Medical Emergency Flashcards
What does AED stand for?
Automated external defibrillation (or defibrillator)
In treatment of anaphylaxis, what is the dose of intramuscular adrenaline for a child aged 10 years?
300 micrograms IM (0.3ml)
In treatment of adult anaphylaxis, what is the dose of intramuscular adrenaline?
500 micrograms IM (0.5ml)
If a patient has stridor, what medical emergency are you immediately considering?
Anaphylaxis
What is the acceptable level of SPO2 for an adult?
95% and above
What are the four factors to be checked when assessing someone’s circulation?
- Manual pulse
- Blood pressure
- Capillary refill
- Colour
How would you manually record peripheral pulse?
This is your radial pulse, you would press down on the wrist in line with thumbline.
How would you manually record central pulse?
This is your carotid pulse, where your carotid artery sits in the neck
If someone has passed out and you check their pupils with a pen torch, what would pinpricked pupils suggest has happened?
Indication that patient has taken opiates such as morphine or heroin
If someone has passed out and you check their pupils with a pen torch, what would large saucer like pupils suggest has happened?
Patient has taken amphetamines or a concoction of other drugs
If there is a difference in size of pupils in each eye, why is this very concerning?
It would indicate a change in pressure on one part of the brain
What does SBAR stand for and when is it used?
S- situation
B- background
A- assessment
R- recommendation
Used when phoning for an ambulance or handing patient over to the ambulance crew
What does NEWS stand for and why is it used?
N- national
E- early
W- warning
S- score
Used in hospital - more in depth ABCDE check
A NEWS score of 7 or more indicates what?
High escalation required, urgent or emergency response required
A patient complains that they have recently experienced decreased hearing in their right ear.
What cranial nerve is suspected to be damaged?
Vestibulocochlear nerve (VIII)
A patient complains of right-sided face paralysis.
What cranial nerve is suspected to be damaged?
Facial nerve (VII)
A patient complains that they can no longer blink with their right eye.
What cranial nerve is suspected to be damaged?
Trigeminal nerve (V)
A patient presents with drooping of their upper eyelid (ptosis).
What cranial nerve is suspected to be damaged?
Occulomotor nerve (CN III)
A patient presents with pupil unresponsiveness to light.
What cranial nerve is suspected to be damaged?
Optic nerve (CN II)
What test would you use for CN I?
Ask patient if they can smell a certain substance
What test would you use for CN II?
- Ask patient to read something
- ask patient to look straight and try to identify someone else’s fingers in peripheral vision
How would you test CN III?
Ask patient to follow moving finger with eyes whilst keeping their head still
How would you test CN V?
Use cotton wool roll to test facial sensation in all three segments.
How would you test CN VII?
Ask patient to show different facial expressions
What is meant by cyanosis?
When your skin, lips or nails turn blue due to a lack of oxygen in your blood
In an epileptic seizure, what would signal a patient is in the tonic phase?
Rigidity and cyanosis
In an epileptic seizure, what would signal a patient is in the clonic phase?
- jerking movements of limbs
- tongue may be bitten
- frothing at mouth
- incontinence
What position should epileptic patients be put in once clonic phase has stooped in seizure?
Recovery position
What checks should be made when a patient has an epileptic seizure?
Check:
- slow heart rate (this can cause seizure)
- blood glucose levels (hypoglycaemia can cause seizure)
What medication and dosage should be administered to an adult patient experiencing an epileptic seizure and how?
Midazolam 10mg via buccal route
What medication and dosage should be administered to a child 1-5 years old experiencing an epileptic seizure?
5mg midazolam
What medication and dosage should be administered to a child 5-10 years old experiencing an epileptic seizure?
7.5mg midazolam
What medication and dosage should be administered to a child >10 years old experiencing an epileptic seizure?
10mg midazolam
What are symptoms of a hypoglycaemic attack?
- shaking/trembling
- slurred speech
- vagueness
- sweating
- double vision
- confusion
- unconsciousness
What are the options for treatment of hypoglycaemic attack?
Depending on the circumstances and state of patient:
- 10-20g glucose
- 4x glucose tablets
- buccal glucose gel
- glucagon 1mg IM
What are the ABCDE signs of anaphylaxis?
A- stridor, wheezing
B- increased RR, decreased SPO2, rapid breaths
C- drastically lowered BP, increased CRT, tachycardia, bounding pulse
D- A (with impending sense of doom)
E- flushing, urticarial rash, angiodema of lips, nose and tongue., stomach cramps, vomiting etc.
What are the 5 management steps for anaphylaxis?
- Phone 999 and state anaphylaxis
- Remove the source (if known)
- Lay patient in supine position to restore BP
- Administer 1:1000 adrenaline IM. 0.5mg.
- O2 delivery 15 l/min via non-rebreather mask
What is the dosage of adrenaline to be administered IM in anaphylaxis management for children 6 months-5 years old?
0.15mg
What is the dosage of adrenaline to be administered IM in anaphylaxis management for children 6-11 years old?
