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3rd year medicine > emergency medicine > Flashcards

emergency medicine Flashcards

1
Q

pin point pupils

A

opioid overdose

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2
Q

management for pin point pupils

A

naloxone

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3
Q

acute hypoglycaemia management

A

IV dextrose

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4
Q

what sats should you aim for in COPD

A

88-92%

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5
Q

what sats are normal

A

>94%

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6
Q

what is normal RR

A

12-20

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7
Q

what is normal pulse

A

60-100bpm

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8
Q

what is abnormal GCS

A

<8

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9
Q

what should you carry out if GCS is <13and how quickly

A

CT head within 1hr

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10
Q

differentials for acute chest pain

A
  • MI - ACS - aortic dissection - tearing pain radiating to back - tension pneumothorax - tracheal deviation, displaced apex, DONT DO CXR - PE - pleuritic, calf swellings, hx indicating DVT - oesophageal rupture - severe retching/ haematemesis, severe retrosternal pain GORD, MSK, pericarditis (worse leaning forward), pneumonia
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11
Q

investigations for acute chest pain

A

obs bloods: troponin, FBC, U&Es ECG CXR consider D-dimer if low prob VTE, CTPA if suspect PE

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12
Q

65ys right sided chest pain discharged 2 days ago after an elective knee replacement no PMH, non smoker BP: 140/80 HR: 110 afebrile sats 91% RR: 20 rapid regular pulse and diffusely swollen but not erythematous left leg with clean surgical scar most likely diagnosis

A

PE

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13
Q

64yrs chest pain thats worsened over 2 days run down sore throat 1wk ago PMH: HTN, hyperlipidaemia diffuse chest pain - better on leaning forward temp: 37.9 BP:140/84 HR:76 friction rub is heard on cardiac auscultation ECG: ST elevation in nearly every lead most likely diagnosis

A

pericarditis - post viral complication

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14
Q

20yr girl downs syndrome collapse two days after last period febrile widespread erythematous rash with exfoliation and warm peripheries what type of shock

A

endotoxic due to toxic shock syndrome - by staphylococcus vaginal infection if tampon is not removed - more common in people with learning difficulties or psychiatric illness warm peripheries specific to endotoxic and septic shock

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15
Q

14yrs boy collapse whilst eating at restaurant wheeze stridor swelling of lips and tongue type of shock

A

anaphylactic - due to food allergy

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16
Q

70yrs man fit and well apart from arthritis in knees - diclofenac collapse tachycardia hypotension pale but otherwise normal haemoglobin: 11 urea: 20 creatinine: 70 type of shock

A

haemorrhagic upper GI bleed - drop in Hb but signs of shock can precede this urea may rise first due to digestion of protein load (Hb) in stomach and causes urea to be disproportionately higher than creatinine production of urea

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17
Q

50yr woman unwell after 24hr hx severe abdo pain and vomiting tender in epigastrium without guarding amylase >3000

A

fluid depletion acute pancreatitis - amylase high suffer with intravascular fluid depletion due to intra-abdominal fluid sequestration (3rd spacing) and bowel oedema even though no external sign of fluid loss management: aggressive fluid resus

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18
Q

26yr man collapse following sudden central chest pain cold, clammy, sweaty trachea is deviated to left and absent air entry on right side of chest

A

cardiogenic mostly due to primary myocardial disease can be 2ndry to trauma or tension pneumothorax the mediastinal shift results in reduction of venous return to the heart, cardiac dysfunction and shock

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19
Q

30yrs woman collapse severe lower abdo pain tender, rigid abdo scanty dark brown vaginal discharge type of shock

A

haemorrhagic ruptured ectopic –> intra-abdominal bleeding management: resus + blood products + surgical management of bleeding

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20
Q

myxoedema

A

severe hypothyroidism

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21
Q

6yr boy lips swollen stridor, SOB sweaty and clammy allergy to nuts dosage of adrenaline

