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ACCS EM > Part B 02 > Flashcards

Part B 02 Flashcards

1
Q

Define sepsis

A

Life threatening organ dys
Due to host response
To infx

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2
Q

Septic shock

Definition

A

Circulatory or metabolic ab which increases mortality
- vasopressors MAP>65
- lactate >2
Despite adequate fluid resus

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3
Q

qSOFA

A

sBP<100
RR>22
GCS<15

> 2 = poor outcome

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4
Q

Fluid bolus in sepsis

Volume

A

30ml/kg

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5
Q

Ventilator settings

Tidal Vol

A

6-8ml/kg

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6
Q

Ventilator settings

Rate

A

10-15

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7
Q

Ventilator settings

Fi O2

A

0.21-1.00

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8
Q

Ventilator settings

PEEP

A

0-20cmH2O

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9
Q

Ventilator settings

Inspiratory flow rate

A

40-60L/min

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10
Q

Ventilator settings

I:E ratio

A

<1:1

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11
Q

Ideal body weight
male
Female

A

Male
Height cm - 100

Female
Height cm - 110

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12
Q

Median nerve block

Process

A 
Between palmaris longus and flexor Carpi radialis
Or 1cm medial flexor carpi radialis
2.5cm from wrist crease 
0.5cm deep
5-10ml 1% lidocaine
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13
Q

Decreasing ETCO2

Causes

A 
Cardiopulmonary arrest
PE
Hypotension
Massive blood loss
Cardiopulmonary bypass
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14
Q

% people with no palmaris longus

A

15%

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15
Q

Numbness lateral thigh

Dx

A

Meralgia paresthetica

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16
Q

Meralgia paresthetica

Pathology

A

Lateral femoral cutaneous nerve
Often due to increase weight, pressure from belt
Also DM, trauma

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17
Q

Ottawa ankle rules

A

Pain in malleolar region +

  • tender distal 6cm posterior edge (lat/medial)
  • inability to weight bear immediately and in ED
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18
Q

Ottawa foot rules

A

Pain in mid foot +

  • tender base 5th metatarsal
  • tender navicular
  • Inability to weight bear immediately and in ED
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19
Q

Exclusion to Ottawa rules

A

Pregnancy
HI or intoxicated
(+ unable to follow test)
Children <6

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20
Q

CI to knee joint aspiration

A

Cellulitis
Coagulopathy
Joint prosthesis

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21
Q

Knee joint aspiration

Process

A 
Clean, drape, lidocaine
Approach med/lat/superior/inferior
1cm from patella
Direct needle posterior to patella toward joint space 
Aspirate +/- milk joint space
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22
Q

Knee aspirate

Send for

A

Cell count
Culture and sens
Gram stain
Crystal analysis

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23
Q

APLS

Shock strength

A

4J/kg

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24
Q

APLS

Adrenaline dose

A

10mcg/kg

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25
Q

APLS

Amiodarone dose

A

5mg/kg

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26
Q

APLS

fluid bolus volume

A

20ml/kg

N saline

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27
Q

Paeds
CT head criteria
w/i 1 hour for any of these

A 
Suspected NAI
Post traumatic seizure
Initial GCS<14 or <15 (<1yr)
At 2h post injury GCS <15
?depressed/basal skull #
Tense fontanelle
Focal neuro deficit 
(<1yr) with >5cm injury to head
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28
Q

Manipulate colles’ # if

A

> 10• posterior tilt (lat view)
Displaced ulnar styloid
Ulnar angulation distal fragment
Visual deformity (not swelling)

