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Yr3 geriatrics > emergency medicine AMK > Flashcards

emergency medicine AMK Flashcards

1
Q

A 67-year-old man presents to the Emergency Department with 2 hours of left-sided
chest pain. He reports having had similar pains that come and go when he exercises. The
pain usually subsides when he rests. He appears sweaty, agitated and short of breath.
An ECG is performed and shows new T-wave inversion in V3-V6.
His troponin and d-dimer levels are as shown:
Troponin 223 ng/L (<5)
D-Dimer 932 ng/mL (< 400)
What is the most likely diagnosis?

A

NSTEMI

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2
Q

ACS is umbrella term fro STEMi Nstemi and unstable angina
symtpoms socrates

A

central crushing chest pain
sudden
crushing
jaw and arm
SOB and palpitions pale, clammy m sweating , N+V
not related to food positon
exertion

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3
Q

unstable angina presents with

A

normal troponin and other change on ECG and or no change

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4
Q

immediate management of ACS

MONA

A

ABCDE
MONA
IV morphine and anti-emetic
oxygen sats over 94
nitrate - GTN
aspirin 300mg

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5
Q

long term management ACS

A

aspriin, atorvastatin and ACEi
beta blocker
cardiac rehab
driving , diet and dyspepsia (PPI)

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6
Q

RCA

A

inferior leads II, III, aVF

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7
Q

LAD

A

anterior leads V1-4

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8
Q

left circumflex

A

lateral leads I and V5-6

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9
Q

tachycardia is unstable what to do

A

DC shock 3 times before amiodarone

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10
Q

if not life threatening tachy and narrow QRS management for both regular and irregular

A

regular - vagal manouevere such as valsalva - if not adenosine

irregular prosb AF 0 rate control with beeta blockers - if heart fialure digoxin

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11
Q

broad complex tachy irregulr vs regular

A

regular - amiodaroje 300mg IV over 10 -60 mins

iregular - IV mg

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12
Q

bradycardia life threating mangemetn

A

atropine

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13
Q

if atropine does not work

A

adrenaline or transvenous pacing

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14
Q

A 31-year-old male presents to the emergency department with sudden-onset ‘tearing’ pain in his chest.
On examination, his heart rate is 70 beats per minute, respiratory rate is 16 breaths/min, temperature is
36.7oC, oxygen saturations are 100% on room air, blood pressure is 165/82mmHg in the right arm and
138/70mmHg in the left arm. He has no past medical history but on examination, you note he has a tall
stature, pectus excavatum and joint hypermobility.
Chest x-ray is performed which shows a widened mediastinum.
What is the most appropriate investigation?

A

CT TAP

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15
Q

aortic dissection tear through what wall

A

tunica intima

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16
Q

type a is in the ascendign aorta type b is where

A

descendign aorta

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17
Q

type a is surgical what happens to type b

A

conservative management and labetaolol

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18
Q

PE worst on isnpriation and cough up blood can show as sinus tachy on ECG what is the gold standard

A

CTPA

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19
Q

ci to CTPA

A

allergic , pregnant, renal impairment

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20
Q

acute asthma what do you given like an attack
OSHITME

A

Oxygen
salbutamol
hydrocortisone
ipratropium bromide
theophylline
magnesium sulphate
escalation to ITU

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21
Q

mild moderate asthma is 50-77 PEFR
norm speach
RR under 25
pulse under 1220
wheeze
sats above 92

what is severe nad life threatening ( 2nd number)

A

33-50%
use of accesoory mucles t complete exhausted bradycaridas and cannpto speak

