Emergency Medicine

Question 1

How long after ingestion of a drug does hypersensitivity arise?

Answer 1

Usually within minutes of parenteral or mucosal exposure to a drug. 30 minutes after ingestion of a drug.

Question 2

What are the characteristics of anaphylaxis?

Answer 2

Bronchospasms

Upper airway obstruction

Hypotension

Question 3

What are the symptoms of anaphylaxis?

Answer 3

Difficult/noisy breathing

Swelling of the tongue

Tightness in throat

Difficulty talking

Wheezing

Collapse

Question 4

How should anaphylaxis be treated?

Answer 4

Cease administration of allergen

Assess severity of reaction

Call 000

Give 0.5mL adrenaline 1:1000 via IM injections. These injections can be to the thigh, arm, hip, or buttocks

Question 5

What are the signs of moderate asthma?

Answer 5

Some use of accessory muscles

Unable to complete sentences

Respiratory rate >25/minute

Tachycardia >110/minute

Hospital admission if poor initial treatment response

Question 6

What are the signs of life-threatening asthma?

Answer 6

Marked use of accessory muscles

Cyanosis or respiratory rate <8/minute

Bradycardia <50/minute

Exhaustion, confusion, decreased conscious level

Transfer to hospital immediately

Question 7

How should a mild asthma attack be treated?

Answer 7

Sit upright and reassure

4 separate puffs of inhaler. 1 puff 4 breaths in and out

Wait 4 minutes to see if inhaler is effective

Repeat step 2

Question 8

How should moderate or severe asthma be treated?

Answer 8

Call 000

O2 at flow rate 6L/min

4 separate puffs of inhaler as with mild

Wait 4 minutes

Continue 4 puffs until assistance arrives.

Instead of inhaler consider giving salbutamol 5mg by nebuliser. Repeat every 15 - 30 minutes until assisstance arrives.

Question 9

What does FAST stand for regarding strokes?

Answer 9

Facial weakness

Arm weakness

Slurred speech and patient unable to comprehend what is being said.

Time

Question 10

How should partial airway obstruction be managed?

Answer 10

Call 000

Reassure patient and encourage to dislodge object by coughing. Check expectorant.

If patient unable to cough, 5 back blows between shoulder blades using heel of the hand

Question 11

How should complete airway obstruction be managed?

Answer 11

Call 000

Turn patient to side

Attempt to clear airway by manually removing obstruction

Check for signs of breathing. If no signs, give up to 5 back blows between shoulder blades using heel of the hand (check between each blow)

Give up to 5 chest thrusts (identical to cardiac compression but sharper and harder)

If complete obstruction , cricothyroidotomy indicated

Question 12

How is a cricothyroidotomy done?

Answer 12

Extend head to stretch neck

Palpate cricothyroid ligament

Incise through skin and ligament

Maintain airway until assistance arrives

Question 13

What are the types of seizures?

Answer 13

Partial - involves only part of the brain may or may not lose consciousness

Generalized - Involves the whole brain and loss of consciousness. Tonic clonic seizure with unconsciousness.

Status epilepticus - Recurrent seizures occur without recovery of consciousness between attacks

Question 14

What are the signs and symptoms of generalized seizures?

Answer 14

Sudden loss of consciousness

Tonic phase-become rigid, fall, give a cry and becomes cyanosed

Clonic phase-jerking movements of the limbs,
may bite tongue

Aura

Urinary incontinence

Frothing from the mouth

Question 15

How should seizures be managed?

Answer 15

Do not try to restrain convulsive movements

Ensure the patient is not at risk of injury

After convulsive movements subsided, place patient in recovery position and check airway

Assess consciousness

If there is vomit, suction

If fitting repeated or prolonged >5mins, continue O2 and administer buccal midazolam 10mg

Call 000

Maintain airway and monitor until assistance arrives

Question 16

What are the symptoms of hypoglycaemia?

Answer 16

Pale skin
Sweating
Tachycardia > 100/min
Shaking and trembling
Aggression and confusion
Difficulty in concentration
Slurring of speech
Fitting
Unconsciousness

Question 17

How should hypoglycaemia be treated?

Answer 17

if conscious:

Administer oral glucose 20-25g or fast-acting glucose containing food or drink
Followed by a lower glycaemic load carbohydrate
Observe until patient recovered. Do not allow to drive home and advise seek medical review

If drowsy/unconscious:

Administer glucagon 1mg, I.M. injection and oral glucose when regain consciousness
If no respond, call 000, commence BLS

Question 18

What are the signs and symptoms of syncope?

Answer 18

Faint, dizzy and light-headed
Slow pulse rate
Loss of consciousness
Pallor and sweating
Nausea and vomiting

Question 19

How should patient with syncope be managed?

Answer 19

Lay patient flat and raise feet
Loosen tight clothing around neck
Assess consciousness
If unconscious, measure BP and pulse rate
Place patient on their side
Stimulate and cool patient by placing cold compress on forehead
Administer 100% O2 until consciousness regained
If not, consider other causes, call 000 and institute BLS