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29
Q

Entonox
Time to act
Time to wear off

A

Time to act - 30s

Time to wear off - 60s

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30
Q

Suxamethonium
Type drug
Onset time and length of action

A

Depolarising NM blocker
30s to onset
3-5 mins action

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31
Q

CI to suxamethonium

A

Malignant hyperthermia
Hyperkalaemia
Severe burns
Severe muscle trauma

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32
Q

Suxamethonium dose

A

~1mg/kg

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33
Q

Causes of

Rising ETCO2

A

Hypoventilation
High temp (increased metabolism)
Pain

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34
Q

Sharkfin or sawtooth
Capnography
Indicates

A

Bronchospasm or

Airway obstruction

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35
Q

Drugs for conscious sedation

A

Opioids or Benzos

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36
Q

Curare cleft

A

Notch in ETCO2
Due to spontaneous breathing
NM block wearing off

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37
Q

Mallampati score

A

1: soft palate, uvula, Fauces, pillars
2: as above, no pillars
3: s palate, Base uvula
4: hard palate only

38
Q

Path external jugular vein

A

Inferior from ear lobe to mid clavicle

39
Q

Ulnar nerve block

Process

A 
Needle under flexor carpi ulnaris 
Distal to styloid process 
Advance 5-10mm
3-5ml lidocaine 1%
Further 2-3ml at ulnar aspect of wrists for dorsal branch
40
Q

Atracurium

Type drug

A

Non depolarising

Cf sux

41
Q

Atracurium
Intubating dose
V
Maintenance dose

A 
Intubating dose 
0.3-0.6mg/kg
V
Maintenance dose : 1/3 above
0.1-0.2mg/kg
42
Q

Cause of

Horners syndrome

A

Disruption of sympathetic chain

43
Q

90% sialoliths

Found in

A

Whartons duct

Submandibular gland

44
Q

Scoring system

Sore throats

A 
FeverPAIN
Facet over last 24h
Purulence
Attended in <3d 
Inflamed tonsil
No cough/coryza
45
Q

When to give abx

For sore throat

A

FeverPAIN
0-1 nil abx
2-3 delayed script
>4 abx

46
Q

Tx strep throat

A

Phenoxy…
or
Clarith
10d

47
Q

BRUE

Stands for

A

Brief resolved unexplained incident

48
Q

BRUE

Criteria

A 
Brief resolved unexplained incident
<12m
Last<1m
Resolved
No clinical explanation
Altered level responsiveness
49
Q

BRUE aka

A

ALTE

Apparent life threatening event

50
Q

BRUE

RF

A 
Prematurity
<10w
Recent anaesthesia
Airway obs
GORD
Previous apneic episode
51
Q

Paeds

Trauma analgesia

A 
Intranasal diamorphine 
0.1mg/kg in 0.2ml H20
IV morphine
0.1mg/kg
Oral paracet 
20mg/kg
Oral ibuprofen
10mg/kg
52
Q

Paeds

Femoral # immobilisation

A

Distal:
Padded long leg splint
Proximal
Skin traction (weight 10% body weight)

53
Q

Coopers sign

A

Meniscal tear
Pain when changing position even w/I weight bearing

Arthritis usually with weight bearing

54
Q

MCL attached to

A

Medial meniscus

55
Q

Causes of T1 resp failure

A 
PE
Atelectasis
P edema
ARDS 
High altitude
56
Q

Cause T2 resp failure

A 
Ex COPD
Life threatening asthma
OSA
Obesity
Kyphoscoliosis
CF
NM disorder
57
Q

Causes of
Airway obstruction in
Maxillofacial trauma

A 
FB: teeth, vomit
Bleeding
Swelling airway
Mid face # displaces posteriorly
Bilat mandible #
Trauma larynx/trachea
58
Q

Thiopental sodium

Type drug

A

Barbiturate

Non depolarising anaesthetic

59
Q

Dose

Thiopental sodium

A

5mg/kg

60
Q

Thiopental sodium

SE

A 
Hypotension
Arrhythmia
Myocardial depression
Laryngeal spasm
Cough
Rash
61
Q

Manoeuvres to aid

Intubation

A 
Position:
Neck flex 35’, face ext 15’
Gum elastic bougie
BURP
Alternate laryngoscope
Reduce cricoid pressure
62
Q

