Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NMF: acute care > Emergency medicine > Flashcards

Emergency medicine Flashcards

1
Q

What is a pneumothorax?

A

a collection of air between the visceral and parietal pleura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a primary pneumothorax?

A

a pneumothorax that occurs without any underlying disease causing it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a secondary pneumothorax?

A

a pneumothorax that occurs due to an underlying disease eg. asthma or COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a tension pneumothorax?

A

a life-threatening event where air is trapped in the pneumothorax under positive pressure so the intrathoracic pressure rises, reducing venous return to the heart and potentially cardiac arrest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are symptoms of a pneumothorax?

A

sudden onset chest pain
acute SOB
a feeling of not being able to take a deep breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the signs of a pneumothorax?

A 
tachypnoea
tachycardia
hypoxia
reduced breath sounds on affected side
hyperresonance on affected side
tracheal deviation away from affected side in tension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the target oxygen sats for a

a) normal patient?
b) COPD patient?

A

a) 94-98

b) 88-92 only if CO2 retaining as shown in ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why do COPD patients have lower target o2 sats?

A

they are CO2 retainers so if given too much oxygen you can reduce their hypoxic drive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is seen on CXR for pneumothorax?

A

Air in the pleural space
Decreased lung markings around the outer edge of the lung field
Lung collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is a simple pneumothorax managed?

A

high flow O2
sit up if conscious
aspirate with 16-18G cannula if large primary, symptomatic or small secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is tension pneumothorax managed?

A

peri-arrest call on 2222
needle decompression into 2nd intercostal space, mid-clavicular line
chest drain insertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What IV access is needed for an acutely unwell patient?

A

2 large bore cannulas (grey or orange)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which fluid is used for fluid resuscitation?

A

NaCl 0.9% or Hartmann’s solution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Name some signs of airway compromise

A

see-saw breathing
use of accessory muscles
diminished breath sounds
added sounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What clinical findings might suggest respiratory compromise?

A

tachypnoea

reduced air entry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does a hypoxic patient with a falling respiratory rate indicate?

A

impending respiratory failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is an acute asthma attack managed?

A

O SHIT ME

oxygen
salbutamol 2.5-5mg nebs
hydrocortisone 100mg IV
ipratropium 500mcg NEB
theophylline

magnesium sulphate 2g IV over 20 mins
escalate care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does diaphoretic mean?

A

extreme sweating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where is a chest drain inserted?

A

4th or 5th intercostal space in triangle of safety

just anterior to the mid axillary line and posterior to the lateral border of the pectoral muscle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In trauma, what is a shocked patient assumed to be suffering?

A

blood loss/ haemorrhagic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which areas can have significant blood loss?

A

on the floor and 4 more

external haemorrhage
chest
abdo
pelvis 
long bones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the mainstay treatment of a shocked patient?

A

IV crystalloid fluid

0.9% saline or Hartmann’s

250-500ml boluses of warmed NaCL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the 3 components of the GCS?

A

eyes /4
verbal /5
move /6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is the patients eye response for GCS scored?

A

4 spontaneous
3 voice
2 pain
1 no response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is the patients verbal response for GCS scored?

A 
5 orientated 
4 confused
3 inappropriate words
2 noises
1 no response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How is the patients movement response for GCS scored?

A 
6 obeys command
5 localises to pain
4 normal flexion
3 abnormal flexion
2 extension
1 no response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How is hyperkalaemia treated?

A

calcium chloride then an infusion of insulin dextrose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How would you investigate a ? abdominal aortic aneurysm?

A

US if trained

definitive is CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How would you investigate ischaemic gut or DKA?

A

ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How would you investigate shocked patient?

A

FBC U+E LFT lactate ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which medication is good for crampy abdominal pain?

A

buscopan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What medication is good for renal colic?

A

diclofenac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Differentials of chest pain

A

CV eg. acute MI, angina, aortic dissection, PE, pericarditis

resp: pneumothorax, pleurisy, pneumonia

costochondritis

GI: oesophageal rupture, cholecystitis, GORD, biliary colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are atypical presentations of MI? Who presents like this?

