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Medical emergencies Flashcards

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USMLE® Step 1 flashcards
1
Q

Faints and collapse of unknown cause

A

Collapse - sudden loss of postural tone
Faint - transient loss of consciousness
Common
Divided into several groups

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2
Q

NICE assessment for faints or collapse of unknown cause: record details about

A

Circumstances of event
Pt’s posture immediately before LoC
Prodromal symptoms
Appearance
Presence/ absence of movement during event
Any tongue-biting
Injury occurring during event
Presence / absence of confusion during recovery period
Weakness down one side during recovery period

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3
Q

Causes of faints and collapse

A

Neurogenic Syncope
Cardiogenic Syncope
Neurocardiogenic Syncope including “Simple Faint”

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4
Q

Neurogenic syncope causes

A

Seizures / Epilepsy
Sub-Arachnoid Haemoarrhage
Not stroke

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5
Q

Features of neurogenic syncope

A 
History of Neurogenic problems: Epilepsy
Loss of sphincter tone 
Tongue Biting
Prodrome
Clinical features
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6
Q

Cardiogenic syncope causes

A

Arrhythmias: Bradycardia, Tachycardia
Valvular Pathology: Aortic Stenosis, Mitral Stenosis
Structural Heart Disease: Hypertrophic Cardiomyopathy (HCM)
Pulmonary Embolus
Primary Electrophysiological Abnormalities:
-Brugada Syndrome
-Long QT Syndrome

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7
Q

Vasovagal syncope - neurocardiogenic syncope

A

Commonest type of faint
3 P’s: Posture Provoking Prodrome
-prolonged standing, or similar episodes that have been prevented by lying down)
-pain or medical procedure
-sweating or feeling warm/ hot before TLoC
Transient LOC
Rapid recovery, often ongoing headache, mild nausea
Overstimulation of vagus nerve +/- sympathetic tone loss

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8
Q

Diagnose situational syncope when

A

There are no features that suggest alternative diagnosis AND
Synope is clearly and consistently provoked by straining during micturition (usually whilst standing) or by coughing or swallowing

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9
Q

NICE red flag signs - collapse or faint

A

Refer within 24 hrs for specialist CV assessment if TLoC and any of following:
-ECG abnormality
-heart failure
-TLoC during exertion
-family history of sudden cardiac death in people aged <40yrs and/ or inherited cardiac condition
-heart murmur
Consider referring anyone >65yrs who has experienced TLoC without prodromal symptoms

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10
Q

Assessment and treatment of faints

A

Assess the Airway, Breathing and Circulation
-lay flat, elevate legs (if tolerated), recovery position if necessary
If occurs after an unpleasant stimulus (e.g. LA injection) and recovery rapid - likely ‘simple’ faint
If any doubt - emergency department assessment

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11
Q

Hypoglycaemia

A

Lower than normal blood sugar
-normal blood sugar (BM) ~ 4-7
Differing thresholds for symptoms

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12
Q

Causes of hypoglycaemia

A 
Too little fuel
Too much insulin (e.g. diabetics)
Excess oral diabetes drugs
Alcohol induced hypoglycemia 
Sepsis
Insulin-secreting pancreatic tumor
Adrenal insufficiency / hypopituitarism
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13
Q

Symptoms of hypoglycaemia

A 
Hunger
Irritability
Headache
Altered / reduced LOC
Difficulty speaking, slurred speech
Ataxia dyscoordination, (drunkenness)
Seizures
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14
Q

Treatment of hypoglycaemia

A

Sugar!
If symptoms minimal - carbohydrate (e.g. sandwich, sugary drink)
With increasing symptoms - oral gel e.g. “hypostop”
IV if significant symptoms (reduced LOC / seizures)
Hospital assessment focused on treatment and identifying cause

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15
Q

Anaphylaxis

A

Extreme allergy
IgE mediated (anaphylactoid reactions clinically similar, but not IgE mediated)
Caused by reaction to allergen (food / drugs esp. antibiotics / NSAIDS)

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16
Q

Pathophysiology of anaphylaxis

A

Antigen binds to IgE antibodies on mast cells based in CT throughout body
Degranulation of mast cells with release of inflammatory mediators
Inflammatory mediators cause common symptoms of allergic reactions, such as itching, rash, and swelling
Can also cause bronchial constriction, vasodilation
Anaphylactic shock is allergic reaction with respiratory symptoms and circulatory collapse

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17
Q

Clinical features of anaphylaxis

A

Respiratory distress – stridor, tachypnoea, wheeze, cyanosis
Circulatory signs - pallor, cool peripheries, tachycardia, hypotension
CNS - anxiety, agitation, reduced LOC
GI - abdominal pain, D&V
Skin - urticaria

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18
Q

Treatment of anaphylaxis

A 
Remove / stop cause (e.g. LA injection)
Assess Airway, Breathing and Circulation
Intramuscular adrenaline (0.5mg)
Oxygen
Nebulised ß agonist (salbutamol)
999 to ED
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19
Q

Asthma

A

Increased airway reactivity
Atopic / non - atopic (atopy - triad of atopic eczema, allergic rhinitis (hay fever) and asthma)
Various triggers
Acute attacks - wheezing, SOB, ‘tight chest’, coughing