A

300mcg of 1:1000 adrenaline IM

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22
Q

dosages of adrenaline

A

adults and children >12: - 500mcg = 0.5ml children 6-12: - 300mcg = 0.3 ml children <6: 150mcg = 0.15ml

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23
Q

35yr fallen off third step of ladder and hit head on pavement feeling well since accident no reported LOC able to recall GCS 15/15 no neurological abnormality no external injury other than bruise behind his left ear most appropriate management

A

arrange urgent CT head scan battles sign

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24
Q

what is bruising behind the ear called and what is it a sign of

A

Battle’s sign sign of possible basal skull fracture

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25
Q

signs of basal skull fracture

A

Battle’s sign (bruising tot he mastoid process) panda eyes (periorbital bruising) rhinorrhoea (CSF leak from nose) otorrhoea (CSF leak from ears)

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26
Q

young man road traffic collision tachycardia: 120bpm sweating and pale decreased breath sounds on right side decreased chest movement trachea deviated to left asked to insert a large bore cannula where will you place it in this patient

A

2nd intercostal space, mid clavicular line on the side of the decreased breath sounds

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27
Q

young man road traffic collision tachycardia: 120bpm sweating and pale decreased breath sounds on right side decreased chest movement trachea deviated to left asked to insert a large bore cannula where will you place it in this patient

A

2nd intercostal space, mid clavicular line on the side of the decreased breath sounds needle thoracocentesis

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28
Q

where do you place the chest drain in a pneumothorax/ pleural effusions

A

between the base of axilla and 5th intercostal space and between the lateral edge of the pectoris major and the lateral edge of latissimus dorsi

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29
Q

40yr SOB otherwise fit and well recently prescribed amox by GP for LRTI unable to talk harsh upper airway sounds on inspiration florid rash pulse: 160bpm BP: 80/40 O2: 90% on high-flow O2 most appropriate first step in management

A

0.5ml of 1:1000 adrenaline solution IM follow ABC (so deal with airways before circulation)

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30
Q

45yr woman falling down stairs at home rib pain unable to complete full sentences due to SOB sats:91% air nurses concerned about deterioration BP: 80/40 HR: 120bpm RR: 40 sats:85% left chest does not move very well no audible breath sounds on left on auscultation

A

needle thoracocentesis of left chest (tension pneumothorax)

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31
Q

when is a nasopharangeal tube contraindicated

A

basal skull fracture

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32
Q

what would you do first in opioid overdose

A

protect airway

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33
Q

22yr F unwell in restaurant red, unable to breath making noises when trying to breath generalised urticarial rash responsive to voice once had allergy to peanuts - may have been peanuts in dessert most likely diagnosis

A

anaphylaxis

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34
Q

patient with anaphylaxis with SOB and stridor given adrenaline IM 500mcg + high flow O2 was given epipen after previous allergic reaction which three other medications would you give to the patient

A

200mg IV hydrocortisone 10mg IV chlorphenamine 1000ml Hartmanns solution

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35
Q

anaphylaxis criteria

A
  • sudden onset symptoms - life threatening airway/ breathing/ circulation - skin and/or mucosal changes (flushing urticarial, angioedema) - exposure to known allergen - most reactions occur over several minutes - patient look and feel unwell - may also be GI symptoms (ie. diarrhoea and vomiting)
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36
Q

92yr M

dementia and myelodysplasia

2d hx cough, fever, lethargy, confusion, and reduced urine output

temp: 39
pulse: 180bpm

BP: 77/35

RR: 28

O2 sats 85% on air

care home, mobile with zimmer frame

looks unwell

respiratory distress, course crackles and bronchial breathing at the right base with a dull percussion note

cool peripheries, an irregularly irregular pulse and normal heart sounds

skin changes on torso and abdo (skin mottling)

most likely diagnosis

4 immediate management

A

sepsis caused by community acquired pneumonia

febrile, tachycardia, hypotensive, end organ dysfunction (confusion, reduced urine output)

age and hx of cough (LRTI)

myelodysplasia will render him immunosuppressed and therefore more susceptible to severe infection

sepsis 6

IV access for bloods (ABG for oxygenation & lactate, cultures, FBC, U&Es, CRP, LFTs, bone profile)

urine output - catheter

high flow O2

antibiotics

20mls/kg fluid bolus - if remains hypotensive then consider vasopressors

after resus phase CXR

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37
Q

what is this skin mottling called

what is it caused by

A

livedo reticularis or ‘mottling’

caused by reduced blood flow to the skin and therefore oxygenation of the skin

can be a normal phenomenon - particularly in babies and children

in clinical context, it is concerning for a severe sepsis or disseminated intravascular coagulopathy