A

burping
reflux
more common in diabetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the typical presentation of acute MI?

A 
central chest pain
sudden onset
heavy, achy, dull
radiates to left shoulder
assoc N+V
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the typical presentation of PE?

A

sudden onset sharp, pleuritic pain

assoc SOB

37
Q

When would a patient with chest pain get a CT?

A

? massive PE
aortic dissection
oesophageal rupture
major trauma

38
Q

What is a PERC score? what forms it?

A

rules out PE

criteria to rule in:

  • age >50
  • HR >100
  • O2 sats <95 on room air
  • unilateral leg swelling
  • haemoptysis
  • recent surgery or trauma
  • previous PE/DVT
  • on hormonal contraceptive
39
Q

What is a Wells score? what forms it?

A

work out risk of PE: low risk or high risk

  • clinical signs +symptoms present
  • immobilisation > 3 days or surgery in past 4 weeks
  • HR >100
  • previous DVT/PE
  • haemoptysis
  • malignancy
40
Q

How is someone with a
a) low-risk
b) high risk
Wells score managed?

A

a) needs d-dimer

b) CTA

41
Q

What are the differential diagnoses for shortness of breath?

A

resp: airway obstruction, anaphylaxis, PE, pneumothorax, asthma, COPD, pneumonia, pleural effusion, rib #

Abdo: ascites, obesity, pregnancy

metabolic: acidosis, poisoning, renal failure

anaemia, anxiety

42
Q

What type of breathing can be seen in DKA?

A

kussmaul’s breathing

fast, sighing breath trying to blow off CO2

43
Q

What can cause respiratory acidosis?

A

severe asthma
pneumonia
hypoventilation

44
Q

What can cause respiratory alkalosis?

A

hyperventilation
panic attack
salicylate poisoning

45
Q

What can cause metabolic acidosis?

A

DKA, lactic acidosis, alcohol, salicylate

46
Q

What can cause metabolic alkalosis?

A

vomiting

potassium loss

47
Q

What are the differentials for abdominal pain ?

A

GI:oesophagitis, gastritis, PUD, pancreatitis, bowel obstruction, appendicitis, diverticular disease, IBD, ischaemic bowel, gastroenteritis, acute liver failure, constipation

gynae: ectopic, PID, ovarian cyst
urology: renal colic, pyelonephritis, UTI, testicular torsion
vascular: AAA
other: DKA, hypercalcaemia, mesenteric adenitis

48
Q

What must be done for
a) male patients
b) female patients
presenting with abdo pain?

A

a) testicular exam

b) pregnancy test

49
Q

What is Rovsig’s sign? what diagnosis does it indicate?

A

palpation of LIF illicits RIF pain

appendicitis

50
Q

What is Mcburney’s point?

A

2/3rd way from umbilicus to right ASIS

painful to palpate in appendicitis

51
Q

What is Murphy’s sign?

A

when palpating under right ribs, ask patient to take a deep breath

this will cause pain and a sharp inspiration when hand comes into contact with inflamed gallbladder

indicating acute cholecystitis

52
Q

What dose is used for morphine?

A

0.1-0.2 mg/kg

so adult needs 7-14 mg

53
Q

How should suspected STEMI be managed?

A 
Phone CCU
give 5000 units heparin IV
600 mg clopidogrel orally
300 mg aspirin orally
transfer to cath lab for PCI
54
Q

If PCI cannot be done, how is STEMI managed?

A

thrombolysis with alteplase

55
Q

How does appendicitis present?

A 
abdo pain: general then to RIF
anorexia
N + V
tender RIF
fever
rebound tenderness
56
Q

What can be used to confirm ACS if clinical signs but no ECG changes?

A

cardiac biomarkers eg. troponin

57
Q

Which features of history are important when someone presents with a head injury?

A 
mechanism
LOC
vomiting
seizure
visual problems
amnesia
bleeding risk
58
Q

Who is at risk for bleeding with a head injury?

