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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
Q

What is the management of sepsis?

A 
Sepsis 6 
in:
IV fluid 
ABx
O2

Out:
Urine
Lactate
Blood cultures

26
Q

What is the criteria for an AKI?

A

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
Q

What is the management of AKI?

A

Supportive
Fluids
Medication review - stop ACEi, NSAID, diuretics and hold aspirin

28
Q

What is the treatment of hyperkalaemia?

A

STABILISE heart: calcium gluconate

Insulin
calcium resonium

29
Q

What is the criteria for DKA?

A

Hyperglycaemia
Metabolic acidosis
Ketonuria

30
Q

What is the management of DKA?

A

INSULIN: 0.1units/kg/hr
When BM <15 add dextrose

FLUID:
1L STAT
4L over next 12 hours

31
Q

What is the criteria for hypoglycaemia?

A

BM <3

32
Q

What is the management of hypoglycaemia?

A

If can swallow: GlucoJuice
Or 15-20g of carbs

If unconscious:
IV glucose
Glucagon 1mg IM

33
Q

What is the management of HSS?

A

aggressive fluids

?Insulin

34
Q

What are the causes of T1RF?

A

Pneumonia/consolidation
Fibrosis
PE
Emphysema

35
Q

What is the management of T1RF?

A

O2

36
Q

What is the cause of T2RF?

A 
Ventilation 
neuromuscular - MG/DMD/NMD
Central brainstem: overdoe, trauma
Obesity 
Trauma
37
Q

What is the mx of T2RF?

A

Bi-pap

NIV

38
Q

What is the criteria for moderate/severe/lifethreatening asthma?

A

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
Q

What is the management of acute asthma attack?

A 
A-E
OSHIMT 
O2
Salbutamol 5mg NEB 
Hydrocortisone 100mg IV
Ipratropium: 500 micrograms NEB
Mg2So4 
Theophylline
40
Q

What is the management of acute COPD exacerbation?

A 
A-E
OSHITA
O2
Salbutamol 
Hydrocortisone 200mg OR prednisolone 30mg
Ipratropium 
Abx
41
Q

What is the management of Anaphylaxis?

A

A-E
Adrenaline 1:1000 0.5ml
Hydrocortisone 200mg
Chlorphenamine 10mg

42
Q

What is the management of pulmonary oedema?

A

O2
Diuretics - Furosemide
Morphine
Blood pressure meds

43
Q

What is the management of post-op bleeding?

A 
A-E
IV accesses: G+S
Fluids, read operation notes
Senior review
MHP
back to theatre
44
Q

What is the presentation of major GI haemorrhage?

A

Haematemesis
Melaena
Pain
Collapse

45
Q

What are the causes of major GI haemorrhage?

A 
VARICES 
Oesophagitis
Cancer
M-W tear
Gastric cancer
Gastritis
Ulcer
46
Q

What is the treatment of GI bleed?

A 
A-E
Blatchford score
G+S, FBC, LFT, U+E, clotting 
O-ve transfusion 
Varices: terlipressin + endoscopy 
OGD

Surgery

47
Q

What are the symptoms of bacterial meningitis?

A 
headache 
fever 
N+V
Photophobia
Drowsiness
Seizures
Neck stiffness
Purpuric rash
48
Q

What is the appearance of CSF in bacterial meningitis?

A

Cloudy
decreased glucose
protein

49
Q

What is the management of meningitis?

A

IM Benzypenicillin in community
ABX: cefotaxime
Dexamethasone

50
Q

What is the management of STEMI/NSTEMI?

A 
STEMI: 
Morphine
Antiemetic
Nitrates
Aspirin 300mg
PCI
NSTEMI: BROMANCE
Bblocker
Reassurance
O2
Morphine 
Aspirin 300mg 
Nitrates
Ticagrelor
Enox (fondaparinoux)
51
Q

What is the management of Status?

A

Lorazepam IV

If still fitting after 5 mins, repeat
Then phenytoin 15-20mg/kg/IV
Propofol and ventilate

52
Q

What is the management of ruptured AAA?

A

MHP

Surgery

53
Q

What is the management of Aortic dissection?

A

A: surgical
B: conservative
bed rest
blood pressure reduction)

CP3 Crit Care (11 decks)

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