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ACCS EM > Part B 04 > Flashcards

Part B 04 Flashcards

1
Q

Clinical test prior to ABG/ART line

Name and procedure

A 
Allen’s test
Occlude both radial and ulnar artery’s
Make fist 
open hand - white
Remove occlusion ulnar artery 
<6s = good collateral circ
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2
Q

Ventilation in HI
PCO2 aim for
Normally vs deteriorating

A

PCO2 = 4.7
Deteriorating patient
<4.3kPa

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3
Q

Radial nerve block

Process

A 
Wrist dorsiflexion 
Lidocaine 
Radial/dorsal wrist 
~ 3cm prox to radial styloid 
Aim medially toward radial artery
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4
Q

ASA classification

A

1: healthy
2: mild systemic ds
3: severe systemic ds
4: severe systemic ds that is constant threat to life
5: moribund pt not expected to survive w/o operation
6: brain dead: organ donation

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5
Q

BiPAP

Stands for

A

Bilevel positive airway pressure

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6
Q

BiPAP

Types

A

Timed cycled

or flow cycled

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7
Q

BiPAP

Name of 2 different pressures

A

IPAP: inspiratory positive airway pressure
EPAP: expiratory positive airway pressure

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8
Q

CPAP equivalent to which pressure of BiPAP

A

EPAP

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9
Q

CPAP/EPAP

Assists breathing how?

A

Inspiration
- recruits alveoli -> increase gas exchange
Expiration
- stents alveoli open -> increases functional residual capacity -> increases gas exchange

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10
Q

IPAP

Assists breathing how?

A

Higher IPAP pressure

  • recruits alveoli as per CPAP
  • decreases work of breathing , fatigue, myocardial O2 demand
  • increases tidal volume -> washes out CO2
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11
Q

Pressure support =

A

IPAP-EPAP

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12
Q

Starting pressure for NIV

A

CPAP - 5cm H20

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13
Q

Starting pressure for NIV

BiPAP

A

10/5cm H2O

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14
Q

Increasing NIV pressure

How much

A

Increase 2cm every 5 min until response

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15
Q

Max NIV pressure

A

15-20cm H2O

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16
Q

C.I. to NIV

A 
Resp arrest
Cardiac arrest
Nil consent
Uncooperative pt
Unable to tolerate 
Facial trauma/burns
Reduced GCS
Untreated pneumothorax 
Basal skull #
Intractable vomiting
Untrained staff
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17
Q 
Knee ligament injury mechanism 
ACL
PCL
MCL
LCL
A 
ACL - pivoting
PCL - dashboard injury
- blow to tibia w’ flexed knee
MCL - blow to lat knee
(Valgus stress)
LCL - blow to med knee 
(Varus stress)
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18
Q

Mechanism of injury

ACL

A

Pivoting

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19
Q

Mechanism of injury

PCL

A

Dashboard injury

Blow to tibia with flexed knee

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20
Q

Mechanism of injury

MCL

A

Blow to lateral knee

Valgus stress

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21
Q

Mechanism of injury

LCL

A

Blow to medial knee

Varus stress

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22
Q

Unhappy triad

A

ACL
MCL
Medial meniscus

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23
Q

Emergency thoracotomy indication

A

Penetrating injury

  • witnessed cardiac arrest
  • unresponsive hypotension

Blunt injury

  • chest drain >1500ml
  • unresponsive hypotension
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24
Q

Massive haemothorax

Defined

A

> 1/3 blood vol in chest

> 1500ml blood

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25
Q

APLS
Anaphylaxis
Range of adrenaline dose

A

150-500mcg IM

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26
Q

APLS
Anaphylaxis
Range of chlorphenamine dose

A

2.5-20mg IM

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27
Q

APLS
Anaphylaxis
Range of hydrocortisone dose

A

25-200mg

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28
Q

APLS
Non shockable rhythm
Adrenaline dose

A

10mcg/kg adrenaline

IV/IO

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29
Q

Posterior shoulder dislocation

X-RAY signs

A

Light bulb sign
Absence ext rotation
Trough line sign
Rim line sign

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30
Q

Trough line sign

A

Post dislocation

- vertical dense line in medial humeral head

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31
Q

Rim line sign

A

Widened glenohumeral joint

>6mm

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32
Q

HI and GCS<13 in ED

Imaging

A

CT head and neck

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33
Q

Commonest hip pain

< 10yo

A

Transient synovitis
Septic arthritis
Perthes
Congenital hip dysplasia

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34
Q

Tetanus prone wound requiring

Ig

A 
Puncture 
Wound >6h
Dirty wound
Significant devitalised tissue 
Avulsion 
Open #
Gunshot 
Crush injury
Burns
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35
Q

Ulnar neuritis

Sx

A

Paraesthesia/numb little finger

Hand weakness

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36
Q

Ulnar neuritis

Most common cause

A

Cubital tunnel syndrome

37
Q

Ulnar neuritis

Ix

A

Nerve conduction study

38
Q

Ulnar neuritis

Tx

A

Surgical decompression

39
Q

Cubital tunnel

Location

A

Medial epicondyle

Under osbournes ligament

40
Q

Fight bite abx

A

Co amoxiclav
Or
doxy and metronidazole

41
Q

Peri anal haematoma

Pathology

A

Rupture of small vein
> small collection of blood
> firm clot w/i 1h

42
Q

Peri anal haematoma

Tx

A

Needle aspiration blood w/i 1h

Spontaneously resolves w/i days
Or
I+D if too painful

43
Q

Scoring system for

Acute appendicitis

A

Alvorado score

44
Q

SIGN guideline
Lower GI bleed
Admit for early endoscopy if:

A 
>60yo
Haemodynamic instability 
Evidence of gross rectal bleed
Aspirin/NSAID
Significant comorbidity
45
Q

AAA

RF

A 
Age
Male 
Smoking
HTN
PVD
fHx
Connective tissue ds
46
Q

Commonest cause LBO

A

Malignancy

47
Q

Tripod #

Includes

A

Lat orbit
Zygoma
Maxilla

48
Q

Tripod #

Aka

A

zygomaticomaxillary complex

49
Q

Tripod #

Tx

A

Severe angulation or comminuted = ORIF

Otherwise conservative

50
Q

Mandible #

Location

A

30% condyle
25% angle
25% body
15% mental

51
Q

Mandible #

Complications

A

Osteomyelitis
Paraesthesia
Malocclusion

52
Q

malocclusion

Define

A

malocclusion is a misalignment or incorrect relation between the teeth of the two dental arches when they approach each other as the jaws close.

53
Q

LMN facial nerve palsy

Ddx

A 
Bells 
Ramsey hunt synd
Trauma
Parotid bland tumour
Vestibular schwanomma 
Middle ear infx 
Cholesteatoma
Sarcoidosis
54
Q

Traumatic aortic rupture

% RTA deaths

A

15-20%

55
Q

Traumatic aortic rupture

Most common location

A

Incomplete laceration

Next to ligamentum arteriosum

56
Q

Traumatic aortic rupture

CXR signs

A

Widened mediastinum

Trachea deviated to Right

57
Q

De Quervains tenosynovitis

Sx

A

Thickened and inflamed tendons

Radial side of wrist

58
Q

De Quervains tenosynovitis

Tendons involved

A

Extensor pollicis brevis

Abductor pollicis longus

59
Q

De Quervains tenosynovitis

Test

A 
Finkelsteins test 
Flx wrist 
w ulnar deviation 
And thumb flx across palm 
Stretches tendons > pain
60
Q

De Quervains tenosynovitis

Tx

A

Rest

Thumb splint to immobilise

61
Q

Barton’s #

Define

A

Intra articular # distal radius
W’ dislocation of radiocarpal joint

Distal fragment can be displaced dorsal or volar

62
Q

Barton’s #

Tx

A

Inherently unstable#

Needs ORIF

63
Q

Consider SBP if

A

Any patient with ascites that is deteriorating

Asymptomatic cases have been reported

64
Q

% patients with ascites that develop SBP per year

A

30% per year

65
Q

Tx

SBP

A

Ceftriaxone or cipro
+
IV albumin (reduces renal failure)

66
Q

Ascetic tap

Process

A
  • Find flank dullness
  • Lateral to rectus abdominis
  • 5cm superior and medial to ant superior iliac spine
67
Q

Arctic tap fluid analysis that suggests SBP

A 
WCC >500 cells/ml
Neut>250
Lactate >25mg/dl
pH<7.35
Bacteria on gram stain
68
Q

Prophylactic abx for SBP

A

Norfloxacin

69
Q

WPW causes what type of tachyarrhythmia

A

AVRT

Atrioventricular re-entrant tachycardia

70
Q

WPW

ECG features

A

Short PR<120ms
Delta wave
Widened QRS

71
Q

Types WPW

A

Type A; features sim RBBB

Tube B; sim LBBB

72
Q

Drop INR by 1

Decrease warfarin dose by

A

15%

73
Q

Types transfusion reaction

A 
Acute haemolytic reaction
Febrile transfusion reaction
Allergic reaction
TRALI ~6h
Delayed haemolytic reaction (4-8d)
GVHD (1-4w)
74
Q

Cause of

Acute haemolytic reaction

A

ABO mismatch error

75
Q

Cause of

Febrile transfusion reaction

A

Cytokines in blood

76
Q

Cause of allergic reaction to blood transfusion

A

Eg due to anti IgA Ab

77
Q

Cause of TRALI

A

Ab in donor blood vs recipient

78
Q

Theophylline
Type of drug
And risk using

A

Phosphodiesterase inhibitor

Narrow therapeutic window

79
Q

Theophylline

OD sx

A

Headache, N+V
Seizure, low electrolytes
High BG

80
Q

Cannabinoid hyperemesis syndrome

Time to develop

A

Average 16 years of chronic use

V rare for cannabinoid toxicity

81
Q

Cannabinoid hyperemesis syndrome

Improves with

A

Hot baths

82
Q

Cannabinoid hyperemesis syndrome

Complications

A

Cannabinoid hyperemesis acute renal failure

Hypovolaemic

83
Q

Paracetamol OD
Toxin
And how it accumulates

A

NAPQI
Hepatotoxic

Glutathione used up allowing NAPQI to damage liver

84
Q

Paracetamol OD

Amount taken that can cause severe Damage

A

> 12g
Or
150mg/kg

85
Q

Paracetamol OD

Time to

  • abnormal LFT
  • hepatic failure
A
  • abnormal LFT ~18h

- hepatic failure ~48h

86
Q

Paracetamol OD

Significant ingestion
What dose

A

> 75mg/kg

87
Q

Start NAC Tx

If

A

4h level over Tx line
Or
>8h and significant OD (75mg/kg)

88
Q

NAC

Effectiveness reduced if over x h since OD

A

8h since OD

89
Q

NAC

Tx dose, vol, time

A

1) 150mg/kg in 200ml over 1h
2) 50mg/kg in 500ml over 4h
3) 100mg/kg in 1L over 16h

ACCS EM (11 decks)

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