EMERGENCY MEDICINE Flashcards
what are the airway features of anaphylaxis?
- Throat and tongue swelling.
- Difficulty breathing and swallowing.
- Hoarse voice.
- Stridor.
what are the breathing features of anaphylaxis?
- Tachypnoea.
- Wheeze.
- Hypoxia.
- Confusion.
- Fatigue.
- Cyanosis.
- Respiratory arrest.
what are the circulatory features of anaphylaxis?
- Signs of shock (patient appear pale and clammy).
- Tachycardia.
- Signs of low blood pressure (dizziness, collapse).
- Decreased loss of consciousness.
- Chest pain.
- Cardiac arrest.
what are the skin features of anaphylaxis?
- Flushing.
- Urticaria.
- Angio-oedema.
- Erythema.
how is anaphylaxis managed?
- Start cardiopulmonary resuscitation and advanced life support if the patient is in cardiorespiratory arrest
- IM adrenaline
- positional changes according to most prominent symptoms
- remove the trigger
- oxygen
- IV fluid challenge with crystalloid
- IM or IV antihistamine
- Corticosteroid to prevent biphasic reaction
what are the clinical features of skull fractures?
- Fall from height, motor vehicle accident, assault or gunshots to the head
- Palpable discrepancy in bone contour
- Battle’s sign: bruising over the mastoid which is a sign of basilar fracture, or fracture of the petrous part of the temporal bone
- Periorbital bruising
- Bloody otorrhoea
- CSF rhinorrhoea
- Facial paralysis, nystagmus or paraesthesia
how are skull fractures diagnosed?
-Perform cranial CT: detects skull fractures and intracranial pathology
how are closed non-depressed skull fractures managed?
-observe and monitor the patient with conservative management
how are closed depressed skull fractures managed?
- observe and monitor
- offer operative elevation and repair of dura if the fracture >1cm, there is gross cosmetic deformity or an intracranial lesion
how are open skull fractures managed?
- observe and monitor
- prompt debridement and operative dural repair and cranioplasty
how is major haemorrhage managed?
- clear clots
- direct pressure
- indirect pressure
- tourniquet
- TXA
- blood
what are the absolute indications for intubation in major trauma?
- Inability to maintain and protect own airway
- Inability to maintain adequate oxygenation with less invasive manoeuvres (PaO2<10kPa)
- Inability to maintain normocapnia (PaCO2 <4 or >6)
- Deteriorating conscious level (>2 points on motor scale)
- Significant facial injuries
- Seizures
what are the relative indications for intubation in major trauma?
- Haemorrhagic shock, particularly in the presence of an evolving metabolic acidosis
- Agitated patient (often caused by hypoxia or hypovolaemia)
- Multiple painful injuries
- Transfer to another area
define flail chest
-consecutive, segmental (i.e., multiple fractures in the same rib) ipsilateral rib fractures.
what are the clinical features of rib fractures?
- Pain
- Dyspnoea
- Signs of impaired ventilation
- Paradoxical chest wall motion in flail chest
how are rib fractures managed?
- Ensure that associated parenchymal injury (pneumothorax) is treated as appropriate
- Offer analgesia appropriate for the level of pain e.g. paracetamol and an opioid
- Provide chest physiotherapy for ventilation impairment
- Mechanical ventilation may be required in major trauma, with difficulty weaning from this being an indication for rib fixation, particularly in flail chest
what are the clinical features of shoulder dislocation?
- Anterior shoulder dislocations present with the arm in a characteristic position of external rotation and slight abduction.
- Posterior shoulder dislocations are rare and present with the arm held in adduction and internal rotation; the shoulder cannot be externally rotated, either actively or passively.
- Inferior shoulder dislocations present with the arm fully abducted and elbow commonly flexed on or behind the head.
- pain
- inability to move
- swelling
what are the clinical features of patellar dislocation?
-Patellar dislocation often presents with a swollen knee held in flexion with an obvious lateral prominence.
what are the clinical features of elbow dislocation?
-Elbow dislocation typically presents with the elbow held in flexion.
what are the clinical features of hip dislocation?
- The classic appearance of posterior hip dislocation is with the hip in a position of flexion, internal rotation, and adduction.
- With anterior hip dislocations, the hip is classically held in external rotation, with mild flexion and abduction.
how is a shoulder dislocation managed?
- Perform manual reduction with local anaesthesia and sedation
- Each of the reduction methods works by abduction and external rotation to disengage the humeral head from the glenoid, with axial traction to reduce it
- Follow up with AP and lateral x-rays to confirm reduction
- Immobilise with a sling
- Refer anyone under 25 to an orthopaedic surgeon
- Offer physiotherapy
how is a finger dislocation managed?