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38
Q

stabilised patient

CXR - right lower lobe pneumonia with an effusion

pain on right side of chest - morphine

40mins later - cardiac arrest

what type of rhythm

is this a shockable rhythm

what should be given

A

asystole - flat line but wondering baseline

non-shockable rhythm

give adrenaline every 3-5 mins (given at alternative cycles of CPR)

dont look for a pulse

poor prognosis

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39
Q

resuscitating patient for 6 mins without change in his rhythm

management

A

adrenaline every 3-5mins

100% O2 via tracheal tube

fluid bolus - 0.9% saline or Hartmanns

team should prepare that resus is unlikely to be successful

40
Q

35yr M

house fire

alert and responsive

burns to front of face, neck, chest and whole of left arm

skin is erythematous with some patchy white areas, sensation decreased

cap refill time 6s

temp: 36.2

HR: 115bpm

BP:110/79

RR:31

breathing: shallow

given the distribution and extent of his burns what is the percentage

A

22.5%

rule of nines (palm represents 1% )

face & neck: 4.5%

front of chest: 9%

whole arm: 4.5%

= 22.5%

41
Q

burns to head neck chest (front) whole of left arm and torso and legs

calculates perentage burns at ~50%

weighs 70kg

calculate fluid requirement in first 24hrs following burn

A

Parkland Formula: for all adults with burns >15%

fluid requirements in first 24hrs after burn= 4ml x patients weight in Kg x % burn

4 x 70 x 50 = 14000mL

half of the fluid given in first 8hrs from time of burn

2nd half in remaining 16hrs

42
Q

burns to face and neck

shallow breathing

RR:45

stridor

O2 sats: 95% on air

soot in mouth and nose

appropriate interventions?

A

high flow O2 by non-rebreath mask at 15L/min

urgent anaesthetic review by senior anaesthetist with view to early intubation

inhalation and airway burns,

airway oedema - needs intubation by anaesthetist

43
Q

what are indications for referral to a regional burns unit

A

Burns > 10 % TBSA in an Adult

Burns > 5 % TBSA in a Child

Full thickness burns > 5% TBSA

Burns of face, hands, feet, perineum, genitalia, and major joints

Circumferential burns

Chemical or electrical burns

Burns in the presence of major trauma or significant co-morbidity

Burns in the very young patient, or the elderly patient

Burns in a pregnant patient

Suspicion of Non-Accidental Injury

44
Q

what burns patients should be catheterised

what level of urine output should be maintained with fluids

A

patients with burns >20% or intubated should be catheterised

patients with perineal burns or 15-19% catheterisation should be considered

fluids should be titrated to urine output to maintain at least 0.5ml/kg/hr urine output

45
Q

mother brings 4y M to ED

spilt boiling water on left forearm

erythematous and sensitive to touch

~ 3x4cm on forearm

first step management

A

hold under cool running water for 20mins and wrap with cling film

no creams or gels needed

ice packs not recommended as they can cause frost burns

46
Q

what analgesia is appropriate for 4yr old with burn on forearm

A

oral paracetamol loading dose 20mg/kg and then 15mg/kg thereafter

and ibuprofen 10mg/kg

if pain not controlled, one off dose of intra-nasal diamorphine

codeine not recommended in children

47
Q

burn described as painful and sensitive to touch

erythematous and wet with blistered areas

how would you describe the depth of the burn

A

partial thickness - moist and red, usually broken blisters, normal cap refill. involve the dermis. painful unless deep dermis, then slow cap refill

superficial burns - dry, minor blistering, erythema. painful. sunburn or minor scalds. involve epidermis

full thickness burns - dry, charred, white. painless and absent cap refill. destroyed epidermis and dermis and began to destroy underlying SC tissue.

