Emergency medicine Flashcards

1
Q

Those requiring CT head immediately <1 hour

A

GCS <13 on initial or <15 at 2 hrs
Fracture- basal/skull
Seizure
Focal neuro deficits
Vomit >1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Dose of adrenaline for ages

A

6m-6y 150mcg

6-12 300 mcg
>12 500mcg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Order management of suspected meningitis

A

LP before ABx
Unless
Signs of sepsis or rash
Bleeding risk
Raised ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes of confusion

A

PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration

Meds
Electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What to give in aspirin OD

A

Sodium Bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Tx of hypothermia

A

Internal- fluid rewarming
External blanekts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Dx and tx of hypotension of someone on long term steroids with poor compliance

A

Addesonian crisis
IM HC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Dx of confusion, N+V, cherry red skin, 100% sats and tachycardia

A

CO poisoning
Sats high because measures those without CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

IX and Mx of CO poisoning

A

ABG- >20% carboxyhemoglobin
100% O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Types of airway equipment

A

Guedel- OPA- insert up side down
NPA- do not use in basal skull fracture
Good if prominent gag reflex

Supraglottic airway/ laryngeal mask- short procedures

Endotracheal airway- protects against aspiration- inflatable cuff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sx of alcohol withdrawal

A

Hours- insomnia, anxiety, agitation

12-24- hallucinations
72- delirium tremens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mx of alcohol withdrawal

A

Chlordiazepoxide
Pabrinex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Sx of anastomotic leak

A

5-7 days post
Low grade fever
Ileus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ix of anastomotic leak

A

CT with contrast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Beta blocker OD sx

A

Hypotension
Bradycardia
Mild hypoglycaemia
Mild hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

BDZ OD sx

A

Ataxia
Slurred speech
Resp depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Organophosphates OD sx and tx

A

SLUD
Salivation /small pupils
Lacrimation
Urination
Diarrhoea

Treat with atropine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Compartment syndrome sx

A

Parasthesia, paralysis, severe pain, pulseless

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When to refer asthma attack to ICU

A

Severe- failing to respond
Exhaustion
Resp arrest
Deteriorating PEF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define STEMI

A

Chest pain at rest or minimal exertion, lasting >15 minutes
ECG changes (new ST-elevation or left bundle branch block)
Rise in troponin: myocardial necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When to DC cardiovert in AF

A

Shock
Syncope
Acute pulmonary oedema (i.e. does not include chronic heart failure)
Myocardial ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Features of cardiac tamponade

A

Beck triad- reduced heart sound, raised JVP, reduced BP
Pulsus paradoxus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Ethylene glycol posoning

A

Raised anion gap
Intoxication
N+V

Acute tubular necrosis >24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Tx of HHS

A

Fluid- 1L 1-2 hours then 2-4 etc
Insulin- if ketones >1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mx of SE

A

Bloods for glucose, FBC/UE/CRP,Calcium/Phosphate/Magnesium, drug levels if the patient is on anti-epileptic medications

Anaesthetic review to ensure the airway is managed

IV lorazepam 4mg
A second dose of lorazepam should be given if no response
In the absence of IV access, PR diazepam or buccal midazolam can be administered.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Tx of SVT

A

Vasovagal
Adenosine 6,12,18
Verapamil in asthmatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Causes of long QT

A

TIMMES

Toxins- macrolides, anti psychotics, TCA
Inherited
Ischaemia
Myocarditis
Mitral valve prolapse
Electrolytes - hypokalaemia and hypocalcaemia
SAH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Mx of Upper GI bleed

A

IV fluid resus
Blood transfusion if Hb <7
NBM and O2
PPI

If variceal- Abx and terlipressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Mx of AKI

A

Find and treat cause
Bloods, urine

Stop nephrotoxic drugs- ACEi, NSAIDs, diuretics, gentamicin

IV fluids
Treat complications

Dialysis if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Causes of syncope

A

Cardiogenic - palpitations
Postural hypotension- drugs, low volume- more than 20/10 drop after 3 mins of standing
Neurogenic- vasovagal- stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Cause of seizure

A

Electrolytes
Tumour
Infection
Drug
Neuro- epilepsy, stroke
Pre eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Ix of seizure

A

ABG (For acute prolonged seizures looking for hypoxia and hypercapnia)
Blood tests: FBC, U&Es (including serum calcium, magnesium and phosphate) LFTs, glucose
Urine test: urine toxicology screen
Imaging: CT Head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Digoxin poisoning sx

A

Palpitations (due to arrhythmias)
Bradycardia typically without hypotension
Yellow-green colour disturbance
Visual haloes
Confusion
Hyperkalaemia

34
Q

Mx of digoxin OD

A

Measure digoxin level
Fluids
Correct electrolytes
Continuous cardiac monitor
Digabind- symptomatic

35
Q

Causes of hypoglycaemia

A

Insulin, GLP1, sulphonylurea, BB

ALF, sepsis, adrenal insufficiency

36
Q

Ix of hypoglycaemia

A

Check medications
Serum insulin, C peptide- not if acute setting

37
Q

Mx of hypo

A

Conscious- short acting carbs
Unconsious- IV 10% dextrose 200ml or 1g IM glucagon