RR over 25
pulse over 110

cyanosis and agitation adn altered conscious level

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22
Q

anaphylaxis what do you give

A

adrenaline

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23
Q

adult or child over 12 what dose of adrenaline for anaphylaxis

A

500micrograms IM or 0.5ml

24
Q

child 6-12 years what dose of adrenaline

A

300micrograms IM or 0.3ml

25
child 6m to 6 years what dose of adrenaline
150micrograms IM - 0.15ml
26
child under 6 months what dose of adrenlaine do we give
100-150 micrograms IM or 0.1-0.15ml)
27
what should you do in anaphylacitc shock
ABCDE skin itchy and airwyas calling for help remove trigger adn lie pateitn flat with or without legs elevated sitting psotn may make breathign easie r pregnant women needs to be lying on left side give IM adrenaline and montiors repat if no repsonse after 5 min
28
NAC treatmetn over what level
75mg
29
if under 4 hours paracetamol ingestion what do you do
activated charcoal unde teh hour and take paracetamol conc at 4 hours post ingestions
30
serotonin syndrome sx
increased reflexes , clonus, dilated pupils
31
at what age is Screening for AAA
single abdo USS aged 65
32
AAA are usually asymtpomatic and may be pulsatile and can obstruct GI structures if rupture what triad do they present with
flank or back pain hypotension pulsatile abdo mass other sx radiating to back pain tachycardia profoudn anameia sudden death
33
under 3cm requires no furhter action a small aneurysm 3-4.4 cm is required to be seen
every year
34
medium aneurysm is 4.5-5.4 required to be seen
every 3 months
35
5.5 is considered large what should happen
2WW to vascular surgery for probable intervention
36
unruptured AA treatment
careful control of hypetension, lipid lowering meds adn smokign cessation regular USS and surgical repiar
37
ruputred AAA treatment what blood pressure should you keep them below
ABCDEFG raising BP will dilodge a clot and may precipiate further bleeding so keep BP below 100mghg urgent surgery
38
A 56-year-old man presents to the emergency department with severe abdominal pain. He has a past medical history of atrial fibrillation and type 2 diabetes mellitus. His observations on admission are: respiratory rate = 20/min, heart rate = 112/min, irregularly irregular, blood pressure = 134/97 mmHg, oxygen sats = 97% An arterial blood gas sample is performed and shows the following: What is the most likely diagnosis? A) DKA B) Mesenteric ischaemia C) Ruptured AAA D) Metformin-induced lactic acidosis E) Acute pancreatitis pH 7.21 PaO2 10.3 kPa PaCO2 3.4 kPa HCO3 15.1 mmol/l Lactate 7.1 mmol/l ( range: < 1 mmol/l)
mesenteric ischaemia
39
what is msenteric ischaemia
Rapid block in blood flow through the SMA due to a thrombus or an embolus
40
sx of mesenteric ischaemia
Acute, non-specific abdo pain * Pain disproportionate to exam findings * Go on to develop shock, peritonitis and sepsis
41
sx of mesenteric ischaemia
Acute, non-specific abdo pain * Pain disproportionate to exam findings * Go on to develop shock, peritonitis and sepsis
42
investiagations of choice and what would blood gas show in mescenteric ischaemia
Contrast CT, metabolic acidosis and raised lactate due to ischaemia
43
Mx os mesenteric ischaemia
Surgery- remove necrotic bowel and remove or bypass thrombus
44
A 24-year-old woman presents to her GP with lower abdominal pains that have been getting worse over the past two days. The pain is in the suprapubic area and slightly to the right. She had some vaginal bleeding this morning which she describes as being like a light period. The patient also describes some shoulder pain which she thinks came on following a game of squash. Her last period was eight weeks ago and was described as normal. In the past, she has been treated for Chlamydia infection and admits to not practicing safer sex. On examination, she is tender in the right iliac fossa. Blood pressure is 100/60mmHg and the pulse is 102/min. What is the most likely diagnosis? A) Appendicitis B) Ovarian torsion C) Miscarriage D) PID E) Ruptured ectopic pregnancy
ruptured ectopic
45
peritonitis symtoms
Peritonitis: * Guarding * Rigidity * Rebound tenderness * Coughing test * Percussion tenderness
46
sx of ectopic
Suspect in any female with abdo pain * Missed period * Constant lower abdo pain in RIF/LIF * Vaginal bleeding * Lower abdo or pelvic tenderness * Cervical motion tenderness * Dizziness or syncope (blood loss) * Shoulder tip pain (peritonitis)
47
rf of ectopic
Risk Factors: * Previous ectopic * Previous PID * Fallopian tube surgery * IUD * Older age * Smoking
48
mx of ectopic
Management: * Must be terminated- not a viable pregnancy * Expectant management (awaiting natural termination) * Medical management (methotrexate) * Surgical management (salpingectomy or salpingotomy) Expectant Management: * Follow up needs to be possible to ensure successful termination * The ectopic needs to be unruptured * Adnexal mass < 35mm * No visible heartbeat * No significant pain * HCG level < 1500 IU / l Medical Management: * As above but * HCG level must be < 5000 IU / l * Confirmed absence of intrauterine pregnancy on ultrasound Surgical Management: Anyone not meeting above criteria, including: * Pain * Adnexal mass > 35mm * Visible heartbeat * HCG levels > 5000 IU / l
49
someone who is struglling to breath in ABCDE what can you do to help
15L O2 via non rebreath mask - less for COPD
50
what should you check under d
glucose GCS pupils reactivity and symmetry and pain assessment and CT brain
51
when is a DOAC contrinidacted
renal impairment
52
signs of sepsis
Signs of potential sources such as cellulitis, discharge from a wound, cough or dysuria Non-blanching rash can indicate meningococcal septicaemia Reduced urine output Mottled skin Cyanosis Arrhythmias such as new onset atrial fibrillation There are a few key points worth being aware of: High respiratory rate (tachypnoea) is often the first sign of sepsis Elderly patients often present with confusion or drowsiness or simply “off legs” Neutropenic or immunosuppressed patients may have normal observations and temperature despite being life threatening unwell
53
sepsis 6
bufalo
54
when does neutropenic sepsis occur
Sepsis in patients with a neutrophil count of <1 x 10^9/L Usually the result of chemotherapy, TB drugs or immunosuppression (see notes for list)
55
what do we treat neutropenic spesis with
piperacilin and tazocin
56
what drugs cause neutropenic sepsis
Anti-cancer chemotherapy Clozapine (schizophrenia) Hydroxychloroquine (rheumatoid arthritis) Methotrexate (rheumatoid arthritis) Sulfasalazine (rheumatoid arthritis) Carbimazole (hyperthyroidism) Quinine (malaria) Infliximab (monoclonal antibody use for immunosuppression) Rituximab (monoclonal antibody use for immunosuppression)
57
what test can confirm if someone has had an anaphylactic shock
mast cell tryptase within 6 hours

Yr3 geriatrics (6 decks)

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