48
Q

how would a burn 3x4cm on forearm be managed on 4yr old patient after inital first aid and analgesia

A

de-roof blistered areas

dress with non-adherent dressing

review in dressing clinic in 48hrs

prophylactic abx not indicated unless burn is infected

blisters de-roofed to assess depth of burn

no indication to refer to regional burns unit

49
Q

78yr F

severe respiratory distress for past few hrs

known COPD

pronounced wheeze but no audible crepitations

ABG:

pH: 7.44 (7.35-7.45)

pCO2: 4.9 (3.5-4.5)

pO2: 5.1 (7.5-10)

BE: +4 (-4 to +2)

HCO3: 28 (22-26)

lactate 2.6 (0.5-1)

type of respiratory failure

most appropriate initial management

A

type 1 respiratory failure

60% O2 via fixed rate delivery device (venturi)

watch O2 sats and patients consciousness level and repeat VBG to see CO2 level in 20 mins if no deterioration prior to that

50
Q

patient with respiratory distress given high flow O2

PMH: COPD

patient begins to feel better

RR settles but still audible wheeze from end of bed

CXR consolidation in right lower lobe

diagnosis

three appropriate managment

A

infective exacerbation of COPD

back to back nebulized salbutamol and atrovent

abx

prednisolone 40mg orally (IV if unable to swallow)

51
Q

difference between type 1 and type 2 respiratory failure

A

type 1 respiratory failure:

pO2 < 8

normal pCO2

type 2 respiratory failure:

pO2 <8

high pCO2

52
Q

causes of epistaxis

A

Local trauma:

  • Nose picking
  • Facial trauma
  • Foreign bodies
  • Nasal or sinus infections
  • Nasal septum deviation

Environmental:

  • Dry/cold conditions
  • Prolonged inhalation of dry air (oxygen)

Iatrogenic:

  • NG tube insertion
  • Nasotracheal intubation

Medicinal:

  • Topical corticosteroids and antihistamines
  • Solvent inhalation
  • Snorting cocaine
  • Anticoagulants

Coagulopathic:

  • Inherited coagulopathies
  • Splenomegaly
  • Platelet disorders
  • Chronic alcohol abuse
  • AIDS

Vascular abnormalities:

  • AV malformation
  • Hereditary haemorrhagic telangiectasia
  • Endometriosis
53
Q

65yr F

spontaneous epistaxis from right nostril

haemodynamically stable

active bleeding point visualised on nasal septum in right nostril

bleeding has not stopped despite pressure for 15 mins

next appropriate management

A

cautery with silver nitrate

initial management: pressure to anterior aspect of nose for 15-20mins

patient sit forward

cautery only applied to one side of nasal septum, cauterising both sides –> septal perforation

54
Q

if epistaxis continues after cautery what is the next most appropriate step in management

A

rapid rhino into each nostril

type of nasal tampon consisting of an outer later of carboxycellulose that promotes platelet aggregation, with an inflatable balloon that compresses nasal cavity on insertion tamponading the bleeding site

comes in 2 sizes - smaller to compress anterior nasal cavity

larger to compress posterior cavity also

both nostrils packed to tamponade bleeding vessels effectively

55
Q

what can you do if the rapid rhino is unsuccessful

A

can remove the rapid rhino and place a Foley catheter in nose into oropharynx

blow balloon up

then repack nose

ensures both posterior an anterior nasal cavity are properly packed

56
Q

how long should the rapid rhinos remain in place

A

24hrs

admitted or if well can go home and return next day for assessment and removal

57
Q

40yr M

found unresponsive outside a supermarket

temp: 35.5

HR:90

BP: 100/60

RR: 8

pupils constricted bilaterally but reactive

opens his eyes to painful stimulus, withdraws from pain and is making incomprehensible sounds

what is his GCS

A

GCS= 8

lowest score for anything is 1

eyes out of 4

voice out of 5

motor out of 6

E= 2 + V=2 + M=4

patients with a GCS of 8 or less are at risk of being unable to protect their own airway and may need intubation and ventilation