20
Q

Treatment of asthma

A

Try and prevent - avoid precipitants
Inhaled B-agonists - salbutamol, terbutaline (ventolin / bricanyl) – Patients own or Nebulised
Steroids if indicated - reduce airway inflammation
British Thoracic Society guidelines for hospital management
Others - magnesium, IV aminophylline, ventilation

21
Q

Ischaemic heart disease

A 
Angina/ MI
Common in Western world 
Coronary artery disease
Complicated pathogenesis
Risk factors (fixed &amp; modifiable)
Clinical manifestations variable
22
Q

Preventative measures for ischaemic heart disease

A 
BP control
Metabolic control
Stop smoking 
Ca xP control
Infection screnning
23
Q

Pharmacological measures for ischaemic heart disease

A 
ACE inhibitors
Statins
Aspiring
PPAR-gamma agonists
Anti-oxidants
24
Q

Mechanical measures for ischaemic heart disease

A

By-pass surgery
Coronary angioplasty
Endarterectomy

25
Q

measures for acute coronary event

A

Thrombolysis

Coronary angioplasty

26
Q

‘Stable’ angina symptoms

A
  • pain on exercise

- relieved by rest +/- GTN

27
Q

‘Unstable’ angina symptoms

A

Worsening pain esp. at rest

> frequency of episodes

28
Q

MI symptoms

A

Chest pain – sensation of pressure, tightness or squeezing in centre of chest
Pain in other parts of the body – can feel as if pain is travelling from chest to arms, jaw, neck, back and abdomen
-usually left arm is affected, but can affect both arms
feeling lightheaded or dizzy
sweating
SOB
Feeling sick (nausea) or being sick (vomiting)
Overwhelming sense of anxiety (similar to having a panic attack)
Coughing or wheezing
Collapse
Pallor

29
Q

Signs of MI

A

Symptoms
ECG changes
Biochemical markers

30
Q

Angina/ MI treatment

A 
GTN spray / tablet
Aspirin 300mg (chew / dispersible)
Oxygen (if indicated)
999 to ED
Primary PCI (STH) for AMI that meet criteria
MONA
31
Q

MONA

A

Morphine
Oxygen
Nitrates (GTN)
Aspirin

32
Q

Adrenal insufficiency

A

Inadequate production of steroid hormones
Primarily cortisol
May have impaired aldosterone production
Several causes

33
Q

Causes of primary adrenal insufficiency

A 
Primary adrenal insufficiency - impairment of the adrenal glands.
Idiopathic
Autoimmune - Addison's disease
Congenital adrenal hyperplasia 
Adenoma (tumor) of the adrenal gland
34
Q

Causes of secondary adrenal insuffiency

A

Secondary adrenal insufficiency - impairment of the pituitary gland or hypothalamus
Pituitary microadenoma
Hypothalamic tumour
Sheehan’s syndrome (postpartum pituitary necrosis)

35
Q

Clinical features of adrenal insufficiency

A

Weakness, tiredness, dizziness, hypotension esp. orthostatic
Hypoglycemia, dehydration, weight loss, and disorientation
Myalgia, nausea, vomiting, and diarrhoea
Hyperkalaemia & hyponatraemia
Palmar crease tanning
Vitiligo

36
Q

Clinical features of an adrenal crisis

A 
Lethargy, fever
Abdominal pain (back / legs also)
Severe D&amp;V (+/- dehydration)
Hypotension
Hypoglycaemia
Syncope
Confusion, psychosis, slurred speech
37
Q

Treatment of adrenal crisis

A

Avoid!
Modification of steroid regime before examination / treatment
If signs of crisis - 999
Will need hospital assessment - steroids, fluids and observation

38
Q

Seizures

A

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

39
Q

Partial seizures

A

May have LOC (simple/ complex)

40
Q

Generalised seizure

A

All have LOC

  • absence
  • tonic-clonic
  • myoclonic
  • tonic
  • atonic
41
Q

Causes of seizures

A

Epilepsy (including drug non-compliance or interactions)
Fatigue
Intracranial lesion
Drug and alcohol intoxication / withdrawal
Intracranial infection - encephalitis or meningitis
Metabolic disturbances - hypoglycaemia, hyponatraemia or hypoxia
Multiple sclerosis

42
Q

Treatment of seizures

A

Protect patient from injury
Most come to no harm at all, post-ictal phase may be distressing and prolonged
Classic tonic-clonic seizure rarely more than 1-2 mins
If prolonged - assess Airway, Breathing and Circulation and call 999

43
Q

Supraventricular tachycardia (SVT)

A

abnormally fast heart rhythm arising from improper electrical activity in the upper part of the heart

44
Q

Ventricular tachycardia (VT)

A

Pulse of more than 100 beats per minute with at least three irregular heartbeats in a row
-wide QRS complex

45
Q

Pulmonary embolus (PE)

A

More common than we think…
Massive PE can manifest as collapse
More likely SOB +/- chest pain
Many risk factors

Medical Emergencies (1 decks)

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