

Advanced external defibrillators

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2
Q

ROSC

A

Return of systemic circulation.

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3
Q

Mouth to mouth ventilation

A

3000BC

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4
Q

First attempt of newborn resuscitation by blowing

A

1780

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5
Q

First experimental direct cardiac massage

A

1874

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6
Q

First successful direct cardiac manage in man

A

1901

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7
Q

First experimental indirect cardiac massage and defibrillation

A

1946

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8
Q

Developmental of cardiopulmonary resuscitation due to the works of Peter safar

A

1980

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9
Q

First CPR guidelines

A

1966

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10
Q

Comprehensive review

A

2010AHA guidelines

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11
Q

Update of 2010 was at

A

2015 AHA guidelines

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12
Q

Pathogenesis of cardiac arrest

A

1) loss of blood flow

2) the failure of the heart to effectively pump

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13
Q

Causes of cardiac arrest

A

1) Cardiac

2) extracardiac

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14
Q

Cardiac

A

Primary lesion of cardiac muscle leading to the progressive decline of contractility ,conductivity disorders and mechanical factors

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15
Q

Extra cardiac

A

All cases accompanied with hypoxia

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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

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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

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18
Q

Chances of living

A

Reduce to 7-10%

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19
Q

Bystanders intervene

A

1/3

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20
Q

In hospital survival rate for cardiac arrest

A

Lower than 20%

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21
Q

Out of hospital in cardiac arrest

A

Lower than 10%

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22
Q

Imp reason for tragic consequences

A

1)rapidity and efficacy resuscitation interventions

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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

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24
Q

Order of CPR

A

CAB
Circulation -chief
Airway
Breathing

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25
Q

Pulse should be checked in case of cardiac arrest

A

Carotid artery and brachial artery

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26
Q

Primary cardiac arrest due to

A

1) ventricular fibrillation

2) asystole

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27
Q

Secondary cardiac arrest results from

A

1) asphyxia

2) exsanguination (loss of blood - artham )

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28
Q

Mechanical asystole with electrocardiogram complexes continuing in form of pulseless electric activity (PEA)

A

Electromechanical dissociation (EMD)

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29
Q

During CPR patient should be in which position

A

Supine and placed on the hard surface

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30
Q

During CPR,heel of one hand on

A

Lower half of the sternum

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31
Q

How the elbow should be and how much cm should the depression be

A

Elbow should be extended ,5-6cm depression

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32
Q

How many compression should be done

A

100-120/min and 2 intial breath aft every 30compression 30:2

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33
Q

How should the airway be maintained

A

1) tilting the head backward
2) the jaw thrust or chin lift
3) supplemental oxygen should be administered

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34
Q

In case of insufficient oxygen what should be done

A

Bag mask assisted ventilation,needle or surgical cricothyrotomy and rapid endotracheal and nasotracheal intubation should be done

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35
Q

How many sec for 1breath

A

6 to 8 sec (abt 8 to 10 breaths per min)

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36
Q

Mostly used Intravenous access Bt which is not used

A

Common peripheral vein and should avoid central venous access

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37
Q

How much time will it take for medication admin peripheral site to reach the heart

A

1-2mins

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38
Q

Therapy medication in case of ALs(advance life support )

A

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

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39
Q

If venous is unobtainable then Wat should be done

A

Should be given endotracheal app 2-2.5 times the recommended dose,dilated in 10ml of saline
Beyond the tip of endotracheal

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40
Q

How many joules in case of use of defibrillators

A

1) 360 joules (monophasic)

2) 200vjoules (biphasic)

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41
Q

Where the pads should be positioned

A

Negative pad - right inferior infraclavicular chest

Positive pad -lateral left chest

42
Q

Total number of CPR should be

A

5 cycles

43
Q

Mechanism of restoration of circulation by external cardiac massage

A

1) cardiac pump

2) thoracic pump

44
Q

What is compression equal to

A

Systole

45
Q

Which reaction mimic the feature of an anaphylactic reaction by mast cell/basophil activation is not IgE dependent

A

Anaphylactoid

46
Q

Anaphylaxis not necessarily

A

Type 1 hypersensitivity/IgE mediated

47
Q

Anaphylactic reaction of Systemic ingested (IV drugs) leads to

A

Cardiovascular (hypotension / syncope)

48
Q

Anaphylactic reaction of ingested (food allergens) leads to

A

Respiratory (laryngeal oedma/bronchocontriction)

49
Q

Anaphylactic reaction of percutaneous insect stings

Leads to

A

Respiratory or cardiovascular problems equally likely

50
Q

What are the feature which are suggesting severe anaphylactic reaction will be

A 
Wheeze 
Stridor
Cyanosis
Skin pallor
Prominent tachycardia
51
Q

How many percentage of fatal food related anaphylactic reaction have no skin signs
Compared to bradycardia in vasovagal attack