3-3-2 rule

A

Fingers between

3: incisors
3: hyoid to chin
2: thyroid notch to floor mouth

63
Q

Factors that cause

Difficult intubation

A 
C spine injury
Arthritis c spine
Mid face #
Mandibular #
Limited mouth opening
Receding chin
Overbite
Short/muscular neck
64
Q

Oxygen requirement calculation
Ventilated patient
(During transfer)

A

FiO2xMV + ventilator O2
X
2x transfer time

65
Q

Amount O2 ventilator uses per min

A

1L O2/min

66
Q

Bells phenomena

A

Bell’s palsy
Ask or close eye
Eye rolls up and out
Cannot close eye

67
Q

Bell’s palsy

Tx

A

Prednisone

25mg BD for 10d

68
Q

Subconjunctival haemorrhage

Associated with

A

HTN
Basal skull #
Blood dyscrasia

69
Q

Subconjunctival haemorrhage

Time to resolve

A

Improves w/i 10-14d

70
Q

Cause of optic nerve lesions

A 
MS
Trauma
Malignancy
Infection
Inflx - GCA
B12 deficiency
71
Q

Dendritic eye ulcer

Tx

A 
HSV t1
Aciclovir drops 5x/day 
for 10d
High dose vit c
Eye clinic
72
Q

Mydriatic eye drops

CI

A

Hx AACG

73
Q

Mydriatic eye drops

List drugs

A

Atropine
Phenylephrine
Cyclopentolate
Tropicamide

74
Q

Causes of

Pathological mydriatic pupil

A

Holmes Addie
Traumatic iris damage
3rd nerve palsy
Rubeosis iridis

75
Q

Gout

RF

A 
Medications - diuretics
FHx
Lifestyle - etoh, bmi
Metabolic syndrome 
Renal ds
Trauma/surgery
76
Q

Indication for joint aspiration

A 
?septic joint
?crystal arthropathy
Unexplained arthritis and effusion 
Check response septic arthritis to Tx
Check joint capsule integrity post trauma
77
Q

Unwell or with surgical abdomen
No time for CT
Tx

A

Explorative laparotomy

78
Q

Most common spinal cord infarction

A

Anterior spinal arteries

Anterior cord syndrome

79
Q

Anterior cord syndrome

Sx

A

Loss of motor functions

+ some sensory

80
Q

Lisfranc injury

Define

A

Tarsometatarsal # dislocation

81
Q

Lisfranc injury

Tx

A

Bacslab POP
Non weight bearing
Ortho referral
Likely ORIF

82
Q

SAH + 3rd nerve palsy

Indicates

A

Likely ruptured posterior communicating artery aneurysm

83
Q

HASBLED

Acronym

A 
HTN (sBP>160)
Abnormal liver/renal
Stroke hx
Bleeding predisposition 
Labile INR
Elderly >65
Drugs (NSAIDS, EtOH)
84
Q

HASBLED score

Indicates

A

> 3 indicates high risk bleeding
Consider anticoagulation
Increase review

85
Q

Q fever

Organism

A

Coxiella Burnetti

Zoonotic infection

86
Q

Q fever

Tx

A

Doxycycline 2w

87
Q

Q fever

Complications

A

Atypical pneumonia

88
Q

HIV seroconversion illness
% who get it
When

A

40%

1-6w Post exposure

89
Q

HIV seroconversion illness

Ix

A

p24 antigen tear
HIV RNA levels

NB: Ab test will be negative

90
Q

Thyroid storm

Tx

A 
IV fluids
Paracetamol
Benzodiazepine 
Steroids for adrenal suppression 
Abx for infx 
Propranolol 80mgPO
High carbimazole 50mg/day
Potassium iodide 200mg IV over 1h
(Blocks release thyroid hormones)

ACCS EM (11 decks)

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