Other Emergency Scenarios Flashcards
What are the different types of head injuries?
Focal injury - due to direct mechanical force
Cerebral contusion ‘bruise of brain’
Cerebral laceration: ‘pia/arachnoid torn’
Epidural haemorrhage
Subdural haemorrhage
Where is the bleed in an extradural haemorrhage?
Between skull and dura
What artery bleeds in an extradural haemorrhage?
Middle meningeal artery
What is the CT appearance of extradural haemorrhage?
Lemon
doesn’t cross suture lines
Where is the bleed in a subdural haemorrhage?
Between dura and arachnoid
Which artery bleeds in subdural haemorrhage?
Bridging veins
Who gets subdural haemorrhage?
Old people and alcoholics
What is the CT appearance of subdural haemorrhage?
Crescent
What are the criteria for immediate head CT?
GCS <13 on initial assessment GCS <15 2 hours in hosp Suspected skull fracture Basal skull fracture Post-traumatic seizure Focal neurological deficit >1 episode of vomiting
What are the criteria for CT <9 hours?
On warfarin LOC or amnesia since injury AND 65+ years Hx of bleeding disorder Dangerous mechanism of injury >30 mins retrograde amnesia of events immediately before injury
How is cerebral perfusion pressure done?
MAP-ICP
What level of MAP should be maintained in ?head injury?
WHY?
Brain’s normal regulation of CPP is impaired in head injury
Critical that it doesn’t fall below 80
How do you Increase MAP?
Fluids
Inotropes
How do you decrease ICP?
Fluid restriction
Elevate head to 30 degrees
What investigations should be done in head injuries?
BM
ABG
GCS
ETOL, FBC, U+E, clotting, G+S
Imaging: CT head and C spine
Which head injury patients need urgent neurosurgery?
Extradural, intracerebral or posterior fossa bleeds
Dural bleeds with midline shift
Which head injury patients need ICU?
Ventilation
Monitor ICP
Neurosurgery
What are the GCS for EYES?
4: open spontaneously
3: to speech
2: to pain
1: no response
GCS for VERBAL
(5)
5: orientated in time, person and place
4: confused
3: inappropriate words
2: incomprehensible sound
1: no response
CGS for Motor
6: obeys command
5: localises to pain
4: withdraws from pain
3: abnormal flexion
2: abnormal extension
1: no response
What is the presentation of increased ICP?
Headache - nocturnal, starts when waking
worse on coughing/moving
Altered mental tate
EYES: pupil changes, papilloedema, unilateral ptosis or CN3/6 palsy
What are the causes of Increased ICP?
tumour
trauma
ischaemia
infection
Venous sinus thrombosis
Obstructive / communicating hydrocephalus
What is the management of increased ICP?
Avoid pyrexia Manage seizures CSF drainage IV catheter elevate head of bed Analgesia and sedation Mannitol Hyperventilation
What is the criteria for sepsis?
> 38 or <30
HR over 90
RR over 20
WBC >12 of <4
What is the management of sepsis?
Sepsis 6 in: IV fluid ABx O2
Out:
Urine
Lactate
Blood cultures
What is the criteria for an AKI?
1 <0.5ml/kg/hr for 6 hours
2 <0.5ml/kg/hr for 12 hours
3 <0.3ml/kg/hr for 12 hours or anuria
What is the management of AKI?
Supportive
Fluids
Medication review - stop ACEi, NSAID, diuretics and hold aspirin
What is the treatment of hyperkalaemia?
STABILISE heart: calcium gluconate
Insulin
calcium resonium
What is the criteria for DKA?
Hyperglycaemia
Metabolic acidosis
Ketonuria
What is the management of DKA?
INSULIN: 0.1units/kg/hr
When BM <15 add dextrose
FLUID:
1L STAT
4L over next 12 hours
What is the criteria for hypoglycaemia?
BM <3
What is the management of hypoglycaemia?
If can swallow: GlucoJuice
Or 15-20g of carbs
If unconscious:
IV glucose
Glucagon 1mg IM
What is the management of HSS?
aggressive fluids
?Insulin
What are the causes of T1RF?
Pneumonia/consolidation
Fibrosis
PE
Emphysema
What is the management of T1RF?
O2
What is the cause of T2RF?
Ventilation neuromuscular - MG/DMD/NMD Central brainstem: overdoe, trauma Obesity Trauma
What is the mx of T2RF?
Bi-pap
NIV
What is the criteria for moderate/severe/lifethreatening asthma?
Mod: PEFT 50-75%
Normal speech
RR <25
HR<110
Severe: PEFR 33-50%
can’t complete sentences
RR >25, pulse >110
Life threatening:
PEFR <33%
O2 <92%
Silent chest, cyanosed
Exhaustion
What is the management of acute asthma attack?
A-E OSHIMT O2 Salbutamol 5mg NEB Hydrocortisone 100mg IV Ipratropium: 500 micrograms NEB Mg2So4 Theophylline
What is the management of acute COPD exacerbation?
A-E OSHITA O2 Salbutamol Hydrocortisone 200mg OR prednisolone 30mg Ipratropium Abx
What is the management of Anaphylaxis?
A-E
Adrenaline 1:1000 0.5ml
Hydrocortisone 200mg
Chlorphenamine 10mg
What is the management of pulmonary oedema?
O2
Diuretics - Furosemide
Morphine
Blood pressure meds
What is the management of post-op bleeding?
A-E IV accesses: G+S Fluids, read operation notes Senior review MHP back to theatre
What is the presentation of major GI haemorrhage?
Haematemesis
Melaena
Pain
Collapse
What are the causes of major GI haemorrhage?
VARICES Oesophagitis Cancer M-W tear Gastric cancer Gastritis Ulcer
What is the treatment of GI bleed?
A-E Blatchford score G+S, FBC, LFT, U+E, clotting O-ve transfusion Varices: terlipressin + endoscopy OGD
Surgery
What are the symptoms of bacterial meningitis?
headache fever N+V Photophobia Drowsiness Seizures Neck stiffness Purpuric rash
What is the appearance of CSF in bacterial meningitis?
Cloudy
decreased glucose
protein
What is the management of meningitis?
IM Benzypenicillin in community
ABX: cefotaxime
Dexamethasone
What is the management of STEMI/NSTEMI?
STEMI: Morphine Antiemetic Nitrates Aspirin 300mg PCI
NSTEMI: BROMANCE Bblocker Reassurance O2 Morphine Aspirin 300mg Nitrates Ticagrelor Enox (fondaparinoux)
What is the management of Status?
Lorazepam IV
If still fitting after 5 mins, repeat
Then phenytoin 15-20mg/kg/IV
Propofol and ventilate
What is the management of ruptured AAA?
MHP
Surgery
What is the management of Aortic dissection?
A: surgical
B: conservative
bed rest
blood pressure reduction)
