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Y6 Emergency Care > Emergency Presentations > Flashcards

Emergency Presentations Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

what is shock?

A

inadequate blood flow to organs to meet demand

defined as MAP <65 or SBP <90 + signs (e.g. mottled skin, prolonged cap refill, low UO, agitationo and confusion, raised lactate)

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2
Q

What is the formula you should use for causes of shock?

A

MAP = CO x SVR = HR x SV X SVR

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3
Q

What are causes of shock then?

A

CARDIOGENIC
OBSTRUCTIVE
HYPOVOLAEMIC
DISTRIBUTIVE (SEPTIC, ANAPHYLACTIC)

Low HR: pump failure (cardiogenic shock, PE, tension pneumothorax, tamponade)

Low SV:
- bleeding, fluid losses

Low SVR:

  • sepsis
  • anaphylaxis
  • neurogenic (spinal cord injury, epidural / spinal anaesthesia)
  • endocrine (Addison’s, hypotyroid)
  • drugs
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4
Q

How do you classify hypovolaemic shock?

A

ATLS Classes 1-4

1: compensated
2: tachycardia
3: hypotension
4: LOC

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5
Q

What are the types of shock?

A

Cardiogenic
Obstructive
Hypovolaemic
Distributive (anaphylactic, septic)

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6
Q

What will HR and BP be in all types of shock?

A

high HR, low BP

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7
Q

How do you treat cardiogenic shock?

A

Inotropes, to increase contractility (dobutamine, dopamine)

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8
Q

How do you manage septic shock?

A

Noradrenaline (to vasoconstrict, as there is excessive vasodilation) + sepsis 6

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9
Q

How do you manage hypovolaemic shock=

A

IV fluids / blood

+ treat cause

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10
Q

What is sepsis

A

Life threatening organ dysfucntion caused by dysregulated host response to infection

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11
Q

What is the MAP indicative of shock?

A

MAP <= 65mmHg

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12
Q

What is septic shock?

A

sepsis + lactate >2 (despite fluid resus) or pt needs vasopressor to maintain MAP

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13
Q

How do you manage sepsis

A

sepsis 6
find source of infection
clinician review in <1h, senior review <3h if cause is not identified

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14
Q

How do you manage anaphylaxis first steps

A
  1. Secure airway
  2. Remove cause + raise legs
  3. Meds
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15
Q

What are first line meds for anaphylaxis

A
  1. Adrenaline IM 0.5mg 1:1000 (can repeat every 5 mins PRN)

then insert IV line

  1. Chloramphenamine 10mg IV
  2. Hydrocortisone 200mg IIV

Add IV fluid bolus if in shock

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16
Q

What else must you do after initial management of anaphylaxis - during admission and as long term tx

A

Admit and monitor
ECG
Serum tryptase 1-6 hours later

As long term tx:

  • Allergy clinic referral
  • MedicAlert bracelet
  • Discharge with 2 autoinjectors
  • Teach to self inject
17
Q

When can you discharge anaphylaxis patient

A

After observed for 6-12 hours from onset

18
Q

How many patients have a biphasic response to anaphylaxis

A

Up to 20%

19
Q

What do you do for trauma patient initially?

A

Primary survey (A>E approach)

but first tamponade if they have a massive haemorrhage

20
Q

What do you do for A in a trauma pt

A

no head tilt - just JAW THRUST

Assume cervical spine blunt injury unless proven otherwise

21
Q

What rules do you use for C spine in trauma pts

A

Canadian C spine rules - do they NEED C spine immobilisation

NEXUS criteria - to clear a C spine

22
Q

When do you intubate a trauma pt

A

if GCS <=8

23
Q

What scan must you get if trauma patient is suspected of beeding

A

FAST scan (Focussed Assessment with Sonography for Trauma)

24
Q

What are important trauma investigations done between primary and secondary survey?

A

Basic tests (FBC, LFT, U&E, clotting, bone profile, pregnancy test, urine dip)
Portable XR (may be skipped if CT can be done)
FAST scan
CT scan
Diagnostic Peritoneal Lavage

25
Q

What is the purpose of a secondary survey?

A

To minimise the risk of missed injuries

26
Q

What is the definition of coma?

A

unrousable unresponsiveness, classified with GCS

27
Q

What are causes of coma?

A

metabolic or neurological

28
Q

list metabolic causes of coma

A
  • Drugs, pooisoning (CO, alcohol, tricyclics)
  • hypoxia, COPD
  • hypothermia
  • hepatic / uraemic encepalopathy
  • hypoglycaemia, hyperglycaemia
  • sepsis
29
Q

list neuro causes of coma

A

trauma
infection
tumour m
vascular (stroke, haemorrhage, hypertensive encepalopathy)
epilepsy (post-ictal, non convulsive ststus epiletticus)

30
Q

what type of shock is JVP raised in

A

cardiogenic

Y6 Emergency Care (9 decks)

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