38
Q

Mx of thyrotoxic storm

A

Propanolol
Propylthiouracil
IC HC

39
Q

Mx of epistaxis

A

Direct compression 10-15 mins
Then nasal cautery
Then nasal packing

40
Q

Mx of bradycardia with adverse features

A

Atropine
If do not respond- pacing

41
Q

Causes of sudden painless vision loss

A

Central retinal vein/artery occlusion
Retinal detachment
Vitreous haemorrhage
Ischaemic optic- GCA painful tho

42
Q

When to CT head <8 hrs

A

Amnesia or LOC

Age >65
Bleeding disorders
Cant remember >30 misnaming before
Dangerous MOA

43
Q

If patient with DKA with tx has reduced GCS what should you do

A

Slow down IV fluids
Then IV mannitol

44
Q

How cerebral oedema presents in DKA

A

New onset headache
Reduced GCS
Bradycardia

45
Q

If septic shock doesn’t respond to fluids what is next Tx

A

Noradrenaline Infusion

46
Q

If someone with HF has low GFR what should you do to frusemide

A

Increase
From 40 to 80- since it MOA works through being absorbed in glomeruli

47
Q

When to dialysis a patient with AKI

A

Persistently high potassium that is refractory to medical treatment

Severe acidosis (pH<7.2)

Refractory pulmonary oedema

Symptomatic uraemia (pericarditis, encephalopathy)

Drug overdose (e.g. aspirin)

FUKAD

48
Q

Where decompression of Pneumothorax occurs

A

MCL
Just above 3rd rib

49
Q

If RR below 10 and hypoxic what should you do

A

Ventilate- manual- connect bag valve to 15L

50
Q

Other Sx of compartment syndrome

A

Pain on passive movement
Increase analgesic requirement
Pain out of proportion

51
Q

When to consider blood transfusion

A

Hb <70
With ACS <80

52
Q

Important Ix for DKA

A

VBG/ ABG

53
Q

Scoring systems for UGI bleed

A

Glasgow Blatchford- pre endo- decide on timing of procedure - <0 outpatient

Rockall- mortality

54
Q

Best prognostic marker of paracetamol OD

A

Prothrombin time

55
Q

What to do if staggered paracetamol OD

A

Give NAC since difficult to interpret graph

56
Q

Aortic dissection presentation

A

Sudden tearing chest pain
Paralysis due to cut off in blood supply
Aortic regurg

57
Q

Spinal cord compression by mets on MRI mx

A

Dexamethasone with PPI cover

58
Q

Cut off for PCI

A

<12 hours
Cant get to PCI centre in 2 hours

59
Q

New anaphylaxis follow up

A

Specialist allergy clinic

60
Q

Patient with low GCS has oropharyngeal airway what should you do

A

If <8 intubate with cuff endotracheal tube

61
Q

Tx of LA OD

A

Lipid emulsion

62
Q

When to remove spleen

A

Haemodynamically unstable and complete devascularisation

63
Q

Types of syncope

A

Orthostatic- going from lying to standing- on BP meds

Cardiogenic- whilst sitting or lying, palpitations

Vasovagal- cough, stress

Regain consciousness quickly, orientated, can have brief jerks

64
Q

Differentiating types of shock

A

Septic- warm peripheries

Cardiogenic- cool, weak pulse, crackles

Hypovolaemia- cool, weak pulse, no pul oedema

Obstructive- signs obstructing heart- murmur

Neuro- damage to back- warm peripheries- decrease in symp

65
Q

Tx of paracetamol OD

A

Give NAC if
If >150mg/kg 8hr ago
>24hr if clearly symptomatic or deranged LFTs

Give if Hx of anorexia

66
Q

Tx of close contact on meningitis

A

Cipro to close contacts of last 7 days

67
Q

After new anaphylaxis mx

A

6 hours observation
Home if stable
Specialist allergy clinic
Prescribe 2 adrenaline with training

68
Q

Alcoholic ketoacidosis sx and tx

A

Ketones
Vomitting, pain
Normal BM
High anion gap

Saline and thiamine

69
Q

Scoring for those at risk for developing a pressure sore

A

Waterlow score

70
Q

Change in sight with thyroid disease

A

Urgent referral

71
Q

Anaphylaxis protocol

A

Adrenaline M - 5 mins apart

Administer chlorphenamine and hydrocortisone (latest Resus Council guidance puts significantly less emphasis on this in the immediate management)
IV fluid challenge if hypotensive

72
Q

Tx of acute reseeding sx

A

IV phosphate

73
Q

Upper GI bleed when should you give PPI

A

After endoscopy confirms no variceal bleed

74
Q

Double vision when both eyes are open, and it is painful to open his mouth.

A

Depressed fracture of zygoma

75
Q

Flushing, N+V, palpitations with drinking alcohol and what medication

A

Metronidazole

76
Q

Major haemorrhage protocol

A

Baseline bloods before transfusion- FBC< GS, clotting

Trauma <3h- Tranexamic acid bolus followed by infusion

Use O neg until known

6U RBC for 4U FFP

77
Q

If fluid resuscitation with several L of NaCl what may happen

A

Hypercholremic acidosis
Normal anion gap

78
Q

Abdo pain, constipation, weakness, neuropsychiatric blue lines on lips

A

Lead poisoning

79
Q

Shock classification

A

Class I shock would be completely compensated for. <15

Class II shock would cause tachycardia. 15-30

Class III shock causes tachycardia and hypotension as well as confusion. 30-40

Class IV shock causes loss of consciousness as well as severe hypotension >40

80
Q

Stabbed patient with raised CVP tx

A

Tamponade- treat with thoracotomy