medical emergencies Flashcards
What are normal ranges?
RR- 12-20 breaths per min
O2 saturation- over 95%, 88% in COPD
HR- 60-100bpm
Blood pressure- 110-140 systolic
Temperature- 36.1-38
Glucose- 4-7mmol/L
How do you manage a medical emergency?
DRABCDE
Danger
Response
If not breathing- CPR, call 999
Airway
Breathing
Circulation
Disability
What is adrenaline for?
Anaphylaxis
500mg IM
Repeated 5 min intervals if necessary
<6yrs 150mg
6-12yrs 300mg
>12 yrs 500mg
What is a beta2 bronchodilator inhaler for?
Eg salbutamol
Asthma attack
2 actuations inhaled
Spacer device and repeats if necessary
What is GTN spray for?
Angina/suspected heart attack
2 actuations sub lingually
May be repeated
What is dispersible aspirin for?
Suspected heart attack
300mg oral chewed
What is quick acting glucose for?
Hypoglycaemia (pt can swallow safely)

15-20g eg. 1.5-2 tubes of Glucogel
What is glucagon for?
Hypoglycaemia (eg. Unconscious)
1mg IM
<8 yrs (<25kg) 0.5mg
What is midazolam oromucosal solution for?
Prolonged convulsive seizures (>5mins)/repeated (>3 an hour)
Buccal, single dose 10mg
<5yrs 5mg
5-10yrs 7.5mg
What are causes of loss of consciousness?
Meds (opiates, benzodiazepines, alcohol, drugs, anaphylaxis, poisoning)
Cardiac (arrhythmia, MI, cardiac arrest, vasovagal, hypovolaemia, orthostatic hypotension)
Neuro (seizure, intracranial haemorrhage)
Chest (PE, hypoxia, aortic dissection)
Ab (sepsis, ruptured AAA, ectopic pregnancy)
Endocrine (hypo/hyperglycaemia, Addisonian crisis)
What is vasovagal syncope?
Most common
Overstimulation of vagus nerve +/- sympathetic tone loss
Posture
Provoking factors
Prodromal symptoms
Rapid recovery, headache, mild nausea
DRABCD Recovery position if unconscious, lie down and raise legs
What are red flag signs of syncope?
Loss of consciousness during exertion
Hx of heart disease
Family hx of heart disease/sudden death
New/unexplained breathlessness
>65yrs w/o prodromal symptoms
What are causes of seizures?
Epilepsy
Drug/alcohol intoxication/withdrawal
Intracranial infection
Metabolic disturbances
Intracranial lesion
How do you manage seizure?
Don’t put anything in mouth
DRABCD
Position, consider airway when post-ictal, recovery position?
Give oxygen
Check glucose and give if low
Consider buccal midazolam
What is sepsis?
Life threatening end organ dysfunction due to a dysregulated host immune response to infection
How might sepsis present?
Fever/hypothermia
Hypotension
Confusion/reduced consciousness
Signs of infection
Difficulty breathing
What are sepsis red flags?
New reduction in consciousness
BP less than 90 systolic
HR >130
RR >25
Needs O2 to keep above 92%
Non blanching rash
Mottled/cyanotic/ashen rash
Not passed urine in last 18hrs
Chemo in last 6 weeks
How do you manage sepsis?
DRABCD
Give oxygen
If BP low, lie down and raise legs
Check glucose and give if low
What is an adrenal crisis/Addisonian crisis?
Sudden lack of steroids in someone w underlying adrenal insufficiency
Cortisol increases blood glucose
Fight/flight
Enhances brains use of glucose
Increases availability of substances that repair tissues
What are causes of adrenal crisis?
Withdrawal of steroid therapy
Infection
Trauma
MI and cerebral infarction
Hypothermia
Surgery
Dehydration
Emotional distress
What are clinical features of Adrenal crisis?
Lethargy/malaise
Muscle pains
Fever
Ab pain
Diarrhoea/vomiting
Hypotension/syncope
Hypoglycaemia
Confusion/slurred speech
Vitiligo/darkening of palmar creases
How is adrenal crisis managed?
DRABCD
Consider recovery position
If low BP, lie down and raise legs
Check glucose and give if low
Hydrocortisone 100mg IM
What are causes of confusion?
Mental health- anxiety, psychosis
Metabolic- hypo/hyperglycaemia, electrolyte disturbances
Delirium- infection, pain, meds, dehydration, unfamiliar environment
Meds- alcohol, drugs, opiates, benzodiazepines, poisoning
Acute illness- stroke, MI, sepsis, CNS infection, adrenal crisis
What are symptoms of hypoglycaemia?
Hunger
Irritability
Headache
Altered/reduced consciousness
Difficulty speaking/slurred speech
Ataxia discoordination
Seizures
What are causes of hypoglycaemia?
Too little fuel
Too much insulin
Excess oral diabetes drugs/beta blockers, drug interactions
Alcohol induced hypoglycaemia
Sepsis
Adrenal insufficiency
How do you manage hypoglycaemia?
DRABCD
Give glucose if low
Give carbs
W increasing symptoms- oral gel
Consider glucagon IM
What is a stroke?
An interruption of blood flow to the brain
Due to clot/haemorrhage
How do you manage stroke?
DRABCD
Consider recovery position
Patient nil by mouth
Give O2
Check glucose, give if low
What are causes of difficulty breathing?
Cranial- panic attack, CNS lesion
Lungs- asthma, COPD, pneumothorax, pneumonia
CVS- PE, pulmonary oedema
Airway obstruction- choking, upper airway infection
Metabolic- poisoning, anaphylaxis, acidosis
What is anaphylaxis?
Extreme allergy
IgE mediated mast cell release of histamine
Reaction to allergen (food/drugs esp antibiotics/NSAIDs)
What are clinical features of anaphylaxis?
Stridor, tachypnoea, wheeze, cyanosis
Pallor, cool peripheries, tachycardia, hypotension
Anxiety, agitation, reduced LOC
Ab pain, D&V
Urticaria, oedema of lips and tongue
How do you manage anaphylaxis?
DRABCD
Give oxygen
Lie down and raise legs if low BP
Adrenaline IM (1:1000) 500mg
What are features of LA toxicity?
Tingling around the mouth
Sudden agitation, confusion
LOC, seizures
CVS collapse w arrhythmias
How do you manage LA toxicity?
DRABCD
Give O2
Lie down and raise legs if low BP
Stop injecting
What is asthma?
Increased airway reactivity
Atopic v non atopic
Various triggers
Acute attacks- wheezing, SOB, tight chest, coughing
How do you manage an asthma attack?
DRABCD
Give O2
Salbutamol inhaler w so we
Up to 10 puffs
What are signs of choking?
Evident distress
Red face
Inability to talk
Wheezing/noisy breathing
Coughing
Watery eyes
Holding throat
Panicking
How do you manage choking?
DRA
Effective cough- encourage to cough
Ineffective cough- 5 back blows, 5 ab thrusts
If unconscious- start CPR
Paeds- if conscious- alternate 5 back blows, 5 chest thrusts
If unconscious- open airways and rescue breaths- basic paeds life support
What are causes of chest pain?
Vascular- PE, aortic dissection
Lung- pneumothorax, pleural effusion, pneumonia
Heart- angina/ischaemia, myocarditis, pericarditis
Muscles of chest wall- chest injury/strain
Gastritis/reflux
What are symptoms of angina/MI symptoms?
Anxiety/fear
Pallor
Chest pain +/- radiation
N&V
Sweating/clammy
How would you manage angina/MI?
DRABCD
Give O2
GTN spray 1-2 sublingual
Aspirin 300mg crushed
