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BDS4 BAMS (all years) > Medical Emergencies > Flashcards

Medical Emergencies Flashcards

1
Q

What is the ABCDE approach? How do you use it?

A

Airway
Breathing
Circulation
Disability
Exposure

You assess the pt in this order and treat as you come across problems. Done in this order as it is the order of what is most life-threatening

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2
Q

With airway, what is it are you looking for/assessing?

A

Airway obstruction

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3
Q

Untreated airway obstruction can lead to what?

A

Hypoxia and risks damage to brain, kidneys, heart, cardiac arrest and death

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4
Q

Causes of airway obstruction?

A
  • Loss of consciousness
  • Infection
  • Swelling
  • Inflammation
  • Sedation
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5
Q

How do you recognise an airway obstruction?

A
  • Paradoxical chest and abdominal movements (see-saw respirations) and use of the accessory muscles of respiration
  • Can the pt talk?
  • Listen to the sound of breathing
    o Complete airway obstruction = no breath sounds at the mouth or nose
    o Partial obstruction = air entry is diminished and often noisy
  • Look – central cyanosis late sign of airway obstruction
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6
Q

Tx of an airway obstruction?

A

-airway opening manoeuvres (head tily, chin lift, jaw thrust) - this will solve it 90% of the time but need to hold position until airway secured
-use suction if required
-insert an oropharyngeal airway
-give O2 high conc.

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7
Q

How do you measure oropharyngeal airway?

A

o Measure from angle of mandible to vertical height of incisors to size
o Male normally an orange and female green

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8
Q

What can cause breathing probs?

A
  • Change in demand
  • Infection
  • Inflammation
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9
Q

How to recognise breathing prob?

A
  • Rate
    o Normal rate = 12-20 breaths per min
    o >25 per min – marker of illness
  • Look and feel for signs of respiratory distress
    o Sweating
    o Central cyanosis
    o Use of accessory muscles respiration
    o Abdominal breathing
    o Feel patients back but distract and say doing pulse
  • Listen
    o Rattling noises – airway secretions
    o Stridor or wheeze suggests partial airway obstruction
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10
Q

Tx of breathing probs?

A
  • O2 (even in COPD patients)
  • Posture into tripod position to open intercostal muscles
  • Bronchodilators
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11
Q

Causes of circulatory probs?

A
  • Arrhythmia
  • ACS
  • Heart Failure
  • Loss of fluid (blood)
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12
Q

How to recognise circulation prob?

A
  • Check pulse
    o Check on wrist (if can feel here then BP is adequate for organ perfusion)
    o If not regular then have an arrhythmia
    o If can’t feel on wrist then go to radial pulse on arm. Then move to neck – if can’t feel pulse here then BP <50 and lose organ perfusion at 45
  • Capillary refill
    o Press on nail bed for 5 secs with finger at heart level or above
    o It should re-perfuse within 2 seconds
    o If it doesn’t, suggests poor peripheral perfusion
  • Limb temperature – feel pts hands – are they cool or warm?
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13
Q

Tx of circulatory problem?

A
  • Treat cause
  • Raise legs
  • Apply pressure
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14
Q

What can cause disability? (unresponsive/unconsciouss)

A
  • Drugs (can be new prescribed medicines etc)
  • Brain injury
  • Hypoglycaemia
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15
Q

How to recognise disability?

A
  • Use AVPU method to made rapid initial assessment:
    o Alert
    o responds to Vocal stimuli
    o responds to Painful stimuli (supra-orbital pressure)
    o or Unresponsive to all stimuli
  • Can check motor responses – squeeze my hand etc.
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16
Q

Tx of disability?

A

-optimise ABC
-not much we can do

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17
Q

What conc./volume of O2 do we always give and via what?

A
  • You always give 15l of 100% O2 via a non-rebreathing mask
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18
Q

How many O2 cylinders should you have in your practise?

A

2

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19
Q

How often should the O2 cylinders be checked?

