Emergency Medicine (A-E) Flashcards
what is the presentation of acute severe asthma?
acute breathlessness and wheeze
what investigation would you do if suspect of acute severe asthma
Peak expiratory flow rate
ABG
CXR
FBC
U&E
the different of severe and life-threatening acute asthma attack
severe attack:
- can’t complete sentences in 1 breath
- RR >_25/min
- PR >_110bpm
- PEF 33-50%
Life threatening attack
- Silent chest, cyanosis feeble respiratory effort
- arrhythmia / hypotension
- exhaustion, confusion /coma
- PEF <33%
Immediate treatment and management for acute asthma
Give O2 -> maintain 94-98%
salbutamol 5mg nebulized with O2
severe/ life-threatening -> ipratropium 0.5mg /6hrs to nebulizer
Hydrocortisone 100mg IV / prednisone 40-50mg PO
Which department to refer if the acute asthma doesn’t improve?
ICU
what is in the presentation of acute exacerbations of COPD?
- Increase cough
- breathlessness
- wheeze
- decreased exercise capacity
what investigation would you do on acute exacerbations of COPD?
ABG
CXR - exclude pneumothorax and infection
FBC
U&E
CRP
ECG
sputum culture
blood cultures if pyrexia
management of acute COPD
- Nebulized bronchodilators - salbutamol 5mg/4hrs and ipratropium 500mcg/6hrs
____________________________ - controlled oxygen therapy if SaO2 <88% or PaO2<7kPa
starts at 24-28% aim sats 88-92% - steroids
IV hydrocortisone 200mg and oral prednisolone, 30mg OD (continue for 7-14days) - antibiotics (if there’s infection)
amoxicillin 500mg/8hrs PO
alternatively clarithromycin / doxycycline
**if no response to nebulizers and steroids –> IV aminophylline
Clinical features on pneumothorax?
-sudden onset of dyspnoea
-pleuritic chest pain
-sudden deterioration
-mechanically ventilated patient - suddenly develop hypoxia / increase in ventilation pressures
-reduced expansion
-hyper-resonance to percussion
-diminished breath sounds on the affected side
Clinical features on tension pneumothorax?
SOB
tachycardia
hypotension
distended neck veins
trachea deviated away from the side of pneumothorax
hyperresonance
reduced air sound on the affected side
how you would investigate pneumothorax?
CXR *(don’t use when suspicion of tension pneumothorax)
ABG
Bloods and U&E
Differences of primary and secondary pneumothorax
primary pneumothorax develops in the absence of an underlying disease process.
secondary pneumothorax develops as a result of underlying lung disease such as asthma or COPD.
management of pneumothorax
needle decompression
What’s the signs and symptoms of pneumonia
fever
rigors
malaise
anorexia
dyspnoea
cough
purulent sputum
haemoptysis
pleuritic chest pain
cyanosis
confusion
tachypnoea
tachycardia
hypotension
diminished expansion, dull percussion, tactile vocal fremitus, vocal resonance
investigation on pneumonia
CURB-65
CXR
ABG
FBC, U&E, LFT, CRP
BLOOD CULTURES
SPUTUM CULTURES
urine pneumococcal antigen
viral throat
how would you assess the severity of pneumonia?
CURB-65
Confusion
Urea >7mmol/L
Respiratory rate>30/min
BP <90/60mmHg
Age >65
0-1 home treatment
>2 hospital therapy
>3 severe pneumonia and consider ICU referral
Management of pneumonia
treat oxygen of hypoxia
dehydration then iv fluid support 500ml bolus
amoxicillin / Doxycycline / clarithromycin (if allergic to penicillin)
paracetamol/NSAIDS 1g/6hrsfor pleuritic chest pain
signs and symptoms of Pulmonary embolism (PE)
acute dyspnea
pleuritic chest pain
hemoptysis
syncope
hypotension
tachycardia
gallop rhythm (added S3 / S4)
raised JVP
right ventricular heave
pleural rub
tachypnoea
cyanosis
AF
loud p2
common cause of PE?
DVT
What is a risk score for PE/DVT?
Well score
what investigation if suspect of PE?
U&E
FBC
baseline clotting
ECG
CXR
ABG
D-dimer
CTPA
management of pulmonary embolism
Oxygen if hypoxic - 10-15L/min
morphine 5-10mg IV with anti-emetic if pt in pain / very distressed
IV LMWH/ fondaparinux
if BP low give 500ml IV fluid bolus & call ICU
if hemodynamic instability –> thrombolysis
long-term anticoagulation - DOAC / warfarin
recognition of sepsis
Altered mental state – ‘confused’, ‘drowsy’, ‘not themselves’
Fever – ‘warm to touch’, ‘shivery’, ‘burning up’
Hypotension – ‘dizzy’, ‘faint’, ‘lightheaded’
systolic bp <90mmHg mean arterial pressure <65mmHg
Tachypnoeic – ‘out of breath’, ‘breathless’
RR >25 bpm
Tachycardic – ‘heart is racing’, ‘heart is pounding’.
> 130 bpm
lactate > 2mmol/l
Not passed urine in 18hours
non-blanching petechial or purpuric rash
What are the sepsis 6?
Give oxygen
Give IV fluids
Give IV antibiotics
Take bloods and latate & blood cultures
Monitor NEWS2 & urine output
Notify senior clinician
Signs and symptoms of AAA
intermittent / continuous abdominal pain (radiates to the back, iliac fossae / groins)
hypotension
collapse / lightheadedness
expansible pulsatile abdominal mass
shock
What are the 9 quadrants?
What are the management for AAA
Surgical review (for if EVAR is needed)+ anesthetics + ITU ASAP
FAST scan - bedside USS
*CT abdo if stable
Crossmatch
Fluid resus
Analgesia
What are the 6P’s of vascular assessment?
Pain
Pallor (pale appearance of the limb)
Paresthesia (abnormal sensation of the limb)
Paralysis
Pulselessness
Perishing with cold
clinical features of acute limb ischaemia
sudden onset of the 6P’s
limb appears white
vascular examination in the other leg is usually normal
chronic rest pain (worst at night)
absent foot pulses
investigation for limb ischemia
past history
vascular examination
ankle brachial pressure index (APBI)
CT angiography
bloods
serum lactate
group and save
ECG
thrombophilia screen
management on limb ischemia
urgently refer to a vascular specialist
paracetamol and weak / strong opioids
in the ABPI what ratio shows the present of disease of the limbs?
<0.5 - severe arterial disease
0.5-<0.8 presence of arterial disease / mixed a/v disease
0.8-1.3 normal result
1.3< - arterial calcification
how long should acute limb ischemia be treated before becoming irreversible ?
And what need to be done?
within 4-6 hours
Oxygen
start on IV heparin
analgesia
imaging
require surgical intervention within 6hrs
if embolic:
- embolectomy
- bypass surgery
if thrombotic:
- angioplasty + thrombolysis
- bypass
how can DVT be treated?
Start with LMWH then swapped to a DOAC
