Emergency Presentations Flashcards
What are the categories of conditions that may affect someone’s ability to legally drive?
Cardio Neuro e.g. epilepsy, syncope, TIA Diabetes Vision Alcohol/substance misuse and dependence Psychiatry
When can a med prof disclose information to the DVLA?
benefits to an individual or to society of the disclosure must outweigh both the
patient’s and the public interest in keeping the information confidential
What are some signs of terminal illness?
Losing weight Feeling weak Sleeping more Feeling hot or cold Eating and drinking less Bladder and bowel problems Breathlessness Noisy breathing Pain N+V Restlessness or agitation Delirium
What are the different patterns of genetic inheritance?
Autosomal dominant (50% chance, if one affected parent)
Autosomal recessive (25%, if two carrier parents)
X-linked recessive (50% son of mother)
X-linked dominant (100% daughters of father, 50% chance of child if affected mother)
Mitochondrial inheritance
What causes surgical site infections?
Breach in tissue surfaces and allow normal commensals and other pathogens to initiate infection
What increases the risk of surgical site infection?
Shaving the wound using a razor
Using a non-iodine impregnated incise drape
Tissue hypoxia
Delayed administration of prophylactic antibiotics in tourniquet surgery
What can be done pre-op to reduce the risk of surgical site infection?
Don’t remove body hair routinely
If hair needs removal, use electrical clippers with single use head
AB prophylaxis
What can be done intra-op to reduce the risk of surgical site infection?
Prepare the skin with alcoholic chlorhexidine
Cover surgical site with dressing
Consider using antimicrobial triclosan-coated sutures
What can be done post-op to reduce the risk of surgical site infection?
ANTT for changing/removing surgical wound dressings
Use sterile salines for wound cleansing up to 48 hrs postop
What are the main post-op complications?
Sepsis Pyrexia Pain N+V Haemorrhage Delirium
What are the main features of post-op bleed?
Can occur up to 10 day post op
Require rapid pt resus and fluid
Place pressure on site
What is a common cause of post-op arrhythmia?
Susceptibility to hypokalaemia (K+ <4.0 in cardiac patients)
What is a common neurosurgical electrolyte disturbance?
SIADH following cranial surgery causing hyponatraemia
What causes ileus post GI surgery?
gastrointestinal surgery Fluid sequestration and loss of electrolytes
After what surgery is pulmonary oedema common?
Pneumonectomy
Loss of lung volume makes these patients very sensitive to fluid overload
What would an anastamotic leak cause?
Generalised sepsis causing mediastinitis or peritonitis depending on site of leak
What first line investigations should be done in an acutely unwell surgical patient?
FBC, U+Ex, CRP, Calcium, LFTs, Clotting ABG ECG CXR Urinalysis
What are some early < 5 day causes of post-op pyrexia?
Blood transfusion
Cellulitis
Urinary tract infection
Physiological systemic inflammatory reaction (usually within a day following the operation)
What are late > 5 day causes of post-op pyrexia?
Venous thromboembolism
Pneumonia
Wound infection
Anastomotic leak
What is the management of animal bites?
cleanse wound. Puncture wounds should not be sutured closed unless cosmesis is at risk
current BNF recommendation is co-amoxiclav
if penicillin-allergic then doxycycline + metronidazole is recommended
What would a local reaction to venom comprise?
Redness, swelling and pain limited to the skin and soft tissues directly related to the site
What would a systemic reaction to venom comprise?
cutaneous reactions that are relatively distant from the exposure site e.g. widespread redness, itching, urticaria and/or angioedema
What is the management for a venom allergy?
Acutely, supportive
e.g. IM adrenaline/steroids/anti-histamines for anaphylaxis
Oxygen
Venom allergy testing if airway compromise or haemodynamic instability
OR
if allergen is hard to avoid e.g. beekeeper
What is the most common cause of pneumothorax?
Lung laceration with air leakage
What is the most common cause of haemothorax?
Laceration of lung, intercostal vessel or internal mammary artery
Define massive haemorrhage
loss of one blood volume in a 24 hour period or the loss of 50% of the circulating blood volume in 3 hours
OR
150ml/min
What is normal adult blood volume?
7% of body weight
What are the transfusion complications of massive haemorrhage?
Hypothermia - blood is refrigerated
Hypocalcaemia - anticoag in blood products might me chelate calcium
Hyperkalaemia
Transfusion reactions
Coagulopathy
What is the immediate response to massive haemorrhage?
Control bleeding Venous access Avoid hypothermia - warm fluids Take appropriate blood tests O neg transfused
What are signs of opioid overdose?
Altered metal state Bradypnoea Miosis Apnoea Track marks
What is the initial management for opioid overdose?
Ventilation
Naloxone
What investigations should be done for opioid overdose?
Therapeutic trial of naloxone
ECG - look for signs of myocardial ischaemia
What are the presenting features of cocaine overdose?
Tachycardia HTN Hyperthermia Diaphoresis Mydriasis Agitation
What confirms recent cocaine use?
Urine screen
What are RFs for cocaine overdose?
higher ambient temperatures
male
18-25 years
history of cocaine use
What investigations should be done in the case of cocaine overdose?
ECG Serum glucose Creatinine Urea Troponin
What is the management for cocaine overdose?
Benzodiazepine for agitation
Isotonic saline
External cooling and sedation
Anti-arrhythmic therapy
What are some causes of acute stridor?
FB inhalation Epiglottis Croup Laryngitis Anaphylaxis
Stridor vs Wheeze
Stridor - single pitch, inspiratory sound produced by large airway narrowing
Wheeze - musical sound on expiration by airways of any size
What is multiple organ dysfunction syndrome?
spectrum of organ impairment that may change over time
What are the signs and symptoms of MODS?
Altered mental state Decrease in renal perfusion Respiratory deterioration Decrease cardiac function Deranged metabolic status Compromised fluid balance Pale, clammy, peripherally cool skin
