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CP3 Crit Care > Other Emergency Scenarios > Flashcards

Other Emergency Scenarios Flashcards

1
Q

What are the different types of head injuries?

A

Focal injury - due to direct mechanical force

Cerebral contusion ‘bruise of brain’

Cerebral laceration: ‘pia/arachnoid torn’

Epidural haemorrhage

Subdural haemorrhage

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2
Q

Where is the bleed in an extradural haemorrhage?

A

Between skull and dura

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3
Q

What artery bleeds in an extradural haemorrhage?

A

Middle meningeal artery

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4
Q

What is the CT appearance of extradural haemorrhage?

A

Lemon

doesn’t cross suture lines

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5
Q

Where is the bleed in a subdural haemorrhage?

A

Between dura and arachnoid

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6
Q

Which artery bleeds in subdural haemorrhage?

A

Bridging veins

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7
Q

Who gets subdural haemorrhage?

A

Old people and alcoholics

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8
Q

What is the CT appearance of subdural haemorrhage?

A

Crescent

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9
Q

What are the criteria for immediate head CT?

A 
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
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10
Q

What are the criteria for CT <9 hours?

A 
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
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11
Q

How is cerebral perfusion pressure done?

A

MAP-ICP

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12
Q

What level of MAP should be maintained in ?head injury?

WHY?

A

Brain’s normal regulation of CPP is impaired in head injury

Critical that it doesn’t fall below 80

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13
Q

How do you Increase MAP?

A

Fluids

Inotropes

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14
Q

How do you decrease ICP?

A

Fluid restriction

Elevate head to 30 degrees

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15
Q

What investigations should be done in head injuries?

A

BM
ABG
GCS

ETOL, FBC, U+E, clotting, G+S

Imaging: CT head and C spine

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16
Q

Which head injury patients need urgent neurosurgery?

A

Extradural, intracerebral or posterior fossa bleeds

Dural bleeds with midline shift

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17
Q

Which head injury patients need ICU?

A

Ventilation
Monitor ICP
Neurosurgery

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18
Q

What are the GCS for EYES?

A

4: open spontaneously
3: to speech
2: to pain
1: no response

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19
Q

GCS for VERBAL

A

(5)
5: orientated in time, person and place
4: confused
3: inappropriate words
2: incomprehensible sound
1: no response

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20
Q

CGS for Motor

A

6: obeys command
5: localises to pain
4: withdraws from pain
3: abnormal flexion
2: abnormal extension
1: no response

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21
Q

What is the presentation of increased ICP?

A

Headache - nocturnal, starts when waking
worse on coughing/moving

Altered mental tate

EYES: pupil changes, papilloedema, unilateral ptosis or CN3/6 palsy

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22
Q

What are the causes of Increased ICP?

A

tumour
trauma
ischaemia
infection

Venous sinus thrombosis

Obstructive / communicating hydrocephalus

23
Q

What is the management of increased ICP?

A 
Avoid pyrexia
Manage seizures
CSF drainage
IV catheter
elevate head of bed 
Analgesia and sedation
Mannitol
Hyperventilation
24
Q

What is the criteria for sepsis?

A

> 38 or <30
HR over 90
RR over 20
WBC >12 of <4

25
What is the management of sepsis?
``` Sepsis 6 in: IV fluid ABx O2 ``` Out: Urine Lactate Blood cultures
26
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
27
What is the management of AKI?
Supportive Fluids Medication review - stop ACEi, NSAID, diuretics and hold aspirin
28
What is the treatment of hyperkalaemia?
STABILISE heart: calcium gluconate Insulin calcium resonium
29
What is the criteria for DKA?
Hyperglycaemia Metabolic acidosis Ketonuria
30
What is the management of DKA?
INSULIN: 0.1units/kg/hr When BM <15 add dextrose FLUID: 1L STAT 4L over next 12 hours
31
What is the criteria for hypoglycaemia?
BM <3
32
What is the management of hypoglycaemia?
If can swallow: GlucoJuice Or 15-20g of carbs If unconscious: IV glucose Glucagon 1mg IM
33
What is the management of HSS?
aggressive fluids | ?Insulin
34
What are the causes of T1RF?
Pneumonia/consolidation Fibrosis PE Emphysema
35
What is the management of T1RF?
O2
36
What is the cause of T2RF?
``` Ventilation neuromuscular - MG/DMD/NMD Central brainstem: overdoe, trauma Obesity Trauma ```
37
What is the mx of T2RF?
Bi-pap | NIV
38
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
39
What is the management of acute asthma attack?
``` A-E OSHIMT O2 Salbutamol 5mg NEB Hydrocortisone 100mg IV Ipratropium: 500 micrograms NEB Mg2So4 Theophylline ```
40
What is the management of acute COPD exacerbation?
``` A-E OSHITA O2 Salbutamol Hydrocortisone 200mg OR prednisolone 30mg Ipratropium Abx ```
41
What is the management of Anaphylaxis?
A-E Adrenaline 1:1000 0.5ml Hydrocortisone 200mg Chlorphenamine 10mg
42
What is the management of pulmonary oedema?
O2 Diuretics - Furosemide Morphine Blood pressure meds
43
What is the management of post-op bleeding?
``` A-E IV accesses: G+S Fluids, read operation notes Senior review MHP back to theatre ```
44
What is the presentation of major GI haemorrhage?
Haematemesis Melaena Pain Collapse
45
What are the causes of major GI haemorrhage?
``` VARICES Oesophagitis Cancer M-W tear Gastric cancer Gastritis Ulcer ```
46
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
47
What are the symptoms of bacterial meningitis?
``` headache fever N+V Photophobia Drowsiness Seizures Neck stiffness Purpuric rash ```
48
What is the appearance of CSF in bacterial meningitis?
Cloudy decreased glucose protein
49
What is the management of meningitis?
IM Benzypenicillin in community ABX: cefotaxime Dexamethasone
50
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) ```
51
What is the management of Status?
Lorazepam IV If still fitting after 5 mins, repeat Then phenytoin 15-20mg/kg/IV Propofol and ventilate
52
What is the management of ruptured AAA?
MHP | Surgery
53
What is the management of Aortic dissection?
A: surgical B: conservative bed rest blood pressure reduction)

CP3 Crit Care (11 decks)

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