Medical Emergencies

Question 1

Faints and collapse - definition

Answer 1

sudden loss of postural tone

consciousness affected is faint

Question 2

Faints and collapse - cause

Answer 2

Neurogenic syncope - seizures/epilepsy, stroke, sub-arachnoid haemorrhage, stroke does NOT cause this
Cardiac syncope - vaso vagal

Question 3

Neurogenic syncope features

Answer 3

History of problems
Loss of sphincter tone
Tongue biting
Prodrome//aura

Question 4

Cardiogenic syncope

Answer 4

Arrhythmia - bradycardia and tachycardia
Valvular pathology - aortic stenosis/mitral stenosis
Structural heart disease - hypertrophic cardiomyopathy
Pulmonary embolus
Primary electrophysiological abnormalities

Question 5

Vasovagal syncope

What is it

3 features

Answer 5

Common

Posture, provoking, prodrome - more likely when upright
Rapid recovery - ongoing headache//nausea
Overstimulation of vagus nerve and or sympathetic tone

Question 6

Assessment and treatment of faints

Answer 6

Assess airway, breathing and circulation - lay supine and elevate legs
If unpleasant stimulus obvious then assume simple faint
ED assessment if not

Question 7

Hypoglycaemia
Clinical features
Symptoms

Answer 7

Lower than normal blood sugar
Different thresholds 
Aggressive
Headache 
Hungry 
Difficulty speaking 
Seizures

Question 8

Hypoglycaemia causes

Answer 8

Too little fuel 
Alcohol induced
Sepsis
Excess insulin 
Excess oral diabetes drugs
Insulin secreting pancreatic tumour 
Adrenal insufficiency /hypopituitarism

Question 9

Hypoglycaemia treatment

Answer 9

Sugary drink 
Carbohydrate in addition 
Oral gel with increasing symptoms 
IV if unconscious - glucose
IM glucagon

Question 10

Allergic reaction

Answer 10

Hypersensitivity to an allergen

Question 11

Anaphylaxis

Answer 11

Extreme allergy

IgE mediated

Question 12

Anaphylaxis - pathophysiology

Symptoms

Answer 12

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

Question 13

Anaphylaxis - clinical features

Answer 13

Respiratory distress - stridor, tachycardia, cyanosis

Circulatory - pallor, cool peripheries, tachycardia, hypotension

CNS - anxiety, agitation, reduced LOC

GI - abdominal pain, D+V
Skin - urticaria

Question 14

Anaphylaxis - tx

Answer 14

Remove cause 
Adrenaline IM - 0..5mg 
Oxygen 
Assess ABC
Nebulised β agonist e.g salbutamol 
999 to ED

Question 15

Asthma

symptoms

treatment

Answer 15

Bronchocontriction
Wheezing
Shortness of breath

Try and prevent
Inhaled β agonists - salbutamol
Steroids if needed

Question 16

Ischaemic heart disease - angina/MI

Features

Answer 16

Complicated pathogenesis
CAD
Risk factors
Clinical manifestations variable

Question 17

Stable angina

Answer 17

pain on exercise, relieved by rest/gtn

Question 18

Unstable angina

Answer 18

There when resting and on exertion

worsening pain

Question 19

MI -

Answer 19

symptoms, ECG changes, biochemical markers such as high troponin
ST elevated MI is most serious as indicates complete occlusion of an artery

Question 20

Angina/MI symptoms

Answer 20

Chest pain - radiation 
Nausea vomiting
Collapse
sweating
Pallor
Anxiety

Question 21

Angina/MI tx

What do nitrates do?

Answer 21

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

Question 22

Adrenal sufficiency

and causes

Answer 22

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

Question 23

Adrenal/addisonian crisis - clinical features

Answer 23

Lethargy, fever
Abdominal pain 
Severe D&V
Hypotension 
Hypoglycaemia 
Syncope 
Confusion 
Psychosis and slurred speech

Question 24

Adrenal crisis

Tx

Answer 24

Avoid

Modify steroid regime

Have back up plan

Question 25

Seizures

Answer 25

Not always epileptic
Several types
Difficult to diagnose
Classic seizure dramatic but rarely problematic

Question 26

Types of seizures - consciousness

Answer 26

Partial seizure - may have LOC

Generalised - all have LOC - absence, tonic-clonic, myoclonic, tonic, atonic)

Question 27

Causes of seizure

Answer 27

Drugs
Alcohol
Fatigue
Intracranial lesion

Question 28

Seizures

Answer 28

Protect patient from injury
Most come to no harm
Classic tonic clonic seizure rarely more than 1-2mins
Assess ABCDE if no progress