A

on anti-coagulation
haemophiliacs
low platelets (alcoholic)

59
Q

What forms a head injury exam?

A 
GCS/ AVPU
pupil response
examine ears
look for wounds, depression, haematoma
neuro exam
cervical spine
60
Q 
What GCS would a 
a) mild
b) moderate
c) severe
head injury have?
A

a) 13-15
b) 9-12
c) 3-8

61
Q

An AVPU response to pain is equal to a GCS of?

A

<8

62
Q

Which GCS score would indicate that a patient should be intubated?

A

<8

63
Q

What is a fixed, dilated pupil a sign of?

A

late sign of raised ICP caused by 3rd nerve palsy

64
Q

What are the signs of a base of skull fracture?

A

haemotympanum
battle’s sign
panda/racoon eyes
CSF leak

65
Q

What is Cushing’s triad in head injury and why does it occur?

A

triad of hypertension, bradycardia and irregular breathing

occurs when there is an intracranial bleed increasing the ICP so that cranial blood flow is reduced, then the body tries to increase blood pressure to increase this

irregular breathing occurs due to decreased brain stem perfusion

66
Q

What does an extradural haemorrhage look like on CT?

A

a hyperdense convex shape between the skull and dura that is limited by the suture lines

67
Q

What does a subdural haemorrhage look like on CT?

A

a hypodense crescent between the dura and arachnoid that can cause midline shift

68
Q

Where is the bleed usually in an

a) extradural haemorrhage?
b) subdural haemorrhage?

A

a) middle meningeal artery

b) bridging veins

69
Q

How does an extradural haemorrhage present?

A

younger people with brief LOC then lucid then dec. GCS

70
Q

How does a subdural haemorrhage present?

A

insidiously in the elderly after low-impact trauma

71
Q

How can poison absorption be prevented?

A

give activated charcoal within 1 hour of ingestion

72
Q

How can poison metabolism be altered?

A

give antidote

73
Q

How can poison elimination be increased?

A

haemofiltration or dialysis

74
Q

What is the antidote for paracetamol?

A

N-acetylcysteine

75
Q

What is the antidote for TCAs?

A

sodium bicarbonate

76
Q

What is the antidote for beta blockers?

A

glucagon

77
Q

What is the antidote for ethylene glycol?

A

ethanol, fomepizol

78
Q

What is the antidote for opiods?

A

naloxone

79
Q

What dose of paracetamol overdose justifies referral to hospital?

A

> 75mg/kg

80
Q

If paracetamol is taken in its therapeutic dose how is it metabolised?

A

5% converted by cytochrome P450 to NAPQI which is detoxified in the liver by conjugation with glutathione

81
Q

If paracetamol is overdosed, how is it metabolised?

A

excess paracetamol causes increased NAPQI and depleted glutathione supplies in the hepatocytes so NAPQI reacts with cellular membranes causing hepatocyte damage and death which can lead to acute liver necrosis

82
Q

What are the features of paracetamol overdose?

A

N + V
abdominal pain
hepatic necrosis, jaundice, right subcostal pain, hepatic encephalopathy

83
Q

How should paracetamol overdose be managed?

A

give activated charcoal within 1 hour
check blood paracetamol level at 4hrs
treat with n acetylcysteine if above line

84
Q

How should response to nacetylcysteine be monitored?

A

after treatment check LFTs, U+Es and INR

if deranged continue treatment

85
Q

What is INR the most accurate indicator of?

A

synthetic function of the liver

86
Q

How is a c-spine protected?

A

collar, blocks and tape

87
Q

How long does naloxone work for?

A

works in around 15seconds and lasts 20-30 min

88
Q

How should naloxone be dosed?

A

slowly titrate by giving doses of 100-200 mcg until no resp depression but not until patient alert

89
Q

How should hypoglycaemia with a blood glucose <4mmol/L be managed?

A

give 75ml of IV 20% dextrose

NMF: acute care (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions