Medical Emergencies Flashcards
Faints and collapse - definition
sudden loss of postural tone
consciousness affected is faint
Faints and collapse - cause
Neurogenic syncope - seizures/epilepsy, stroke, sub-arachnoid haemorrhage, stroke does NOT cause this
Cardiac syncope - vaso vagal
Neurogenic syncope features
History of problems
Loss of sphincter tone
Tongue biting
Prodrome//aura
Cardiogenic syncope
Arrhythmia - bradycardia and tachycardia
Valvular pathology - aortic stenosis/mitral stenosis
Structural heart disease - hypertrophic cardiomyopathy
Pulmonary embolus
Primary electrophysiological abnormalities
Vasovagal syncope
What is it
3 features
Common
Posture, provoking, prodrome - more likely when upright
Rapid recovery - ongoing headache//nausea
Overstimulation of vagus nerve and or sympathetic tone
Assessment and treatment of faints
Assess airway, breathing and circulation - lay supine and elevate legs
If unpleasant stimulus obvious then assume simple faint
ED assessment if not
Hypoglycaemia
Clinical features
Symptoms
Lower than normal blood sugar Different thresholds Aggressive Headache Hungry Difficulty speaking Seizures
Hypoglycaemia causes
Too little fuel Alcohol induced Sepsis Excess insulin Excess oral diabetes drugs Insulin secreting pancreatic tumour Adrenal insufficiency /hypopituitarism
Hypoglycaemia treatment
Sugary drink Carbohydrate in addition Oral gel with increasing symptoms IV if unconscious - glucose IM glucagon
Allergic reaction
Hypersensitivity to an allergen
Anaphylaxis
Extreme allergy
IgE mediated
Anaphylaxis - pathophysiology
Symptoms
Antigen binds to IgE antibodies on mast cells in connective tissue
Mast cells degranulate and release inflammatory mediators
Common symptoms of allergic reactions - urticaria, sob, oedema
Bronchial constriction and vasodilation
Shock is an allergic reaction with respiratory symptoms and circulatory collapse
Anaphylaxis - clinical features
Respiratory distress - stridor, tachycardia, cyanosis
Circulatory - pallor, cool peripheries, tachycardia, hypotension
CNS - anxiety, agitation, reduced LOC
GI - abdominal pain, D+V
Skin - urticaria
Anaphylaxis - tx
Remove cause Adrenaline IM - 0..5mg Oxygen Assess ABC Nebulised β agonist e.g salbutamol 999 to ED
Asthma
symptoms
treatment
Bronchocontriction
Wheezing
Shortness of breath
Try and prevent
Inhaled β agonists - salbutamol
Steroids if needed
Ischaemic heart disease - angina/MI
Features
Complicated pathogenesis
CAD
Risk factors
Clinical manifestations variable
Stable angina
pain on exercise, relieved by rest/gtn
Unstable angina
There when resting and on exertion
worsening pain
MI -
symptoms, ECG changes, biochemical markers such as high troponin
ST elevated MI is most serious as indicates complete occlusion of an artery
Angina/MI symptoms
Chest pain - radiation Nausea vomiting Collapse sweating Pallor Anxiety
Angina/MI tx
What do nitrates do?
GTN spray Aspirin Oxygen - only if sats <94% - may cause heart to want more O2 999 ED Primary PCI MONA - morphine/oxygen/nitrates/aspirin
Nitrates dilate coronary arteries
Adrenal sufficiency
and causes
Lack of cortisol production
Addison’s disease - autoimmune
Primary adrenal insufficiency - impairment of adrenal gland
Congenital adrenal hyperplasia
Adenoma of adrenal gland
Sheehan’s syndrome - postpartum haemorrhage
Adrenal/addisonian crisis - clinical features
Lethargy, fever Abdominal pain Severe D&V Hypotension Hypoglycaemia Syncope Confusion Psychosis and slurred speech
Adrenal crisis
Tx
Avoid
Modify steroid regime
Have back up plan
Seizures
Not always epileptic
Several types
Difficult to diagnose
Classic seizure dramatic but rarely problematic
Types of seizures - consciousness
Partial seizure - may have LOC
Generalised - all have LOC - absence, tonic-clonic, myoclonic, tonic, atonic)
Causes of seizure
Drugs
Alcohol
Fatigue
Intracranial lesion
Seizures
Protect patient from injury
Most come to no harm
Classic tonic clonic seizure rarely more than 1-2mins
Assess ABCDE if no progress