58
Q

ABG

pH: 7.24 (7.35 - 7.45)

PCO2: 8.9 (4.7-6)

PO2: 6.4 (11-13)

HCO3: 24 (22-26)

what does this show

what type of respiratory failure

A

respiratory acidosis

type 2 respiratory failure

59
Q

40yr M

found unresponsive outside a supermarket

temp: 35.5

HR:90

BP: 100/60

RR: 8

pupils constricted bilaterally but reactive

opens his eyes to painful stimulus, withdraws from pain and is making incomprehensible sounds

diagnosis

most appropriate first line treatment

A

opioid toxicity - constricted pupils and reduced RR

IV naloxone

60
Q

treatment for tricyclic antidepressant overdose

A

IV sodium bicarbonate

61
Q

treatment for Addisons crisis (can present with collapse)

A

IV hydrocortisone

62
Q

treatment for methanol and ethylene glycol poisoning

A

fomepizole/ IV ethanol

63
Q

19yr W

60kg

ingested 16 tablets of 500mg paracetamol 3hrs ago in suicide attempt

nausea but otherwise asymptomatic

first line management step

A

take bloods at 4hrs post ingestion for INR, venous gas, U&Es, LFTs, paracetamol level and FBC

toxic dose of paracetamol is 75mg/kg - patients need urgent assessment above this level - bloods at 4hrs

if 4hr paracetamol levels above treatment line then need NAC

patients ingested >150mg/kg that you will be unable to act on blood results with 8hrs of ingestion need NAC started immediately

this patient ingested 133mg/kg (500x16 /60)

64
Q

19yr W

paracetamol overdose

nausea but otherwise asymptomatic

coming to the end of their 21hrs of NAC treatment

ingested 100mg/kg of paracetamol, no concerning features requiring referral to liver unit

what further tests does she need to be safely discharged

A

at the end of 21hrs NAC re-check INR, plasma creatinine, venous pH or plasma bicarbonate and ALT

if all bloods meet following criteria –> discharge:

  • INR is 1.3 or less AND
  • ALT < 2x upper limit of normal AND

ALT not > than double the admission measurement

if bloods abnormal continue NAC and repeat all bloods in 8-16hrs:
- INR >1.3 OR

  • ALT >2x upper limit of normal OR
  • ALT more than doubled since admission measurement

patients with chronically elevated ALT may not need ongoing NAC (N-acetylcysteine) if ALT has not changed significantly- discuss with national poisons centre

65
Q

paracetamol overdose

bloods done at 4hrs post ingestion

paracetamol levels above treatment level

what further management does this patient need

A

NAC immediately for 21hrs to avoid hepatotoxicity

referral to psychiatry in due course

risk assessment and appropriate management of suicide risk whilst NAC is running

66
Q

23yr F

SOB

6wks post partum

emergency caesarean for failed induction at term

otherwise fit and well

breathlessness progressively worse over week associated with mild chest pain

more unwell today and haemoptysis

temp: 37.8
pulse: 130

BP: 100/60

RR:30

O2 sats: 92% on air

what are some differentials for this patient

what three key bedside investigations would you perform

A

PE (can produce low grade fever and haemoptysis)

myocarditis (patients can get postpartum myocarditis and decompensate into pulmonary oedema and cardiovascular collaose - much less common)

pulmonary oedema

LRTI

ABG

ECG

measure calves

67
Q

ABG taken on 40% O2

pH: 7.52 (7.35-7.45)

pO2: 11.2 (11-13)

pCO2: 2.0 (4.7-6)

HCO3: 25 (22-26)

