- brought on by a lack of insulin - without insulin your body begins to break down fat in attempt to get the energy it needs - this can cause the body to go into shock and swelling if the brain

General Medical Emergency Flashcards by Sio FitzGerald

How many chains of survival are there?

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What are the chains of survival?

early access
early CPR
early AED
early ALS
post ROSC care

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What does ROSC stand for?

Return of spontaneous circulation

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What are the two shockable rhythms?

ventricular fibrillation
pulseless ventricular tachycardia

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What is the term for a nose bleed?

Epistaxis

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Under what circumstances should someone with a nose bleed go to hospital?

if blood flows and doesn’t stop for 20 mins
the nosebleed occurred following a head injury
the bleeding lasts longer than 30 mins despite application of cold and pressure
the bleeding resulted from a severe blow that also caused dizziness/nausea
the nose looks crooked or displaced
the individual is elderly
the individual has high blood pressure
the individual is on blood-thinning medication

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How do you treat a patient presenting with a nose bleed?

Sit them leaning forward
Pinch nostrils
Breathe through mouth

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How long do you apply digital pressure for a nose bleed?

15 mins

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What is diabetes?

A metabolic disorder typified by chronic high blood sugar (hyperglycaemia)

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What is type 1 diabetes?

Patients are unable to produce any insulin. This is typically due to an autoimmune disease that destroys insulin-producing Beta cells in the pancreas

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What is type 2 diabetes?

Patients with relative insulin deficiency due to varying degrees of insulin resistance. It is the most common type of diabetes

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What are underlying causes of diabetes?

genetic factors
obesity
age (beta cell function declines with age)
ethnicity (south Asian/Afro-Caribbean origin)

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What is hypoglycaemia

Relative excess of insulin in the blood and falling blood glucose levels

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What are the three main causes of hypoglycaemia-associated autonomic failure?

previous episodes hypoglycaemia
strenuous exercise
sleep

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What are the symptoms of hypoglycaemia?

-swearing
- palpitations
- shaking
- hunger
- confusion
- odd/aggressive behaviour
- speech problems
- headache
- nausea

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What is hyperglycaemia?

Not enough insulin causing a high level of sugar

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What are causes of hyperglycaemia?

not taking a enough insulin
eating too much food
doing leas exercise than usual

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When do you take a patient who is presenting with hypoglycaemia to the hospital?

if they are elderly
low BMI
live alone
not diagnosed as diabetic
taking oral hypoglycaemic agents (mainly sulphonylureas: glibenclamide/glicazide)
blood glucose < 5mmol/L after treatment
treated with glucagon
signs of illness/infection

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What is the assessment for a diabetic patient?

baseline vitals
take patients glucose and ketone
consider ALS
drug administration
transport to hospital
alert hospital if needed

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What are ketones?

A chemical that is produced by the liver when it breaks down fat

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What happens when ketones build up in the body?

DIABETIC KETOACIDOSIS (DKA)

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What is DKA?

brought on by a lack of insulin
without insulin your body begins to break down fat in attempt to get the energy it needs
this can cause the body to go into shock and swelling if the brain

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What are normal blood ketone meter measurements?

Less than 0.6mmol/L

What are medium (ketosis) BHB?

Between 0.6 and 1.5 mmol/L

What is considered a high BHB?

Between 1.5 and 3 mmol/L

What level of BHB would indicate possible DKA?

Greater than 3.0 mmol/L

What is a normal blood sugar level?

4-10 mmol/L

What would the blood sugar be if someone who is hypoglycaemic?

Less than 4 mmol/L

What is the blood sugar measurement for someone with hyperglycaemia?

Over 10 mmol/L

Who does glucagon not work on?

People with liver damage/disease

What blood sugar level would indicate the consideration of ALS?

10-20 mmol/L

What blood sugar level would indicate a request for ALS?

+ 20 mmol/L

Who is glucagon not indicated for?

Hypoglycaemic non-diabetic paediatric patient

How would a patient who is hypoglycaemic present?

Pale and sweaty ALOC rapid onset (2-3hrs)

How would a patient who is hyperglycaemic to present?

Flushed Acetone breath ALOC slow onset (days)

What is a seizure?

An episode of abnormal electrical activity in the brain The patient can convulse which causes the patients body to shake rapidly and uncontrollably

What is a generalised tonic/clonic seizure?

Seizures associated with you jerking muscle movements

What is a partial (focal) seizure?

stare blankly into space, or experience automatisms (non-purposeful, repetitive movements such as lip smacking, blinking, grunting, gulping or shouting)

What is a petit mal (absence) seizure?

Staring off into space/ blank face

What is fever (febrile) convulsions?

Happens when a child has a fever

What narcotic typically causes medical emergency seizures?

ECSTASY MANDY MANDY MANDY

What is the first concern of a patient who is currently seizing?

Are they able to breathe properly? Are they protected from harm?

Causes of seizures?

- damage from previous cerebral infection - brain injury, brain trauma, lack of O2 during child birth - cerebral haemorrhage/ tumour - cryptogenic (cause unknown)

What is eclampsia?

A seizure that occurs during pregnancy 👶🏻🍼

Patient assessment of a seizure?

- what were they doing before - what movements exhibited - loss of bladder or bowl control - how long did it last for

What is status epilepticus

life threatening condition - more than 1 in five mins without returning to normal - seizure lasts more than 5 mins - can result in permanent neurological damage/respiratory failure/cardiac arrest

Diagnosis of anaphylaxis?

- AIRWAY: angioedema/ stridor - BREATHING: dyspnoea/wheeze - CIRCULATION: signs of shock - DISABILITY: collapse/ sense of impending doom EXPOSURE: hives/flushing/itching

What is angioedema?

Swelling of the deeper layers of the skin due to a build up in fluid

What is a bronchospasm?

Wheeze

What do you use to treat bronchospasm?

Salbutamol

What is hemodynamic compromise?

a condition or state in which a person's cardiovascular functions become unreliable, insufficient, or otherwise problematic due to an underlying condition, such as high blood pressure

What drug is administered to patients with mild allergic reaction?

Chlorphenamine 4mg PO

If a patient suffering from an allergic reaction also has a bronchospasm, what drug is administered before the chlorphenamine?

SALBUTAMOL 5mg NEB ⛽️

What are the dosages of chlorphenamine that can be administered for an allergic reaction?

6-11yrs 2 mg PO 12+ years 4 mg PO OR 1-6months 0.25mg/kg IM 6mths-6yrs 2.5 mg IM 6-12yrs 5 mg IM +12yrs 10 mg IM

What are the dosages of adrenaline that can be administered?

Under 6 months: 10mcg/kg IM 6mths-6yrs: 150mcg IM 6-12yrs: 300mcg IM +12: 500mcg IM

What is fowlers position?

headof bed is elevated 45-60 degrees Knees towards the chest used for mild resp. distress