A

Daily

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20
Q

Key signs of anaphylaxis?

A
  • Key signs:
    o Marked upper airway (laryngeal) oedema and bronchospasm, causing stridor and wheezing
    o Tachycardia (heart rate >110 per minute) and increased respiratory rate
  • Sudden onset of airway and/or breathing and/or circulation problems
  • Also looking for changes in the skin – usually a rash
  • Abdominal pain, vomiting, diarrhoea, and a sense of impending doom
  • Flushing, but pallor might also occur
  • Patients may also display symptoms of minor allergy
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21
Q

ABCDE assessment would show what in anaphylaxis?

A
  • A – swelling (will sound hoarse), stridor
  • B – tachycardia (>120bpm) broncho-constricted (more than 12-20 a min), wheezing (bronchospasm)
  • C – increased HR (as struggling to perfuse organs), hypotension and hypovolaemic (as vasculature becomes leaky and get swelling)
  • D – loss of consciousness
  • E – rash (note: 20% of people won’t get a rash), swelling of lips, tongue etc
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22
Q

Tx for anaphylaxis?

A
  • Call 999 – must get pt to hospital
  • Any airway involvement then give adrenaline (swelling of tongue, lips, hoarseness etc.)
  • Breathing – if get peripheral cyanosis (nailbeds blue) then give adrenaline
  • If you aren’t sure, guidance would rather you gave one inappropriate dose than an appropriate dose too late
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23
Q

What will happen if you give an inappropriate dose of adrenaline?

A

will get tremor, HR increases and get anxious but won’t be fatal

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24
Q

Describe how you would administer adrenaline including the adult dose.

A
  • Get pt lying with legs above head and give IM adrenaline (get better response doing this) into leg
  • Dose for adult= 0.5mg 1:1000 adrenaline
  • Administration:
    o Select site – anterolateral aspect of the thigh (middle 1/3rd)
    o Put tension on muscle
    o Insert needle and aspirate (advance 1mm if +ve aspiration), then inject adrenaline
    o Pull need halfway out, release tension on muscle then remove needle fully
    o ‘Z-tract technique’ – MUST DO THIS
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25
Q

Why must you use Z-tract technique when injecting any drug?

A

If pull needle straight out then lose 50-70% of the drug

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26
Q

If pt doesn’t respond to adrenaline, what do you do?

A

If it has been 5mins and pt still unwell then repeat adrenaline every 5mins til ambulance arrives (but vary the injection site)

27
Q

You should never have an anaphylactic pt standing, why?

A

lots of cardiac arrests happen in anaphylaxis due to postural changes – they can’t tolerate it while in anaphylaxis

28
Q

What is the mode of action of adrenaline?

A
  • Non-selective adrenergic agonist
  • Peripheral vasoconstrictor and central vasodilator – increased HR and bronchodilator and reduces histamine release
29
Q

What is the conc of adrenaline?

A

1mg/ml (1:1000)

30
Q

What are the key signs of angina/MI?

A
  • Progressive onset of severe, crushing pain in the centre and across the front of chest; the pain might radiate to the shoulders and down the arms (more commonly the left), into the neck and jaw or through the back
31
Q

Other symptoms of angina/MI?

A
  • Shortness of breath
  • Increased respiratory rate
  • Skin becomes pale and clammy
  • Nausea and vomiting are common
  • Pulse might be weak and blood pressure might fall
32
Q

What would an ABCDE assessment show in a pt with angina/MI?

A
  • A - Talking
  • B - Increased
  • C - Increased
  • D - Alert
  • E - Pale, clammy, central chest pain
33
Q

With stable angina, how much of coronary artery is blocked?

A

Up to 1/3rds (more than this and will get unstable angina)

34
Q

With unstable anginga/MI get bigger blockage and what?