BE: -2 (-2 to +2)

what type of respiratory failure

interpret ABG

A

type 1 respiratory failure

patient has significant hypoxia (given she is reveiving 40% and O2 levels just normal)

respiratory alkalosis

  • the low CO2 caused by raised RR to compensate for hypoxia, Co2 diffuses at a faster rate than O2
68
Q

patient agitated

holding chest and shouting she feels like she is dying

HR dropped to 25bpm

become very quiet and still

open airway and check for signs of life - none

CPR and airway management

what should you check for

what management

A

check for a pulse

  • in cardiac arrest the rhythm is pulseless electrical activity
  • pulseless electrical activity is any form of organized complexes that does not produce a cardiac output
    management: adrenaline (as its a non-shockable rhythm)
69
Q

cardiac arrest team think most likely cause of cardiac arrest is PE

patient has now had 8 mins of ALS and remains in cardiac arrest

what is the next most appropriate step in management

A

administer thrombolysis

after administering ALS continued for at least an hour following

CTPA should be done once patient is stable

70
Q

interpret the ABG on 100% O2

pH: 6.99 (7.35 – 7.45)

O2: 13 (11-13)

pCO2: 10 (4.7-6)

K+: 7.5 (3.6-5.2)

lactate: 13 (0.5-1)

BE: -6 (-2 to +2)

HCO3: 14 (22-26)

management

A

mixed metabolic and respiratory acidosis

patient is hypoxic despite 100% O2- problem with V/Q ratio

K+ high which could cause further cardiac arrest

lactate high expected in cardiac arrest patient

management:

  • calcium chloride IV - for cardioprotection
  • insulin + dextrose - to force K+ back into cells
71
Q

what are the shockable rhythms

A

Ventricular Tachycardia

Ventricular Fibrillation

Supraventricular Tachycardia

72
Q

what is the management for shockable rhythms

A

defib + adrenaline 10mcg/kg (alternate cycles) then amiodarone 5mg/kg

73
Q

23yr F

SOB

6wks post partum

emergency caesarean for failed induction at term

otherwise fit and well

breathlessness progressively worse over week associated with mild chest pain

more unwell today and haemoptysis

went into cardiac arrest

now intubated and ALS has been in progress for 5 mins

what are the most likely reversible causes of cardiac arrest?

A

hypoxia

thromboembolic

most likely PE causing obstruction to blood flow out of right heart and reducing venous return to left heart

became acutely more hypoxic and had cardiac arrest 2ndry to that

74
Q

48yr F

overdose

unresponsive, unclear what shes taken

2min tonic clonic seizure in ambulance

regular meds: co-codamol, propanolol, diazepam, sertraline, amitriptyline

suicide note and empty bottle of vodka

airway patent

making grumbling noises

breathing normal

abdo soft

temp: 38.7

HR: 121

BP:100/62

RR: 14

pupils dilated bilaterally

in response to painful stimulus she withdraws but her eyes remain closed

what is her GCS

which of her drugs in overdose would explain her presentation

A

GCS = 7/15

(E=1 (not opening) + V = 2 (incomprehensible sounds) + M = 4 (withdraws from pain))

amitriptyline (TCA)

  • TCA overdose cause anticholinergic effects - dilated pupils, tachycardia, drowsiness, dry mouth, urinary retention, confusion, agitation. severe side effects hypotension, cardiac rhythm disturbance, hallucinations and seizures

propanolol overdose –> bradycardia

diazepam –> drowsiness, resp depression, ataxia, hypothermia

sertraline overdose –> vomiting, tremor, drowsiness, dizziness, tachycardia, seizures

75
Q

patient intubated and on ITU

ABG:

pH: 7.24 (7.35-7.45)

pCO2:4.5 (4.7-6)

pO2: 11.5 (11-13)

