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DPD 2020 > Emergency medicine > Flashcards

Emergency medicine Flashcards

1
Q

24 year old male • Acutely short of breath • HR 120 • BP 129/87 • RR 35 • SpO2 98% on 15LO2 • GCS 15

what are your diffferential?

A

Pneumothorax

  • Anaphylaxis
  • Asthma
  • Pneumonia
  • Cardiac failure
  • ARDS
  • Pleural effusion
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2
Q

24 year old male • Acutely short of breath • HR 120 • BP 129/87 • RR 35 • SpO2 98% on 15LO2 • GCS 15

Initial assessment •

Known asthmatic • Acute SOB today • No chest pain • SPO2 92% on arrival- 98% with O2 • Chest- bilateral wheeze • No other PMH • Able to say a few words

WHat is it?

A

Asthma

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3
Q

How do you differentiate between acute severe asthma and life threatening Asthma

A

Acute Severe Asthma •

(PEF) 33-50% of best

Can’t complete sentences

Respiration ≥25/min

ƒPulse ≥110 beats/min

Life-threatening Asthma

  • PEF <33% of best
  • SpO2 <92%

Silent chest, cyanosis, or feeble respiratory effort

Arrhythmia/hypotension

Exhaustion, altered consciousness

Essentially:

Decompensation

Unable to maintain adequate PO2 and PCO2

Drowsy due to rising PCO2, hypotension or exhaustion

Need intubation

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4
Q

how does an Asthmatic present?

A

Wheeze

breathless

tachycardic

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5
Q

How do you treat an acute asthma attack?

A

Nebulised salbutamol • IV salbutamol • Nebulised adrenaline • Nebulised magnesium • Oral steroids • IV steroids

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6
Q

What is the pathophysiology of asthma

A

Reversible airway disease

Hyper reactivity

Airflow limitation

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7
Q

A patient with an acute attack get#s worse

RR drops to 10/minute • SpO2 91% on 15L • HR 90 • Drowsy

What do you do?

A

Call for specialist

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8
Q

is the carbo dioxide high low or normal in asthmatics

A

low

hyperventilating

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9
Q

34 year old female • Suddenly felt unwell • Widespread urticarial rash • HR 130 • BP 75/40 • Collapsed • Wheezy

What are differentials

A
  1. Ectopic pregnancy
  2. Acute severe asthma
  3. Sepsis

4. Anaphylaxis

  1. Pneumonia
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10
Q

What are causes for collapse

A

drugs

  1. alcohol
  2. likely intracranial pathology
  3. low BP
  4. bleeding
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11
Q

What does this person have

A

ANAPHYLAXIS

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12
Q

What is the pathophysiology of anaphylaxis

A
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13
Q

34 year old female • Suddenly felt unwell • Widespread urticarial rash • HR 130 • BP 75/40 • Collapsed • Wheezy

No known allergies • Ate a chicken korma • Lips and mouth felt tingly • 1 episode of diarrhoea • Then was complaining of feeling itchy • Collapsed • Ambulance report she developed wheeze en route to hospital

what does she have?

A

anaphylaxis

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14
Q

How do you treat anaphylaxis

A

Adrenaline • 500mcg • 0.5ml 1;1000 IM

  • Lie her flat and put legs in the air – Why? get blood to the brain
  • Piriton • Hydrocortisone • Fluids
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15
Q

how does adrenaline work

A

α1 – vasoconstriction and relaxation of GI tract

  • α2 – platelet aggregation and reduction in noradrenaline release from nerve terminals
  • β1 – inotropic and chronotropic cardiac effects and relaxation of GI tract
  • β2 – bronchodilatation, increase in noradrenaline release from nerve terminals, increase in intracellular cyclic adenosine monophosphate (cAMP) production in mast cells and basophils, reduction in the release of cellular mediators
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16
Q

Central chest pain to left arm • Pale and sweaty • Smokes 30/day • Hypertension • Diabetes • As his ECG is performed he collapses and becomes unconscious

A

MI anteriorlateral

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17
Q

What are your priorities in someone with an MI?

What do you initiallly

A
  1. Call for help
  2. Open his airway and start rescue breaths
  3. Get IV access
  4. Get a 12 lead ECG

Check for signs of life? • Open airway • Check pulse • no pulse , not breathing = cardiorespiratory arrest

do CPR

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18
Q

What are reversible causes of cardiac arrrest

A

hypoxia

hypovolaemia

hypothermia

hypokalaemia

Tension pneumothorax

Tamponade

Toxins

Thromboembolic

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19
Q

What does this ECHO show

A

cardiac tamponade

20
Q

what are shockable rhythms

A

pulseless VT and VF

21
Q

Which are non shockable rhythms

A

Pulseless activity

asystole

22
Q

What do you do if someone has a cardiac tamponade

A

Emergency pericardial centesis

23
Q

What is a life threatnening feature of Asthma?

