Emergency Presentations

Question 1

what is shock?

Answer 1

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)

Question 2

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

Answer 2

MAP = CO x SVR = HR x SV X SVR

Question 3

What are causes of shock then?

Answer 3

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

Question 4

How do you classify hypovolaemic shock?

Answer 4

ATLS Classes 1-4

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

Question 5

What are the types of shock?

Answer 5

Cardiogenic
Obstructive
Hypovolaemic
Distributive (anaphylactic, septic)

Question 6

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

Answer 6

high HR, low BP

Question 7

How do you treat cardiogenic shock?

Answer 7

Inotropes, to increase contractility (dobutamine, dopamine)

Question 8

How do you manage septic shock?

Answer 8

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

Question 9

How do you manage hypovolaemic shock=

Answer 9

IV fluids / blood

+ treat cause

Question 10

What is sepsis

Answer 10

Life threatening organ dysfucntion caused by dysregulated host response to infection

Question 11

What is the MAP indicative of shock?

Answer 11

MAP <= 65mmHg

Question 12

What is septic shock?

Answer 12

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

Question 13

How do you manage sepsis

Answer 13

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

Question 14

How do you manage anaphylaxis first steps

Answer 14

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

Question 15

What are first line meds for anaphylaxis

Answer 15

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

then insert IV line

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

Add IV fluid bolus if in shock

Question 16

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

Answer 16

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

Question 17

When can you discharge anaphylaxis patient

Answer 17

After observed for 6-12 hours from onset

Question 18

How many patients have a biphasic response to anaphylaxis

Answer 18

Up to 20%

Question 19

What do you do for trauma patient initially?

Answer 19

Primary survey (A>E approach)

but first tamponade if they have a massive haemorrhage

Question 20

What do you do for A in a trauma pt

Answer 20

no head tilt - just JAW THRUST

Assume cervical spine blunt injury unless proven otherwise

Question 21

What rules do you use for C spine in trauma pts

Answer 21

Canadian C spine rules - do they NEED C spine immobilisation

NEXUS criteria - to clear a C spine (if have features that cannot clinically rule out C-spine -> imaging)

Question 22

When do you intubate a trauma pt

Answer 22

if GCS <=8

Question 23

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

Answer 23

FAST scan (Focussed Assessment with Sonography for Trauma)

Question 24

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

Answer 24

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

Question 25

What is the purpose of a secondary survey?

Answer 25

To minimise the risk of missed injuries

Question 26

What is the definition of coma?

Answer 26

unrousable unresponsiveness, classified with GCS

Question 27

What are causes of coma?

Answer 27

metabolic or neurological

Question 28

list metabolic causes of coma

Answer 28

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

Question 29

list neuro causes of coma

Answer 29

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

Question 30

what type of shock is JVP raised in

Answer 30

cardiogenic