- Perform manual reduction with 1% lidocaine anaesthesia
- Perform a neurovascular examination following reduction
- Dorsal PIP AND DIP: hyperextension
- Volar DIP and PIP: mild axial traction and then pressure at the base
- MCP: Flex the wrist and hyperextend the digit, before applying a volar directed pressure to the dorsum
- Splint the affected finger to a non-affected finger
- Offer physiotherapy
how is a patellar dislocation managed?
- Perform manual reduction with local anaesthesia and sedation: seat the patient, flex the knee and then apply medial directed force to the lateral patella while extending the leg
- Perform confirmatory x-rays, immobilise and offer physiotherapy
how is an elbow dislocation managed?
- Perform manual reduction with local anaesthesia and sedation: position patient supine, extend the arm to 30 degrees flexion and then manipulate the gross alignment so that the olecranon is central, before flexing to 90 degrees with longitudinal traction to the forearm and countertraction on the humerus. Continuing flexing until there is a plapable clunk
- Perform confirmatory x-rays, immobilise and offer physiotherapy
how is a hip dislocation managed?
- Perform manual reduction with local anaesthesia and sedation using allis’ method or stimsons gravity technique
- Perform confirmatory x-rays, immobilise and offer physiotherapy
what are the clinical features of a neck of femur fracture?
- History of fall or trauma
- Pain in the affected hip, groin or thigh
- Inability to weight bear or move the hip
- Shortened, externally rotated leg
how is pain managed in a hip fracture?
- paracetamol
- additional opioids
- Nerve blocks
what is a first degree burn?
- Erythema involving the epidermis only
- Usually dry and painful
- Typical of severe sunburn.
what is a second degree burn?
- Superficial partial-thickness burns involving the epidermis and upper dermis
- Deep partial-thickness burns involving the epidermis and dermis
- Usually wet and painful
- Typical of scalding injury.
what is a third degree burn?
- Full-thickness burns involving the epidermis and dermis and damage to appendages
- Usually dry and insensate
- Typical of flame or contact injury.
what is a fourth degree burn?
- Involve underlying subcutaneous tissue, tendon, or bone
- Typical of high-voltage electrical injury.
what are the clinical features of burns?
- Erythema
- Dry and painful if 1st degree
- Wet and painful if 2nd degree
- Dry and insensate burns if 3rd degree
- Burns affecting subcutaneous tissue, tendon or bone if 4th degree
- Cellulitis
- Clouded cornea
how are 1st and 2nd degree burns managed?
- stop the burning
- irrigate with cool water for 20-30 minutes
- offer paracetamol
how should 2nd degree burn wounds be managed?
- cleaning
- debridement of necrotic tissue
- leave blisters intact, unless more than 1cm or likely to rupture, when they should be deroofed
- dress the wound
- if infected, clean with normal saline and prescribe flucloxacillin or clarithromycin
how are 3rd and 4th degree burns managed?
- ABCDE
- intubate if hypoxaemia or hypercapnia, deep facial burns or full thickness neck burns
- fluid resus
- analgesia with opioids
- surgical debridement and grafting
what are the clinical features of a dental abscess?
- Dental pain/toothache
- Thermal sensitivity of teeth
- Fever
- Intra-oral or extra-oral oedema, erythema or discharge
- Trismus
- Tooth percussion sensitivity
- Mobile teeth.
- Deep periodontal pockets, bleeding, gingival recession
- Bone loss around teeth
- Elevated or extruded tooth
- Halitosis
how is a dental abscess managed?
- removal of the source of infection
- analgesia
- broad spectrum antibiotics e.g. phenoxymethylpenicillin, amoxicillin or clindamycin
how is a pelvic fracture managed?
- pelvic binder
- manage arterial pelvic bleeding with interventional radiology
- give IV morphine
when can a pelvic binder be removed?
- there is no pelvic fracture
- a pelvic fracture is identified as mechanically stable
- the binder is not controlling the mechanical stability of the fracture
- there is no further bleeding or coagulation is normal.
- within 24 hours of application.
How are open fractures managed?
- IV morphine
- prophylactic IV antibiotics
- saline soaked dressing
- limb salvage or amputation
- debridement, fixation and cover
what are the clinical features of a long bone fracture?
- Pain
- Soft tissue swelling
- Ecchymosis
- Expanding haematoma
- Impaired limb function
- Inability to bear weight
- Point tenderness
- Deformity
- Guarding
- Wound overlying site of injury
- Signs of an ischaemic limb
- Hypotension/hypovolaemic shock
how are long bone fractures initially managed?
- legs: splint
- analgesia
- assess neuromuscular status
how are femur fractures managed in children?
- harness or traction
- surgical repair
how are humerus fractures managed in adults?
- offer non-surgical management for definitive treatment of uncomplicated injuries
- consider surgery for injuries complicated by an open wound, tenting of the skin, vascular injury, fracture dislocation or a split of the humeral head.