A

rupture of plaques which can cause inflammation and spasm or coronary arteries also

35
Q

Outline the tx for unstable angina

A

o Give oxygen (100%, 15L/minute)
o GTN spray
 400 micrograms per metred dose
 Want to use 2 puffs sublingually – symptomatic relief analgesia
 Repeat after 3 minutes if chest pain remains
 If patient does not respond to 2x GTN treatment, then the priority is to transfer the patient to hospital as an emergency
* Call for ambulance

36
Q

Outline tx for an MI.

A
  • same as with unstable angina and
  • aspirin 300 milligrams crushed or chewed and put under tongue
     Needs to be absorbed in the mouth so do not let the patient have water for at least 10 minutes – improves everything
37
Q

Mode of action of GTN spray?

A

-venous vasodilator
-get less return to the heart so less demand and less pain

38
Q

Mode of action of aspirin?

A

inhibits platelet prostaglandin synthesis

slows down platelet aggregation and clot formation

39
Q

ABCDE assessmne of an asthmatic pt would show what?

A
  • A - Difficult to complete sentences
  • B - Increased rate with wheeze
  • C - Increased rate
  • D - Alert
  • E - Tripods
40
Q

Describe the difference between a mild/moderate, severe and life-threatening asthma attack (signs and symptoms)

A

mild/moderate = normal HR, normal respiratry rate, chest tightness

severe = audible wheeze without stethoscope, HR increased (above 115), increaed RR (>25/min)

life threatening = hr<40, rr<8, barley gasping for breath, exhaustion, confusion and decreased conscious level

41
Q

Tx for mild/moderate asthma attack?

A

-100% O2 15l
-salbutamol 2 puffs (100mg per puff)

42
Q

How should a pt take salbutamol inhaler?

A

1 puff into mouth and hold breath for 10secs

43
Q

Tx for severe asthma attack?

A

Put 10puffs into spacer device and get them to breath for no more than 20secs

NOTE: takes 6-7 puffer devices to overdose so dose not limited

If no response in 5mins straight to hosptial/ambulance

44
Q

Why do you use a puffer device in a severe asthma attack?

A

Because respiratory rate is above 20 and at this rate you can’t hold breath for 10secs

45
Q

tx for life-threatening asthma attack?

A

-intubate and ventilate
-BVM
-oropharyngeal airway

Careful using BVM when airway constricted - risk of aspiration - light squeezing

46
Q

What is the volume of the BVM vs lungs?

A

1.5l vs 500ml lung capactiy

47
Q

Normal respiratory and HR?

A

RR=12-16 breaths/min
HR = 60-100bpm

48
Q

Choking signs and symptoms?

A
  • Patients may cough and splutter
  • Patient may complain of breathing difficulty
  • Patient may develop ‘paradoxical’ chest or abdominal movements
  • Patient may become cyanosed and lose consciousness
49
Q

Managemet of choking?

A
  • Ask if they are choking?
  • Assess severity
  • If MILD:
    o They will have an airway obstruction with an effective cough
    o Encourage them to cough
    o Continue to check for deterioration to ineffective cough or until obstruction relieved (if cannot relieve obstruction and patient is getting worse proceed to severe)
  • If SEVERE:
    o They will have an airway obstruction with an ineffective cough
    o If they are CONSCIOUS:
     Give 5 back blows followed by 5 abdominal thrusts (repeat)
    o If UNCONSCIOUS:
     Start BLS
    o Call an ambulance and transfer patient to hospital as an emergency
50
Q

Key signs and symptoms of hypoglycaemia ?

A
  • Aggression and confusion
  • Sweating
  • Tachycardia (HR >110 per min)

Other symptoms:
* Shaking and trembling
* Difficulty in concentration/vagueness
* Slurring of speech
* Headache
* Fitting
* Unconsciousness

51
Q

Key signs and symptoms of hypoglycaemia ?

