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Year 4 - Acute Care > Emergency medicine > Flashcards

Emergency medicine Flashcards

1
Q

When a patient arrives in A+E, what are the different pathways for triage

A

Stream 1
Stream 2
Resuscitation

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2
Q

what kind of patients end up in stream 1

A

walking wounded

minor ailments

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3
Q

what kind of patients end up in stream 2

A

those that need a bit more attention e.g. NOF #, pneumonia…

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4
Q

What kind of patients end in resus

A

critically ill
trauma patients
airway obstruction

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5
Q

What is a primary survey

A

initial ABCDE

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6
Q

what is the secondary survey

A

examination of patient from top to toe after the initial ABCDE

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7
Q

how can you assess someones airway

A

by talking to them

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8
Q

what are signs of a patent airway

A

patient can talk to you

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9
Q

what are signs of an obstructed airway

A 
snoring
hoarse voice 
stridor 
gurgling 
seesaw chest - paradoxical movement
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10
Q

causes of airway obstruction

A

tongue
burns
trauma
foreign bodies

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11
Q

management of airway obstruction

A

head tilt chin lift / jaw thrust
adjuncts - OPA/NPA
iGel
ETT

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12
Q

how should you assess breathing

A

RR
SaO2
Auscultate chest and check for movements
Check for tracheal deviation

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13
Q

How should you assess circulation

A

check for pulse and rate
check CRT
BP

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14
Q

how should you assess disability

A

neurological: GCS, AVPU
pupils
DEFG - DON’T EVER FORGET GLUCOSE

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15
Q

how should you assess exposure

A

assess for external sources of haemorrhage, cellulitis, trauma, open #, temperature, pressure areas

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16
Q

What are some common presentations to A+E

A 
chest pain 
SOB
abdominal pain 
head injury 
poisoning
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17
Q

what are some differentials of chest pain

A 
ACS: unstable angins, NSTEMI, STEMI
PE 
pneumonia
trauma
MSK 
oesophageal 
AAA rupture 
aortic dissection 
arrhythmia 
acute heart failure
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18
Q

what are some differentials of SOB

A 
PE 
tension pneumothorax 
pneumonia 
anaphylaxis 
asthma 
COPD exacerbation 
pulmonary oedema 
DKA
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19
Q

what are some differentials of abdominal pain

A

GI: appendicitis, diverticulitis, cholecystitis, gastroenteritis, IBD
Gynae: ectopic pregnancy, ruptured ovarian cyst
Uro: renal colic, UTI
Vascular: ischaemic colitis, AAA rupture
Other: DKA

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20
Q

In females with abdominal pain, what is the most important investigation to do

A

pregnancy test

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21
Q

what questions should be asked about head injury

A 
witnessed
LOC
visual disturbance 
confusion 
vomiting 
seizure 
c-spine 
amnesia 
bleeding risk
22
Q

what are some basic investigations for a patient

will vary depending on symptoms

A 
FBC
U+E, LFT, CRP
lactate 
blood cultures 
ABG
urinalysis/pregnancy test
d dimers 
ECG
USS, CT head/abdo, CXR
23
Q

if a patient has a GCS of <8 what does this imply

A

loss of airway control

24
Q

what is Cushings response

A

late response to raised ICP

  • bradycardia
  • hypertension
  • irregular breathing
25
Q

what is involved in a head injury examination

A 
GCS and components
AVPU
Pupils 
ears 
signs of BOS#
neurological exam 
c-spine
26
Q

what are signs of BOS#

A

haemotympanum
CSF from nose/ear
battle sign
raccoon eyes (bilateral)

27
Q

if a patient fits the criteria, how fast should they obtain a CT head

A

within 1 hour

28
Q

what are important questions to ask in someone who has presented with paracetamol overdose

A 
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
29
Q

how do you manage paracetamol overdose

A

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

30
Q

what is a useful resource for toxins and poisons

A

TOX base

31
Q

why is paracetamol overdose toxic

A

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

32
Q

what can happen to some patients who receive N-acetyl-cysteine

A

they may have an allergic like reaction

give piriton and steroids then continue

33
Q

what mneumonic can be used to assess a persons mental health

A

‘SAD PERSONS’

34
Q

what is the management of MI

A

MONA+T
PCI <120 min
thrombolysis >120 min

35
Q

what is ‘redirecting’ in A+E

A

educating patients about going to their GP or pharmacist for non-urgent things

36
Q

what should you give to all patients who show signs of ACS

A

aspirin 300mg
measure troponins
GTN trial

37
Q

in a COPD patient, what SaO2 levels should you aim for

A

88-92%

38
Q

what is given for opioid overdose

A

IV naloxone

39
Q

what are risks of rapidly reversing opioid toxicity

A

aggression
immediate withdrawal
feel really unwell

40
Q

how should you administer naloxone

A

in slow increments until effect is seen

41
Q

how should you monitor a patient after they have received naloxone

A

monitor for signs of withdrawal
U+E
RR
often, patients want to leave ASAP

42
Q

what is important to rule out in paediatrics

A

NAI

although kids are prone to bumps etc but it must be ruled out in all cases

43
Q

what is the most effective method of wound closure in children

A

glue

44
Q

what is a common cause of head trauma with a normal CT

A

concussion

45
Q

symptoms of anticholinergic toxicity

A 
dry skin 
dilated pupils 
tachycardia 
blurred vision 
gait ataxia 
speech dysarthria
46
Q

antidote to anticholinergic toxicity

A

sodium bicarbonate

47
Q 
antidote for overdose on the following drugs:
B blockers
organophosphates 
iron salts 
sulfonylurea 
CO 
warfarin 
tricyclics 
salicylates
Lignocaine 
ethylene glycol
benzodiazepines
A 
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
48
Q

What dose of adrenaline do you give in the following scenarios and via what route:
anaphylaxis
cardiac arrest

A

anaphylaxis 500ug 1:1000 IM

cardiac arrest 1mg 1:10000 IV

49
Q

What are the earliest signs of anaphylaxis

A

hypotension and tachycardia
(flushed peripheries)
angioedema is generally a late sign

50
Q

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

A

should not prescribe cyclizine as it causes tachycardia which is not ideal in an acute patient
ondansetron is a better option

51
Q

how do you activate the major haemorrhage protocol

A

call 2222 and state: “major haemorrhage in ward X”

get urgent bloods and resuscitate the patient with ABCDE

Year 4 - Acute Care (7 decks)

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