Emergency Medicine and Surgery Flashcards
24 year old male Acutely short of breath HR 120 BP 129/87 RR 35 SpO2 98% on 15LO2 GCS 15
What’s the abnormality?
HR 120
BP 129/87
RR 35
24 year old male Acutely short of breath HR 120 BP 129/87 RR 35 SpO2 98% on 15LO2 GCS 15
Differentials?
Pneumothorax Anaphylaxis Asthma Pneumonia Cardiac failure ARDS Pleural effusion
What is acute severe asthma?
(PEF) 33-50% of best
Can’t complete sentences
Respiration ≥25/min
Pulse ≥110 beats/min
What is life threatening asthma?
PEF <33% of best SpO2 <92% Silent chest, cyanosis, or feeble respiratory effort Arrhythmia/hypotension Exhaustion, altered consciousness
What should you always ask an asthmatic?
If they’ve been intubated before
DO NOT SEND THEM HOME
What other info would you want from an asthmatic?
Previous ITU
Other medical conditions
Allergies
Any infective symptoms
What is the pathophysiology of asthma?
Reversible airway disease
Hyper reactivity
Airflow limitation
What is the clinical presentation of acute asthma?
Wheeze?
> Other things which also cause wheeze. Not specific for asthma
Breathless?
Tachycardic?
What is the treatment of asthma?
Nebulised salbutamol IV salbutamol Nebulised adrenaline Nebulised magnesium Oral steroids IV steroids
When does asthma become life threatening?
Decompensation
Unable to maintain adequate PO2 and PCO2
Drowsy due to rising PCO2, hypotension or exhaustion
Need intubation
How would you review asthma?
How pathology creates the clinical signs
How physiology is explained- compensation vs decompensation
Treatment
Started to understand how history, examination and treatment might fit together in one package
What is specific about a meningitis rash?
Non blanching rash
34 year old female Suddenly felt unwell Widespread urticarial rash HR 130 BP 75/40 Collapsed (from low BP) Wheezy
Differentials?
- Ectopic pregnancy
- Acute severe asthma
- Sepsis
- Anaphylaxis
- Pneumonia
MOST LIKELY ANAPHYLAXIS
How do you treat anaphylaxis?
- Adrenaline (500mcg, 0.5ml 1:1000 IM)
> Lie her flat and put legs in the air - Piriton
- Hydrocortisone
- Fluids
How does adrenaline work?
α1 – vasoconstriction and relaxation of GI tract
α2 – platelet aggregation and reduction in noradrenaline release from nerve terminals
β1 – inotropic and chronotropic cardiac effects and relaxation of GI tract
β2 – bronchodilatation, increase in noradrenaline release from nerve terminals, increase in intracellular cyclic adenosine monophosphate (cAMP) production in mast cells and basophils, reduction in the release of cellular mediators