HCO3: 18 (22-26)

what abnormality

A

metabolic acidosis

HCO3 low

pH low - acidotic

CO2 normal so no compensation

76
Q

propanolol overdose features

A

bradycardia

77
Q

diazepam overdose symptoms

A

drowsiness,

respiratory depression,

ataxia

hypothermia

78
Q

sertraline overdose symptoms/ signs

A

vomiting,

tremor,

drowsiness,

dizziness,

tachycardia,

seizures

79
Q

Tricyclic antidepressant overdose symptoms/signs

A

causes anticholinergic effects including:

dilated pupils,

tachycardia,

drowsiness,

dry mouth,

urinary retention,

confusion

agitation

Some severe side effects are:

hypotension,

cardiac rhythm disturbance,

hallucinations

seizures

80
Q

amytripyline overdose

ECG shows widened QRS, ABG shows metabolic acidosis

what is the most appropriate management

A

IV sodium bicarbonate

amitriptyline is a TCA

treatment for TCA overdose is supportive but widening QRS complex or metabolic acidosis –> treat with sodium bicarb

81
Q

treatment for beta blocker overdose (propanolol)

A

IV glucagon - treats the bradycardia

82
Q

60yr M

falling 2m from ladder

PMH: AF

medications: bisoprolol 2.5mg, warfarin 3.5mg

lost consciousness 1-2 mins

ED 1hr after fall - alert although confused and combative (argumentative)

temp: 36.5
pulse: 80

BP: 162/105

RR:16

eyes open, unable to follow commands but withdraws from pain

not orientated to time or place but can give name and birth date

what is his GCS

after initial assessement, what is the single most important investigation

A

GCS = 12

E = 4 (open spontaneously) + V = 4 (confused) + M = 4 (withdraws from pain)

CT head

  • significant mechanism of injury
  • on warfarin - high risk of brain injury
  • confusion
83
Q

paint fall

on warfarin

imaging reveals acute subdural haematoma

INR: 5.1 (normal <1.1)

calcium normal

after discussion with neurosurgery what is the next management step

A

stop warfarin

5mg IV vitamin K (reverses warfarin)

prothrombin complex concentrate (Octaplex) (short half life so needed with Vit K)

84
Q

45yr M

PMH: HTN

severe chest pain - started 1hr ago whilst running at gym

while taking hx patient becomes unresponsive, agonal respirations (struggling)

no signs of life, no pulse

two immediate actions

most likely cause of cardiac arrest

A

call for help

start CPR

(commence basic life support and call for help to commence basic life support)

thomboembolic - cardiac arrest 2ndry to acute MI

also possible PE

85
Q

what is the rhythm

is CPR always required

is defibrillation always indicated

would the patient have a palpable pulse

A

ventricular fibrillation

  • chaotic and irregular

treatment for VF: CPR + defib

VF does not produced organised myocardial contraction therefore pulseless

86
Q

following defibrillation and 2 mins of CPR, you stop for rhythm check (shown)

what is your next step

A

check for a pulse

organised electrical activity - may be compatible with a pulse and therefore change your management from cardiac arrest to post arrest management

if patient did not have a pulse it would be called pulseless electrical activity - non shockable cardiac arrest management

87
Q

reversible causes of cardiac arrest

A

causes: 4Hs 4Ts

Hypovolaemia

Hypoxia

Hyperkalaemia, hypokalaemia, hypocalcaemia

Hypothermia

Thrombosis

Tension pneumothorax

Tamponade (cardiac)

toxins (TCA overdose)

88
Q

benzodiazepine overdose mx

A

flumazenil

89
Q

aspirin (salicylate) overdose

A

IV sodium bicarbonate - if metabolic acidosis (to cause alkalinisation)

activated charcoal - recent overdose

aspirin is a salicylate: causes raised anion gap metabolic acidosis

90
Q

fluid resus for burns

A

Parkland formula

total fluid requirement in 24hrs = 4ml x (total burn SA (%)) x (body weight (Kg))

50% given in first 8hrs

50% given in next 16hrs

after 24hrs - colloid (FFP, albumin): 0.5 x %SA x weight

maintenance crystalloid (dextrose saline) 1.5ml x burn x weight

91
Q

adrenaline doses

A
92
Q

ix to determine true episode of anaphylaxis

A

serum tryptase

93
Q
A
94
Q

Beta blocker overdose mx

A

glucagon

95
Q
A

3rd year medicine (31 decks)

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