Emergency Medicine Flashcards
Define anaphylaxis
Airway, breathing and circulation problems with associated skin changes
Give 3 signs of anaphylaxis
Anxiety Lightheadedness LOC Confusion Headache Hypotension Tachycardia Skin flushing Hives Itching Runny nose Angioedema Cough Hoarseness Odynophagia SOB Wheeze Vomiting Diarrhoea Cramping
How is anaphylaxis managed?
A-E assessment Call for help Lie patient flat and raise legs Give adrenaline (0.5ml of 1:1000 IM) Establish airway Give high flow oxygen, IV fluid challenge, chlorphenamine (10mg IM/IV), hydrocortisone (200mg IM/IV)
How are acute asthma attacks classified by severity? Give a feature of each
Moderate - PEFR 50-75% best/predicted
Severe - PEFR 33-50%, cannot complete sentences
Life threatening - PEFR <33%, SpO2 <92%, silent chest, normal PCO2
Near fatal - raised PCO2, mechanical ventilation
Give 2 indications for NIV
COPD - pH <7.35, pCO2 >6.5, RR >23, persistent
Neuromuscular disease
Obesity
Give an absolute and relative contraindication to NIV
Absolute - severe facial deformity, facial burns, fixed upper airway obstruction
Relative - pH <7.15, GCS <8, confusion/agitation, cognitive impairment
Define trauma
Bodily harm resulting from exposure to an external force or substance (mechanical, thermal, electrical, chemical or radiant) or a submersion
This bodily harm can be unintentional or violence-related
How can trauma be classified by mechanism?
Blunt Penetrating Acceleration/deceleration Burn Crush Fall Immersion/submersion
What approach should be used for a trauma patient?
Catastrophic haemorrhage Airway C-spine Breathing Circulation Disability Everything else
How can the risk of c-spine injury be assessed to determine whether a patient requires imaging?
C-spine XR needed if any of the following are present:
High risk factors - age >=65, dangerous mechanism, paraesthesia
Other factors - not ambulatory/sitting in ED, immediate neck pain, midline tenderness, unable to rotate neck
What options are available for c-spine immobilisation?
Collar
Blocks and tape
How are c-spine x-rays interpreted?
Lateral view - adequacy, alignment, bones, cartilage and corticated ring, prevertebral soft tissues (AABCCP)
AP - adequacy, alignment, bone, spaced spinous processes, soft tissue (AABSS)
How is the adequacy of a c-spine XR determined?
Check if C1-T1 can be seen (8 vertebrae)
What lines are used to check alignment on a c-spine XR?
Anterior vertebral line
Posterior vertebral line
Spinolaminar line
Posterior spinous line
What does a crack in the corticated ring mean?
Hangman fracture
How are prevertebral soft tissues assessed on c-spine XR?
Above C4 they can be 1/3rd of the width of a vertebral body
Below C4 they can be the whole width
What are the 3 views taken on c-spine XR?
Lateral
AP
Open mouth
Give 3 signs of a base of skull fracture
Battle’s sign
Raccoon eyes
CSF/blood leakage from ear/nose (haemotympanum, rhinorrhoea, otorrhoea)
Loss of function of what tracts are responsible for decorticate and decerebrate posturing?
DeCortiCate - Corticospinal
DeceRebRate - Rubrospinal
What are the indications for CT in head injury?
High risk - GCS <15 at 2 hours after injury, suspected open/depressed skull fracture, vomiting >=2 times, age >=65
Medium risk - amnesia >=30 mins before impact, dangerous mechanism
What causes a ‘blown pupil’?
Herniation of uncus through tentorium
What are the 4 types of rewarming in trauma?
Passive (blankets)
Active external (bair hugger)
Active internal (warm fluids, cavity lavage)
Extracorporeal
How should a secondary survey be structured in trauma?
Head to toe examination
Complete neurological examination
AMPLE history - allergies, medications, PMH, last eaten/drank, events related to injury
How should wounds be assessed?
A-E assessment
What information should be obtained in the history for a wound?
Mechanism of injury
Time of injury
PMH
Occupation and hand dominance
Give 2 things to consider on assessing a wound
Damage to regional structures Need for XR Need for anaesthetic for proper examination Control of bleeding Need for washout/debridement
Name 3 types of wounds
Incisional Laceration Abrasion Puncture Penetration Contusion Haematoma
What options are available for wound closure?
None Glue Steristrips Sutures Staples Skin graft
What type of wounds are fit for primary closure?
Clean
Minimal contamination
Recent
Well opposed
What type of wounds are fit for secondary closure?
Puncture Abrasion Late presentation Bites Abscesses
What type of wounds should never be closed?
Bites
What should be considered for bite wounds?
Do not close Always XR Antibiotics Tetanus status BBV Follow-up
What is the maximum dose of lignocaine? What can be used to increase this?
3mg/kg
+ adrenaline = 7mg/kg
Name 3 types of suture and their use
Simple interrupted - shallow, no tension
Continuous - scalp, long
Locking continuous - moderate tension, haemostasis
Subcuticular - cosmetic
Vertical mattress - eversion, reduce dead space, decrease tension
Horizontal mattress - fragile skin, high tension
Percutaneous/deep - reduce dead space, decrease tension
What information should be given to the patient with a wound you have managed before they leave?
Dressing information Keep it dry and clean Warn about infection and signs to look out for Timeline for suture removal (7-10 days) Healing/scarring
What is the difference between a burn and a scald?
Burn - dry thermal damage to the skin and underlying tissues (e.g. flame, electrical)
Scald - wet thermal damage to the skin and underlying tissues (e.g. boiling water)
How is the degree of a burn classified?
Superficial - erythema, mild pain, 7-14 days to heal
Superficial partial - wet pink blisters, moderate pain, 2-4 weeks to heal
Deep partial - drier red may have blisters, sluggish/absent CRT, pain may not be present, 3-8 weeks to heal with severe scarring, needs grafting
Full thickness - dry white, absent CRT and pain, needs grafting
