Medical Emergencies Flashcards by Robyn Harvey

What are the signs and symptoms of an MI?

Crushing central chest pain, radiating to left arm, neck and jaw

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What is the ABCDE for a MI?

A - usually patent but potential for some sounds such as wheezing
B - increased RR, decreased SpO2, rapid
C - HR increases and decreases, BP increases and decreases, CRT increases, pallor
D - ACPVU: Alert but anxious
E - clammy, grey in colour, sweaty, nauseous, potential evidence of cyanosis (blue)

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What is the management of a MI?

O2 15ltrs/min
administer 2 uffs of GTN (400 micrograms) sublingually and repeat after 3 mins, if pain remains. if symptoms alleviate then this was an agina attack
If pain still remains or worsens then 999 and adminsiter 300mg dispersible aspirin (chewed and swallowed ASAP), as this is likely an MI
Monitor and reassure pt until ambulance arrives

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What are the 2 types of epileptic seizures?

Absence
Tonic-clonic

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What are the signs and symptoms of absence seizures?

Blank stare
Zoning out
Usually short lasting

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What are the 4 stages of a seizure?

Aura stage
Tonic stage
Clonic stage
Postictal stage

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What are the signs and symtoms of the aura stage in a seizure?

Hallucination
Dizzy
Numbness
Distorted emotions
Confusion

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What are the signs and symptoms of the tonic stage of a seizure?

Stiff body
Incontinence
Epileptic cry
Back arched

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What are the signs and symptoms of the clonic stage of seizure?

Frothy saliva
blinking eyes
Jerky movements

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What are the signs and symptoms of the postictal stage of a seizure?

Weak limbs
Exhaustion
Sleepy

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What is the ABCDE of tonic clonic seizures

A - difficult to assess but often patent
B- increased RR but hard to assess, decreased SpO2 (difficult to get accurate reading, pasues in breathing (apnoea)
C - increased HR, hypertension
D - ACVPU - unresponsive
E - convulsions, flushed complexion, rigidity, urinary incontinence, frothing from mouth

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What is the management of someone having a seizure?

move objects that may harm a patient during seizure
do not attempt to restrain patient or put anything in their mouth
time the seizure, if > 5 mins then classed as a “status epilepticus”. Administer 10mg midazolam buccally and phone for ambulance (also if seizures are intermittently occuring)
administer O2, 15 ltrs/min through non re-brearher mask
Continuously monitor until help arrives

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What is the midazolam dosage for a 6-11 month old?

2.5mg

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What is the midazolam dosage for a 1-4 yr old?

5mg

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What is the midazolam dosage for a 5-9 yr old?

7.5mg

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What is the midazolam dosage for 10 yrs +?

10mg

What does blood glucose level need to be less than to be considered a hypo?

4mmols

What is the ABCDE of a hypo?

A - patent
B - increased RR, decreased SpO2
C - tachycardia, hypertension, pallor, clammy
D - ACVPU: confused, blood glucose <4mmols
E - Slurred speech, shaking aggressive, appears drunk

What is the management of a hypo?

O2 15 ltrs/min if patient allows
if patient conscious administer 10-20g oral glucose (repeat every 10-15 mins if required)
if patient unconscious then adminsiter 1mg glucagon intramuscularly
Give O2 as before and call 999
When patient regains consciousness adminsiter more oral gluocse to replenish their reserves

What are the 2 types of asthma?

Acute severe
Life threatening

What is the ABCDE of acute severe asthma?

A - wheezing on expiration
B - increased RR, decreased SpO2, rapid shallow breaths
C - Increased HR, hypertension, pallor
D - ACVPU - alert but anxious
E - Pale, distressed, use of accessory muscles for breathing, inability to complete sentences in one breath

What is the ABCDE of life threatening asthma?

A - severe wheeze on expiration
B - decreased RR and effort, severely decreased SpO2, laboured breathing
C - decreased HR, cyanosis in lips/nose (blue)
D - ACVPU - confused due to hypoxia
E - grey/blue in colour, exhausted, sleepy

What is the management of an asthma attack?

salbutamol inhaler: 1 puff of reliever inhaler every 30-60 secs, up to 10 puffs using spacer device - REMEMBER PRIME
call 999 if no improvement
15ltrs/min O2 through non re-breather mask
repeat salbutamol after 10 mins if no improvement
plenty pf reassurance as patient will be distressed
sit patient upright and lean forward to open accessory muscles and aid with breathing

What are the 2 different types of airway obstruction?

partial
complete

What is the management of a choking patient?

- encourage patient to cough - if there is an ineffecrive cough advise patient to stand up and lean them forward, supporting them across their front with one arm and position yourself at the side of patient - Give 5 hard back blows between the shoulder bladed with the flat of your hand, checking between each blow for signs of change - If back blows are unsuccessful, perform 5 abdominal thrusts by making a fist under the point of the patient's ribcage at the diaphragm muscle, locate the landmark by finding the bellybutton with thumb of one hand and creating a fist, then roll up into position (between umbillicus and xiphisternum). Grab fist with other hand and pull inwards and upwards (J shape) check between each thrust for signs of change - phone ambulance early if no sign of recovery from patient - repeat the process until 1 of 2 things happen: the item is dislodged or the patient collapses - If patient collapses ensure abulance is updated and begin CPR

What type of patient is excempt from abdominal thrusts when choking?

pregnant bariatric patients if you cant physically wrap arms around them - if attempting, place hands higher up from sternum if possible

What are the signs and symptoms of someone having an anaphylactic shock?

* sudden onset and rapid progression of ABC problems * Usually skin and/or mucosal changes

What is the ABCDE of anaphylaxis?

A - stridor, wheezing B - increased RR, decreased SpO2, rapid shallow breaths C - drastically decreased BP due to vasodilation, increased CRT, tachycardia, bounding pulse D - ACVPU: A but with impending sense of doom E - flushing, urticarial rash, angioedema of lips/nose/tongue, stomach cramps, urinary incontinence, bowel incontinence, vomiting, nausea

What is the management of someone having an anaphylactic shock?

- phone 999 - remove the source if known - try to line the patient in supine position to restore BP - administer 1:1000 adrenaline IM 0.5mg recommended in the anterolateral thigh - O2 - 15 ltrs/min via non re-breather mask - If patient has no auto injector then use this first before using adrenaline on emergency kit - repeat after 5 mins if required

what is the adrenaline dosage for 6mths-5yrs?

0.15mg

What is the adrenaline dosage for 6-11yrs?

0.3mg

What is the adrenaline dosage for 12+yrs?

0.5mg

What is an acute paracetamol overdose?

extensive ingestion over a period of <1hr in the context of self harm

what is a staggered paracetamol overdose?

excessive ingestion over >1hr in the context of treating pain (therapeutic overdose) can also occur with intent of self harm

what is the red flag dosage of paracetamol a patient can take in 24 hrs for you to be concerned?

≥75mg/kg in any 24 hr period

What is the maximum recommended daily dose of paracetamol in a normal adult?

How do you calculate the dose in mg/kg in 24 hrs of paracetamol?

total dose in 24 hrs in mg/patients weight in kg

What would you have been informed a patient has overdosed on paracetamol?

consult TOXBASE online or phone national poisons information service if these are unavailable, contact local A&E directly