0.3mg
What is the dosage of adrenaline to be administered IM in anaphylaxis management for children 12-17 years old?
0.5mg
Why is adrenaline used to manage anaphylaxis?
Because it is a vasoconstrictor, this means that it squeezes the peripheral vessels to ensure that blood and fluid is forced back towards the heart.
Give ABCDE signs and symptoms of an acute severe asthma attack.
A- wheezing on expiration
B- increased RR. Decreased SpO2, paid shallow breaths
C- increased HR, hypertension, pallor
D- ACVPU: alert but anxious, blood glucose N/A
E- pale, distressed, use of accessory muscles for breathing, inability to complete sentences in one breath.
Give ABCDE signs and symptoms of a life threatening asthma attack.
A- severe wheezing on expiration
B- decreased RR. Severely Decreased SpO2, laboured breaths
C- decreased HR, cyanosis in lips/nose
D- ACVPU: confused due to hypoxia
E- grey/blue in colour, exhausted, sleepy
What is the management of an asthma attack for an adult?
- 15 litres/min O2 non rebreather mask
- administer patients own bronchodilator (2 puffs)
- administer salbutamol through large volume spacer (4 puffs)
- call 999 if no improvement after 5 minutes
- reassure patient
- sit patient upright and lean forward to open accessory muscles and aid with breathing
Give ABCDE signs and symptoms for an epileptic tonic-clonic seizure.
A-difficult to assess but often patent
B- increased RR but hard to assess, decreased SpO2, pauses in breathing (apnoea)
C- increased HR, hypertension
D- ACVPU: unresponsive, blood glucose N/A
E- convulsions, flushed complexion, rigidity, urinary incontinence, frothing and mouth
What are the signs and symptoms of an absence seizure?
- blank stare
- zoning out
- usually short lasting
What is the management of a tonic-clonic seizure (adult)?
- move objects that may harm patient during seizure
- do not attempt to restrain it put anything in their mouth
- time the seizure, if >5 mins then classes as status epilepticus. Administer 10mg midazolam buccaly and phone for ambulance.
- administer O2 15 litres through non-rebreather mask
What dosage of midazolam is given to a child 6-11 months of age having a tonic-clonic seizure?
2.5mg
What dosage of midazolam is given to a child 1-4 years of age having a tonic-clonic seizure?
5mg
What dosage of midazolam is given to a child 5-9 years of age having a tonic-clonic seizure?
7.5mg
What dosage of midazolam is given to a child 10-17 of age having a tonic-clonic seizure?
10mg
Give ABCDE signs and symptoms of hypoglycaemic attack.
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 hypoglycaemic attack?
- O2 15 litres if patient allows
- if conscious = 10-20g oral glucose (repeat every 10-15 mins)
- if unconscious = 1mg glucagon IM, CALL 999
- if patient regains consciousness, give more oral glucose.
Give the ABCDE signs and symptoms of angina and MI.
A- patent, but potential for some wheezing sounds
B- increased RR, decreased SpO2, rapid
C- HR can increase or decrease, BP can increase or decrease, CRT increases, pallor.
D- ACVPU: A but anxious, blood glucose N/A
E- clammy, grey in colour, sweaty, nauseous, potential evidence of cyanosis
What is the management of angina attack/ MI?
- O2 15 litres/min
- administer 2 puffs of GTN spray (400 micro grams) sublingually (repeat after 3 mins)
- if symptoms alleviate this was ANGINA ATTACK
- if pain remains CALL 999, administer 300mg aspirin tablet
- this is likely MI
Give the ABCDE signs and symptoms of anaphylaxis.
A- stridor, wheezing
B- increased RR, decreased SpO2, rapid shallow breaths
C- drastically decreased BP, tachycardia, increased CRT, bounding pulse
D- ACVPU: A but with impending sense of doom
E- flushing, urticarial rash, angiodema, stomach cramps, urinary incontinence, bowel incontinence, vomiting, nausea
What is the management of anaphylaxis (adult)?
- phone 999
- remove source of infection if known
- lie patient supine to restore BP
- administer 1:1000 adrenaline IM 0.5mg (1mg/1ml) in anterolateral thigh
- 15 litres O2 through non-rebreather mask
- repeat every 5 mins till ambulance arrives
What is the dose of adrenaline for management of anaphylaxis in a 6month-5 year old child?
0.15mg
What is the dose of adrenaline for management of anaphylaxis in a 6-11 year old child?
0.3mg
What is the dose of adrenaline for management of anaphylaxis in a 12 + year old child?
0.5mg
What are the 4 main features of tonic stage of seizure?
- Back arched
- Incontinence
- Stiff body
- Epileptic cry
What are the 3 features of the clonic stage of siezures?
- Jerking
- Frothing saliva
- Blinking eyes
What is normal respiratory rate?
12-20 breaths per minute
What is the acceptable limit for an adults BP?
120/70
What is considered a low BP?
90/60
What is considred a high BP?
140/90
