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medical emergencies Flashcards

1
Q

What are normal ranges?

A

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

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2
Q

How do you manage a medical emergency?

A

DRABCDE

Danger
Response
If not breathing- CPR, call 999
Airway
Breathing
Circulation
Disability

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3
Q

What is adrenaline for?

A

Anaphylaxis

500mg IM
Repeated 5 min intervals if necessary

<6yrs 150mg
6-12yrs 300mg
>12 yrs 500mg

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4
Q

What is a beta2 bronchodilator inhaler for?

A

Eg salbutamol

Asthma attack

2 actuations inhaled
Spacer device and repeats if necessary

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5
Q

What is GTN spray for?

A

Angina/suspected heart attack

2 actuations sub lingually
May be repeated

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6
Q

What is dispersible aspirin for?

A

Suspected heart attack

300mg oral chewed

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7
Q

What is quick acting glucose for?

A

Hypoglycaemia (pt can swallow safely)

15-20g eg. 1.5-2 tubes of Glucogel

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8
Q

What is glucagon for?

A

Hypoglycaemia (eg. Unconscious)

1mg IM

<8 yrs (<25kg) 0.5mg

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9
Q

What is midazolam oromucosal solution for?

A

Prolonged convulsive seizures (>5mins)/repeated (>3 an hour)

Buccal, single dose 10mg

<5yrs 5mg
5-10yrs 7.5mg

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10
Q

What are causes of loss of consciousness?

A

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)

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11
Q

What is vasovagal syncope?

A

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

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12
Q

What are red flag signs of syncope?

A

Loss of consciousness during exertion
Hx of heart disease
Family hx of heart disease/sudden death
New/unexplained breathlessness
>65yrs w/o prodromal symptoms

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13
Q

What are causes of seizures?

A

Epilepsy
Drug/alcohol intoxication/withdrawal
Intracranial infection
Metabolic disturbances
Intracranial lesion

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14
Q

How do you manage seizure?

A

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

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15
Q

What is sepsis?

A

Life threatening end organ dysfunction due to a dysregulated host immune response to infection

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16
Q

How might sepsis present?

A

Fever/hypothermia
Hypotension
Confusion/reduced consciousness
Signs of infection
Difficulty breathing

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17
Q

What are sepsis red flags?

A

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

18
Q

How do you manage sepsis?

A

DRABCD
Give oxygen
If BP low, lie down and raise legs
Check glucose and give if low

19
Q

What is an adrenal crisis/Addisonian crisis?

A

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

20
Q

What are causes of adrenal crisis?

A

Withdrawal of steroid therapy
Infection
Trauma
MI and cerebral infarction
Hypothermia
Surgery
Dehydration
Emotional distress

21
Q

What are clinical features of Adrenal crisis?

A

Lethargy/malaise
Muscle pains
Fever
Ab pain
Diarrhoea/vomiting
Hypotension/syncope
Hypoglycaemia
Confusion/slurred speech
Vitiligo/darkening of palmar creases

22
Q

How is adrenal crisis managed?

A

DRABCD
Consider recovery position
If low BP, lie down and raise legs
Check glucose and give if low

Hydrocortisone 100mg IM

23
Q

What are causes of confusion?

A

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

24
Q

What are symptoms of hypoglycaemia?

A

Hunger
Irritability
Headache
Altered/reduced consciousness
Difficulty speaking/slurred speech
Ataxia discoordination
Seizures

25
Q

What are causes of hypoglycaemia?

A

Too little fuel
Too much insulin
Excess oral diabetes drugs/beta blockers, drug interactions
Alcohol induced hypoglycaemia
Sepsis
Adrenal insufficiency

26
Q

How do you manage hypoglycaemia?

A

DRABCD
Give glucose if low
Give carbs
W increasing symptoms- oral gel
Consider glucagon IM

27
Q

What is a stroke?

A

An interruption of blood flow to the brain
Due to clot/haemorrhage

28
Q

How do you manage stroke?

A

DRABCD

Consider recovery position
Patient nil by mouth
Give O2
Check glucose, give if low

29
Q

What are causes of difficulty breathing?

A

Cranial- panic attack, CNS lesion
Lungs- asthma, COPD, pneumothorax, pneumonia
CVS- PE, pulmonary oedema
Airway obstruction- choking, upper airway infection
Metabolic- poisoning, anaphylaxis, acidosis

30
Q

What is anaphylaxis?

A

Extreme allergy
IgE mediated mast cell release of histamine
Reaction to allergen (food/drugs esp antibiotics/NSAIDs)

31
Q

What are clinical features of anaphylaxis?

A

Stridor, tachypnoea, wheeze, cyanosis
Pallor, cool peripheries, tachycardia, hypotension
Anxiety, agitation, reduced LOC
Ab pain, D&V
Urticaria, oedema of lips and tongue

32
Q

How do you manage anaphylaxis?

A

DRABCD
Give oxygen
Lie down and raise legs if low BP

Adrenaline IM (1:1000) 500mg

33
Q

What are features of LA toxicity?

A

Tingling around the mouth
Sudden agitation, confusion
LOC, seizures
CVS collapse w arrhythmias

34
Q

How do you manage LA toxicity?

A

DRABCD
Give O2
Lie down and raise legs if low BP
Stop injecting

35
Q

What is asthma?

A

Increased airway reactivity
Atopic v non atopic
Various triggers
Acute attacks- wheezing, SOB, tight chest, coughing

36
Q

How do you manage an asthma attack?

A

DRABCD
Give O2
Salbutamol inhaler w so we
Up to 10 puffs

37
Q

What are signs of choking?

A

Evident distress
Red face
Inability to talk
Wheezing/noisy breathing
Coughing
Watery eyes
Holding throat
Panicking

38
Q

How do you manage choking?

A

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

39
Q

What are causes of chest pain?

A

Vascular- PE, aortic dissection
Lung- pneumothorax, pleural effusion, pneumonia
Heart- angina/ischaemia, myocarditis, pericarditis
Muscles of chest wall- chest injury/strain
Gastritis/reflux

40
Q

What are symptoms of angina/MI symptoms?

A

Anxiety/fear
Pallor
Chest pain +/- radiation
N&V
Sweating/clammy

41
Q

How would you manage angina/MI?

A

DRABCD

Give O2
GTN spray 1-2 sublingual
Aspirin 300mg crushed

ihd (19 decks)

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