A can’t complete a sentence

resp rate >25

PEF <33%

Pulse >110

A

PEF <33%

24
Q

Which is the correct dose of adrenaline in anaphylaxis

A 0.5ml of 1:10

B: 0.5ml to 1:100

C. 0.5 of 1:1000

D. 0.5 of 10000

A

C. 0.5 of 1:1000

25
Q

38 year old male • Motorcycle vs car • Bullseye windscreen • LOC initially then GCS 15/15 • HR 100 BP 145/78 • GCS 9/15

What does he have?

how do you approach it

A

extradural haematoma

Structured approach to the injured patient • Catastrophic Haemorrhage?

  • Airway with c spine control
  • Breathing
  • Circulation
  • Disability
  • Exposure
  • ‘C-ABC’

A- Noisy •

B - Good air entry, no obvious injury – Normal breath sounds, Percussion resonant

  • C- HR 100 BP 145/78
  • D- E 2 V 2 M 5 = 9/15 – Dilated left pupil
  • E- large scalp wound, blood from ear
26
Q

What does he have?

A
  1. Subarachnoid haemorrhage
  2. Subdural haemorrhage
  3. Extradural haematoma
  4. Tumour
27
Q

Why do you get a dilated pupil in head trauma

A

herniation of the brain through the foramen magnum - at first one pupil and then the other

28
Q

How do you know how bad an extradural haematoma is?

A

midline shift

29
Q

How do you manage an extradural haematoma?

A
  • Optimise oxygenation – A, B, C
  • Keep CO2 normal – A,B
  • Maintain cerebral perfusion – (CPP= MAP-ICP)
  • Make sure nothing more life threatening takes priority – Primary survey
  • Neurosurgical input & theatre
30
Q

WHat could you when looking for an airway in ABCD

IF there is a problem what would you do?

A

Are they breathing?

• Is it normal or noisy?

– Noisy = obstructed

– Obstructed = do something!

• Do they need a ‘definitive airway’

  • LMA
  • intubation
31
Q

How do you assess breathing in a trauma patient?

A

– Look: chest rising

– Palpate: surgical emphysema, lacerations

– Percuss: look for pleural effusion

– Auscultate

32
Q

What does this guy have

A

pneumothorax

33
Q

What does this guy have

A

broken ribs

haemothorax

surgical emphysema

34
Q

How do you treat a tension pneumothorax

A

large bore canula in th e 2nd intercostal space

35
Q

How do asses circulation

A

Assessment

– Pulse, BP, capillary refill time

– General appearance

36
Q

if someone is really hypotensive and you suspect bleeding

Where would you look?

A

Source of haemorrhage – ‘ on the floor & 4 more’ – Chest/Abdo/Pelvis/Long bones

37
Q

How do you deal with haemorrage

A
38
Q

What is this?

A

open book fracture

close the hip with a pelvic binder

39
Q

if someone is hypotensive due to haemorrhage or blood loss, how do you get their BP up

A

transfusion of packed red cell and plasma

Turn off the tap

  • Fluids
  • Warfarin •

Coagulopathy to correct

• TXA

Damage control surgery

40
Q

how quickly do you need to give TXA

A

wihtin an hour

41
Q

HOw do you look at dissability out of ABCD

A

GCS

  • Glasgow Coma Score – level of consciousness •

Pupils

  • Blood sugar
  • Limb movements
42
Q

A 17-year-old male is stabbed in the left side of his chest just medial to the nipple. • His blood pressure is 90/60 and his pulse is 130. • On inspiration his JVP increases and his peripheral pulses and blood pressure decrease.

A

*Diagnosis?*

  1. Tension pneumothorax

2. Cardiac tamponade

  1. Pneumonia
  2. Thoracic heamorrhage
43
Q

If someone has a caridac tampopnade due to trauma how would you treat it

A

thoracotomy

need to close off the site of bleeding

Pericardiocentesis - would just refill

44
Q

what are injuries you want to look out for in people that were in a fire?

A

Direct Burns

  • Inhalation Injury
  • Smoke Inhalation
  • Carbon Monoxide Poisoning
  • Cyanide Poisoning
  • Trauma
45
Q

how does a full thickness burn look like

A

turn white

46
Q

According to ATLS principles what should you treat first?

A. cardiac tamponade

B. splenic rupture

C. traumatic haemothorax

D. fractured pelvis

E.bladder rupture

A

C. traumatic haemothorax

47
Q

if a patient had a history of a lucid period which traumatic brain injury would you be most concerned about

subarachnoid

subdural

extradural

diffuse axonal injury

A

extradural

DPD 2020 (48 decks)

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