Emergency medicine Flashcards

1
Q

what is the zero point survey?

A

ZERO POINT SURVEY
Pre-resus
Self – physical readiness ‘I’m safe’, cognitive readiness: breath, talk, see focus
Team – leader identified, roles allocated, briefing
Environment – danger, space, light, noise, crowd control
Resus commenced
Patient – primary survey – ABCDE
Update – share mental model of patient status
Priorities – identify team goals and set mission trajectory

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2
Q

why might you have difficulty maintaining an airway of someone who is have a seizure?

A
  • Seizure may cause upper airway obstruction and respiratory depression
  • Also the gag reflex is suppressed during a seizure and patient may aspirate if they vomit
  • The patients upper airway may also be obstructed by their relaxed tongue
  • Difficult to inspect airway- because of the jaw clench – often you cannot move the jaw if this happened - you could give nasopharyngeal airway as you won’t be able to put and oropharyngeal airway in. Also the nasopharyngeal airway is more tolerable.
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3
Q

if you are struggling to get IV access of someone who is having a seizure what medication could you give?

what should you check prior to giving it

A
  • Buccal midazolam 10 mg
  • Rectal lorazepam 10 mg
  • Has she already be given any drugs – is she already epileptic and taken medication for the seizure, have the paramedics given her this – this is because you don’t want to overdose on a certain drug or if they have already been given two doses now you would want to escalate the treatment.
  • Have they got any allergies, You would want to check that she had not taken any opioids, as risk of respiratory depression and other CNS depressant effects
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4
Q

if you gain Iv access in someone who is seizing what could you give?

what is the side effect you are most concerned about?

A
  • IV lorazepam 4mg ( this can be given following one dose of buccal or rectal benzo)
  • resp depression
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5
Q

Why is lorazepam now used in preference to diazepam?

A
  • Has a much longer duration and reduced cardio-respiratory side effects
  • Lorazepam has much less respiratory depression effect but has a much longer anti-epileptic effect
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6
Q

if they are still fitting after the diazepam what would you try next?

A
  • Phenytoin infusion at a dose of 15-18mg/kg at a rate of 50 mg/minute
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7
Q

what should you monitor whilst phenytoin is being infused?

A

therapeutic drug monitoring

monitor ECG and BP

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8
Q

if phenytoin is contradicted when treating seizures what could you give instead?

A
  • Levetiracetam – Keppra – this is probably going to become this first choice second line drugs rather than phenytoin because it is just as effective and has less side effects
  • Phenobarbital
  • Sodium valproate
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9
Q

what are the problems with using long acting paralytic agents in patients who are having seizures?

A

they could still be fitting just you can’t see it, so they brain will still be having a seizure which can be detrimental to the brain. This is why a short acting paralytic agent is used. Because you have to be sure you have stopped them fitting and not just stopped them moving.
- You could perform an EEG to see if they are still fitting when under GA.

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10
Q

causes of status epilepticus?

A
  • People with epilepsy – drug withdrawal due to poor adherence to their medication – likely
  • Hypoxia – unlikely
  • Stroke – possible – would be a haemorrhagic stroke – get CT – give stroke treatment
  • Metabolic abnormalities, low sodium, can also happen with low calcium - possible, U&E’s, correct electrolyte abnormalities
  • Alcohol intoxication or withdrawal – possible cause – so she could have delirium tremens, suggestive IV pabrinex and benzos
  • Infection -possible, check temp, start broad spec antibiotics or antivirals
  • Brain trauma -possible – get CT
  • Tumour - possible, CT head, dexamethasone
  • Hypoglycaemia – possible – check BM’s give dextrose, give glucagon
  • Drug withdrawal
  • Eclampsia, give magnesium sulphate and deliver baby
  • Acute alcohol intoxification
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11
Q

medical complications of status epilepticus?

A
  • Pulmonary oedema
  • Cardiac arrhythmias
  • Hyperthermia
  • Aspiration pneumonias

Later on complications

  • Focal neurological deficit
  • Cognitive dysfunction – most likely memory deficits
  • Behavioural problems
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12
Q

features of alcohol withdrawal?

A

Tremors, sweating, tachycardia, anxiety

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13
Q

how do you treat alcohol withdrawal?

A

chlordiazepoxide

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14
Q

features of delirium tremens?

A

Coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

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15
Q

how is delirium tremens managed?

A

benzo - IV lorazepam

thiamine

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