Emergency medicine Flashcards
When a patient arrives in A+E, what are the different pathways for triage
Stream 1
Stream 2
Resuscitation
what kind of patients end up in stream 1
walking wounded
minor ailments
what kind of patients end up in stream 2
those that need a bit more attention e.g. NOF #, pneumonia…
What kind of patients end in resus
critically ill
trauma patients
airway obstruction
What is a primary survey
initial ABCDE
what is the secondary survey
examination of patient from top to toe after the initial ABCDE
how can you assess someones airway
by talking to them
what are signs of a patent airway
patient can talk to you
what are signs of an obstructed airway
snoring hoarse voice stridor gurgling seesaw chest - paradoxical movement
causes of airway obstruction
tongue
burns
trauma
foreign bodies
management of airway obstruction
head tilt chin lift / jaw thrust
adjuncts - OPA/NPA
iGel
ETT
how should you assess breathing
RR
SaO2
Auscultate chest and check for movements
Check for tracheal deviation
How should you assess circulation
check for pulse and rate
check CRT
BP
how should you assess disability
neurological: GCS, AVPU
pupils
DEFG - DON’T EVER FORGET GLUCOSE
how should you assess exposure
assess for external sources of haemorrhage, cellulitis, trauma, open #, temperature, pressure areas
What are some common presentations to A+E
chest pain SOB abdominal pain head injury poisoning
what are some differentials of chest pain
ACS: unstable angins, NSTEMI, STEMI PE pneumonia trauma MSK oesophageal AAA rupture aortic dissection arrhythmia acute heart failure
what are some differentials of SOB
PE tension pneumothorax pneumonia anaphylaxis asthma COPD exacerbation pulmonary oedema DKA
what are some differentials of abdominal pain
GI: appendicitis, diverticulitis, cholecystitis, gastroenteritis, IBD
Gynae: ectopic pregnancy, ruptured ovarian cyst
Uro: renal colic, UTI
Vascular: ischaemic colitis, AAA rupture
Other: DKA
In females with abdominal pain, what is the most important investigation to do
pregnancy test
what questions should be asked about head injury
witnessed LOC visual disturbance confusion vomiting seizure c-spine amnesia bleeding risk
what are some basic investigations for a patient
will vary depending on symptoms
FBC U+E, LFT, CRP lactate blood cultures ABG urinalysis/pregnancy test d dimers ECG USS, CT head/abdo, CXR
if a patient has a GCS of <8 what does this imply
loss of airway control
what is Cushings response
late response to raised ICP
- bradycardia
- hypertension
- irregular breathing
what is involved in a head injury examination
GCS and components AVPU Pupils ears signs of BOS# neurological exam c-spine
what are signs of BOS#
haemotympanum
CSF from nose/ear
battle sign
raccoon eyes (bilateral)
if a patient fits the criteria, how fast should they obtain a CT head
within 1 hour
what are important questions to ask in someone who has presented with paracetamol overdose
intentional vs accidental mood SH and personal history was it taken with anything else e.g. alcohol leave a note anyone else doing it how much and when witnesses previous attendances
how do you manage paracetamol overdose
ABCDE
U+E, LFT
plasma paracetamol levels at 4 hours, plot of graph
N-acetyl-cysteine infusion over 23 hours
liaison psychiatry involvement
after infusion, INR and LFTs and paracetamol levels
what is a useful resource for toxins and poisons
TOX base
why is paracetamol overdose toxic
it forms a toxic metabolite called NAPQI which is really harmful to the liver
depletion of glutathione means that this toxin accumulates and remains in circulation
what can happen to some patients who receive N-acetyl-cysteine
they may have an allergic like reaction
give piriton and steroids then continue
what mneumonic can be used to assess a persons mental health
‘SAD PERSONS’
what is the management of MI
MONA+T
PCI <120 min
thrombolysis >120 min
what is ‘redirecting’ in A+E
educating patients about going to their GP or pharmacist for non-urgent things
what should you give to all patients who show signs of ACS
aspirin 300mg
measure troponins
GTN trial
in a COPD patient, what SaO2 levels should you aim for
88-92%
what is given for opioid overdose
IV naloxone
what are risks of rapidly reversing opioid toxicity
aggression
immediate withdrawal
feel really unwell
how should you administer naloxone
in slow increments until effect is seen
how should you monitor a patient after they have received naloxone
monitor for signs of withdrawal
U+E
RR
often, patients want to leave ASAP
what is important to rule out in paediatrics
NAI
although kids are prone to bumps etc but it must be ruled out in all cases
what is the most effective method of wound closure in children
glue
what is a common cause of head trauma with a normal CT
concussion
symptoms of anticholinergic toxicity
dry skin dilated pupils tachycardia blurred vision gait ataxia speech dysarthria
antidote to anticholinergic toxicity
sodium bicarbonate
antidote for overdose on the following drugs: B blockers organophosphates iron salts sulfonylurea CO warfarin tricyclics salicylates Lignocaine ethylene glycol benzodiazepines
B blockers - glucagon organophosphates - atropine iron salts - desferrioxamine sulfonylurea - glucose, octreotide CO - O2 warfarin - vitamin K, clotting factors, FFP tricyclics - sodium bicarbonate salicylates - activated charcoal lignocaine - lipid emulsion ethylene glycol - fomepizole benzodiazepines - flumazenil
What dose of adrenaline do you give in the following scenarios and via what route:
anaphylaxis
cardiac arrest
anaphylaxis 500ug 1:1000 IM
cardiac arrest 1mg 1:10000 IV
What are the earliest signs of anaphylaxis
hypotension and tachycardia
(flushed peripheries)
angioedema is generally a late sign
in the management of an MI, you follow MONA+T
which anti-emetic should you not prescribe with morphine and why?
what is a better option
should not prescribe cyclizine as it causes tachycardia which is not ideal in an acute patient
ondansetron is a better option
how do you activate the major haemorrhage protocol
call 2222 and state: “major haemorrhage in ward X”
get urgent bloods and resuscitate the patient with ABCDE
