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Year 3 Emergency > Emergency Presentations > Flashcards

Emergency Presentations Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What are the categories of conditions that may affect someone’s ability to legally drive?

A 
Cardio
Neuro e.g. epilepsy, syncope, TIA
Diabetes
Vision
Alcohol/substance misuse and dependence
Psychiatry
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2
Q

When can a med prof disclose information to the DVLA?

A

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

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3
Q

What are some signs of terminal illness?

A 
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
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4
Q

What are the different patterns of genetic inheritance?

A

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

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5
Q

What causes surgical site infections?

A

Breach in tissue surfaces and allow normal commensals and other pathogens to initiate infection

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6
Q

What increases the risk of surgical site infection?

A

Shaving the wound using a razor
Using a non-iodine impregnated incise drape
Tissue hypoxia
Delayed administration of prophylactic antibiotics in tourniquet surgery

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7
Q

What can be done pre-op to reduce the risk of surgical site infection?

A

Don’t remove body hair routinely
If hair needs removal, use electrical clippers with single use head
AB prophylaxis

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8
Q

What can be done intra-op to reduce the risk of surgical site infection?

A

Prepare the skin with alcoholic chlorhexidine

Cover surgical site with dressing

Consider using antimicrobial triclosan-coated sutures

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9
Q

What can be done post-op to reduce the risk of surgical site infection?

A

ANTT for changing/removing surgical wound dressings

Use sterile salines for wound cleansing up to 48 hrs postop

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10
Q

What are the main post-op complications?

A 
Sepsis
Pyrexia
Pain
N+V
Haemorrhage
Delirium
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11
Q

What are the main features of post-op bleed?

A

Can occur up to 10 day post op
Require rapid pt resus and fluid
Place pressure on site

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12
Q

What is a common cause of post-op arrhythmia?

A

Susceptibility to hypokalaemia (K+ <4.0 in cardiac patients)

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13
Q

What is a common neurosurgical electrolyte disturbance?

A

SIADH following cranial surgery causing hyponatraemia

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14
Q

What causes ileus post GI surgery?

A

gastrointestinal surgery Fluid sequestration and loss of electrolytes

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15
Q

After what surgery is pulmonary oedema common?

A

Pneumonectomy

Loss of lung volume makes these patients very sensitive to fluid overload

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16
Q

What would an anastamotic leak cause?

A

Generalised sepsis causing mediastinitis or peritonitis depending on site of leak

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17
Q

What first line investigations should be done in an acutely unwell surgical patient?

A 
FBC, U+Ex, CRP, Calcium, LFTs, Clotting
ABG
ECG
CXR
Urinalysis
18
Q

What are some early < 5 day causes of post-op pyrexia?

A

Blood transfusion
Cellulitis
Urinary tract infection
Physiological systemic inflammatory reaction (usually within a day following the operation)

19
Q

What are late > 5 day causes of post-op pyrexia?

A

Venous thromboembolism
Pneumonia
Wound infection
Anastomotic leak

20
Q

What is the management of animal bites?

A

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

21
Q

What would a local reaction to venom comprise?

A

Redness, swelling and pain limited to the skin and soft tissues directly related to the site

22
Q

What would a systemic reaction to venom comprise?

A

cutaneous reactions that are relatively distant from the exposure site e.g. widespread redness, itching, urticaria and/or angioedema

23
Q

What is the management for a venom allergy?

A

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

24
Q

What is the most common cause of pneumothorax?

A

Lung laceration with air leakage

25
Q

What is the most common cause of haemothorax?

A

Laceration of lung, intercostal vessel or internal mammary artery

26
Q

Define massive haemorrhage

A

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

27
Q

What is normal adult blood volume?

A

7% of body weight

28
Q

What are the transfusion complications of massive haemorrhage?

A

Hypothermia - blood is refrigerated

Hypocalcaemia - anticoag in blood products might me chelate calcium

Hyperkalaemia

Transfusion reactions

Coagulopathy

29
Q

What is the immediate response to massive haemorrhage?

A 
Control bleeding
Venous access
Avoid hypothermia - warm fluids
Take appropriate blood tests
O neg transfused
30
Q

What are signs of opioid overdose?

A 
Altered metal state
Bradypnoea
Miosis
Apnoea
Track marks
31
Q

What is the initial management for opioid overdose?

A

Ventilation

Naloxone

32
Q

What investigations should be done for opioid overdose?

A

Therapeutic trial of naloxone

ECG - look for signs of myocardial ischaemia

33
Q

What are the presenting features of cocaine overdose?

A 
Tachycardia
HTN
Hyperthermia
Diaphoresis 
Mydriasis
Agitation
34
Q

What confirms recent cocaine use?

A

Urine screen

35
Q

What are RFs for cocaine overdose?

A

higher ambient temperatures
male
18-25 years
history of cocaine use

36
Q

What investigations should be done in the case of cocaine overdose?

A 
ECG
Serum glucose
Creatinine
Urea
Troponin
37
Q

What is the management for cocaine overdose?

A

Benzodiazepine for agitation
Isotonic saline
External cooling and sedation
Anti-arrhythmic therapy

38
Q

What are some causes of acute stridor?

A 
FB inhalation
Epiglottis
Croup
Laryngitis
Anaphylaxis
39
Q

Stridor vs Wheeze

A

Stridor - single pitch, inspiratory sound produced by large airway narrowing

Wheeze - musical sound on expiration by airways of any size

40
Q

What is multiple organ dysfunction syndrome?

A

spectrum of organ impairment that may change over time

41
Q

What are the signs and symptoms of MODS?

A 
Altered mental state
Decrease in renal perfusion
Respiratory deterioration
Decrease cardiac function
Deranged metabolic status 
Compromised fluid balance
Pale, clammy, peripherally cool skin

Year 3 Emergency (11 decks)

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