A

80%

52
Q

Which histamine produces the classical triple response

A

Intradermal histamine

53
Q

What are all the classical triple response

A

Central red spot (vasodilatation)
Flare
Wheal(odema overlying initial red spot)

54
Q

Which histamine causes 1)vasodilatation 2)increased capillary leak

A

Intravenous histamine

55
Q

What kind of categorisation is made for anaphylaxis condition

A

Odema/itch -good
Hypotension - modest
Bronchoconstriction - negligible

56
Q

What does DCAP BTLS used in case of abdominal trauma

A

D- deformity
C-contusion
A-abrasion
P-puncture or penetration

B-burns
T-tenderness
L-laceration
S-swelling

57
Q

Destruction of the surface layer on body by dry heat(fire)

A

Burns

58
Q

Destruction of the surface layer on body by moist heat(hot water,oil)

A

Scalds

59
Q

What is most common causes of accidental death

A

Burns

60
Q

What causes the burns

A

Heat,radiation,harmful chemicals,sunlight or electrical shock

61
Q

The immediate threat to the life results from

A

Fluid loss,infection and effects of burned,dead tissue

62
Q

How are burns classified

A

According to the depth of the tissue

63
Q

Classification of burns

A

1st and 2nd degree burns

Third degree burns

64
Q

1st and 2nd degree burn is also called

A

Partial thickness burns

65
Q

Third degree burns are called

A

full thickness burn

66
Q

What does the first degree burn characterised by

A

Redness
Pain
Slight edema

67
Q

What does the first and sec degree burn involve

A

1st only epidermis

2nd epidermis And part of dermis

68
Q

What are the characteristics of second degree burn

A

Red,tan,white,blistered,painful

69
Q

What does the third degree burn involve

A

Epidermis,dermis,subcutaneous layer which are often destroyed

70
Q

Characteristic of 3rd degree burn

A

Painless due to loss of nerve endings,no blanching,contracture and deformity are common

71
Q

Urinary catheter is also called

A

Foleys catheter

72
Q

Ng tube is also known as

A

Ryles tube

73
Q

Parklands formula

A

Fluid required = 4ml * wt* % of burn

74
Q

Muir and barclay formula

A

1 ration = (% of burn * wt)/2

75
Q

What is fluid of choice for burn

A

Ringer lactate

76
Q

What is the stage 1 hypertension

A

140-159/90-99

77
Q

Stage 2 hypertension will be

A

> 160/100

78
Q

Hypertensive urgency

A

SBp >180 or DBP >120 in the ab of end organ damage

79
Q

Hypertensive emergency

A

SBp > 180 or DBP >120 in the presence of end organ damage

80
Q

GI bleeding arising from esophagus,stomach,proximal duodenum

A

Upper GI bleeding

81
Q

GI bleeding arising from the distal duodenum to illeocecal valve

A

Mid intestinal bleed

82
Q

GI bleeding arises from colon/rectum

A

Lower intestinal bleed

83
Q

Ocult blood in stool

A

Guaiac positive stool

84
Q

Very dark,tarry,pungent stool

A

Melena

85
Q

Bright red blood,dark red,maroon bleeding

A

Hematochezia

86
Q

Most common differential diagnosis of upper GI bleeding

A

Peptic ulcer disease

Gastroesophageal varices

87
Q

Most common differential diagnosis of lower GI bleeding will be

A

Diverticulosis

88
Q

Vit k

A

Slow acting ,long lived

89
Q

FFP

A

Fast acting ,short lived and give 1U FFP for every 4U PRBCs

90
Q

IV drip for hypertensive emergency

A

Nitroprusside,nicardipine,labetalol

91
Q

Antiseptic and cream used

A

Iodine ,silver sulfadiazine

92
Q

Should adrenaline be give IM or SC

A

IM

93
Q

How should not given in arrhythmogenic in high dose

A

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
Q

If adrenaline should be give IVI what should be done

A

Must be diluted and should not be delayed administration to set up IVI and gain IV access given 5-10mins

95
Q

Fluid volume over time

A

Volume* drip factor /time in min =gtts/min

500cc*10gtt/ml/60 mins =83.3gtts/min

96
Q

The effect of adrenalin are markedly potentiated in patients taking concurrent

A

Tricyclic antidepressants,MAOIs or cocaine

97
Q

The b-effect of adrenaline may also be antagonised if patient taking

A

B -blocker

98
Q

What are the potent Alpha blocker

A

Phenothiazine

99
Q

First generation of histamine receptor antagonist

A

Chlopheniramine(only for systemic use)

Diphenhydramine

100
Q

Sec generation of histamine receptor antagonist

A

Terfenadine and cetrizine

101
Q

Other drugs in anaphylaxis

A

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
Q

Investigation for anaphylaxis

A

Mast cell tryptase assay
Allergen specific IgE levels(RAST)

Within 1hr and not >6hr,10ml of clotted blood

Self (6 decks)

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