A
  • Aggression and confusion
  • Sweating
  • Tachycardia (HR >110 per min)

Other symptoms:
* Shaking and trembling
* Difficulty in concentration/vagueness
* Slurring of speech
* Headache
* Fitting
* Unconsciousness

52
Q

ABCDE assessment for a pt with hypoglycaemia would show what?

A
  • A - Initially talking
  • B - Initially increased rate
  • C - Initially increased rate
  • D - Initially alert
  • E - Irritable, confused, pale

note: will probs have diabetes diagnosis obvs

53
Q

Tx of hypoglycaemic pt that is conscious?

A
  • Get sugar into them
    o Glucose – preference is gel over sweets or drinks but give whatever they will take
    o Supposed to eat 3x glucose tablets (20g of glucose) – however they are hard to chew and don’t dissolve easily and dry out the mouth so people tend not to want to take them
    o Repeat this if necessary after 10-15 minutes
54
Q

Tx of a hypoglycaemic pt who is unconsciouss?

A

-100% O2 administration
-Administer glucagon injection (1mg IM injection - use full cartridge)
-once regain consciousness must get glucose into them

55
Q

Why is it important to get glucose into someone once they regain consciouness after an episode of hypoglycaemia?

A

Because the initial dose of glucagon will have used up all of their stores - cannot administer it again
Will initially get well again but can quikcly become unwel again if don’t replenish stores of glucose

56
Q

Key signs and symptoms of seizures?

A

Key Signs:
* Sudden loss of consciousness, patient may become rigid, fall, might give a cry and become cyanosed (tonic phase)
* Jerking movements of the limbs; the tongue might be bitten (clonic phase)
Symptoms Include:
* Brief warning of ‘aura’
* Frothing from the mouth and urinary incontinence
* Febrile seizures are most common to come across – usually in children or people with covid but adults can have them too
* Lots of different types of seizure – alcoholic, trauma to head, epilepsy

57
Q

ABCDE assessment of a seizure would show what?

A
  • A - Compromised
  • B – Can go either way, some hold breath, some breath normally, some breath short sharp breaths
  • C – can have blue lips, central cyanosis
  • D - Unresponsive
  • E - Seizure activity, incontinence
58
Q

Tx of a pt having a seizure?

A
  • Do not try to restrain convulsive movements
  • Ensure safe environment and ensure patient is not at risk from injury
  • Secure patient’s airway if possible
  • Administer 100% Oxygen (Flow rate 15L/min)
  • Majority of seizures start and stop in under 2 minutes
  • If repeated or prolonged (over 5 minutes), give Midazolam 10 milligrams via the buccal mucosa
  • After convulsive movements have subsided, place the patient in the recovery position and check the airway. Do not send the patient home until they are fully recovered
59
Q

Effects of giving midazolam?

A
  • Going to cause sedation – lose airway tone, can interfere with respiration and can cause problems with BP so need to manage all of these things
60
Q

Would you ever reverse midazolam with flumazenil in a seizure scenario?

A

no

61
Q

When would you call an ambulance for a seizure?

A
  • If seizures are prolonged (last for 5 minutes or longer), recur in quick succession, if it was the first episode of epilepsy for the patient, the convulsion was atypical, injury occurred or there is difficulty monitoring the patient, call for an ambulance
62
Q

Key signs and symptoms of syncope?

A

Key Signs:
* Patient feels faint, dizzy, light-headed
* Slow pulse rate
* Loss of consciousness
Symptoms include:
* Pallor or sweating
* Nausea or vomiting

63
Q

ABCDE assessment of syncope would show what?

A
  • A - Compromised
  • B - Reduced rate
  • C - Reduced rate and pressure
  • D - Unresponsive
  • E - Pale, clammy
64
Q

Tx of syncope ?

A
  • Assess the patient
  • Lay patient flat and, if patient is not breathless, raise patient’s feet. Loosen any tight clothing around the neck
  • Administer 100% Oxygen – flow rate 15L/min until consciousness regained

BDS4 BAMS (all years) (2 decks)

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