Y5 Emergency Medicine > 7 - A-E Assessment and Acute Presentations > Flashcards

7 - A-E Assessment and Acute Presentations Flashcards

(48 cards)

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1
Q

What tool is used to determine whether someone with a PE can be treated as an outpatient?

A

PESI

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2
Q

How should you approach someone with SOB in ED?

A
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3
Q

What questions should you ask when a patient presents to ED with shortness of breath?

A
  • Onset
  • Duration
  • Severity
  • Precipitating events
  • Associated symptoms
  • Postural changes
  • Previous episodes
  • PMHx
  • SHx
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4
Q

What are some differentials you need to consider in ED when someone presents with SOB?
How can you differentiate between the different conditions based on their presenting symptoms?

A
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5
Q

What are the important exams to do on top of an A to E assessment when someone presents with SOB?

A
  • Respiratory
  • Cardio
  • Abdominal
  • General (see image)
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6
Q

What investigations should you do in ED if someone presents with SOB?

A
  • Sats
  • ABG
  • CXR
  • ECG
  • D-dimer or CTPA if Well’s score suggests PE
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7
Q

How would the following presentations show on a CXR?

A
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8
Q

What is the acronym to remember the management of SOB caused by pulmonary oedema?

A

Pour SOD

  • Pour away (stop) their IV fluids
  • Sit up
  • Oxygen
  • Diuretics (40mg Furosemide STAT)
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9
Q

If initial management of pulmonary oedema is not working what can you do next?

A

PODMAN

  • Intravenous opiates to act as vasodilators
  • NIV like CPAP
  • Inotropes if on ITU
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10
Q

What life threatening differentials do you need to consider when a patient presents with chest pain?

A
  • ACS (STEMI/NSTEMI/Unstable angina)
  • Aortic dissection
  • PE
  • Pneumothorax
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11
Q

Once you have ruled out life threatening differentials, what are some other causes of chest pain that may present to ED?

A
  • Anxiety
  • Shingles
  • Costochondritis
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12
Q

How may aortic disecction present?

A

Chest pain PLUS 1

  • Radiates to back or neck
  • Any neurological symptoms
  • Limb ischaemia
  • Renal colic type pain
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13
Q

What test should you order if you suspect an aortic dissection?

A

CT angiogram of Aorta

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14
Q

What is the acronym for the ACS initial protocol?

A

MONAC
- Morphine
- Oxygen if sats <94%
- Nitrates
- Aspirin
- Clopidogrel

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15
Q

How should you approach a patient in ED with chest pain?

A
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16
Q

How will the following causes of chest pain present?

A
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17
Q

What are some risk factors you need to enquire about in the history of a patient with acute chest pain as it could mean they are more likely to have an ACS, aortic dissection or PE?

A
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18
Q

What investigations should you perform for a patient with acute chest pain?

A
  • ECG
  • CXR
  • Serial troponins
  • D-dimer/CTPA/VQ if indicated
  • CT angiogram of aorta if indicated
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19
Q

What signs may be found on examination of a patient with acute chest pain and the following diagnosis (especially aortic dissection and MI)

A

Aortic dissection will have different blood pressures in both arms and may have neurological symptoms

MI often has diaphoresis. May be silent in women and diabetics, may present as indigestion.

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20
Q

What is included in an A to E assessment?

21
Q

What are the signs of a compromised airway?

Study These Flashcards
A
  • Stridor/stertor
  • Reduced breath sounds
  • Cyanosis
  • Confusion
  • Rapid shallow breathing
  • Unconscious
22
Q

What are some common causes of a compromised airway?

Study These Flashcards
A
  • Allergic reaction
  • Foreign body
  • Trauma to airway
  • Inhalational injury
  • Bacterial/viral infections e.g croup, epiglotitis
  • Asthma
  • COPD
23
Q

What are some techniques to combat a compromised airway?

Study These Flashcards
A
  • Heimlich manouevre
  • Head tilt chin lift/jaw thrusts
  • Oro/nasopharyngeal airways
  • I-gel
  • Laryngeal mask
  • Endotracheal intubation
  • Tracheostomy
24
Q

What is type 1 and type 2 respiratory failure and some causes of each?

Study These Flashcards
A

Type 1 (PaO2 <8)

Hypoxic (pneumonia, pulmonary oedema, PE)

Type 2 (PaO2<8 PCO2>6)

Hypercapnia (coma, COPD, asthma, pneumothorax, intracerebral haemorrhage)

25
What is the difference between type 1 and type 2 respiratory failure?
**Type 1 - **V/Q mismatch **Type 2 -** Alveolar hypoventilation
26
How do you take an ABG?
https://geekymedics.com/wp-content/uploads/2021/04/OSCE-Checklist-ABG-Sampling.pdf
27
What do you need to remember when cannulating?
Only withdraw the needle slightly until you get the plastic tube full in
28
What are some common causes of tachypnea?
- First sign of shock - Anxiety - Asthma - PE - COPD - DKA - Pleural effusion - Pneumonia - Sepsis
29
What are some common causes of bradypnoea?
- Opioids/drug induced - Raised ICP - Hypothyroidism - Low GCS - Electrolyte imbalances - High blood pressure - Head injury - Stroke
30
How may bradypnoea be treated?
- Reversal of drugs - BiPAP - Oxygen
31
Is CPAP classed as NIV?
NO - it does not ventilate only oxygenates and holds airway open NIV is a way to ventilate, usually BiPAP
32
What are the indications for CPAP?
- Hypoxia in the context of chest wall trauma despite adequate anaesthesia and high flow oxygen (pneumothorax should be ruled out using CXR before CPAP) - Cardiogenic pulmonary oedema - Pneumonia - Sleep apnea
33
What are the indications for NIV?
- COPD with respiratory acidosis (pH 7.25-7.35) - Hypercapnic respiratory failure secondary to chest wall deformity (scoliosis, thoracoplasty) or neuromuscular disease - Weaning from tracheal intubation - Cardiogenic pulmonary oedema unresponsive to CPAP
34
What monitoring has to be done whilst on CPAP/NIV?
- Pulse oximetry - ECG - BP - RR - Consciousness - Pulse - ABG before starting and 30-60 minutes after any change in settings
35
What are some complications with NIV?
- Mask leak - Stomach inflation and aspiration - Pressure sores
36
What is the modified Wells score for PE and how do you interpret the findings?
37
What is circulatory failure?
Inadequate effective blood flow leading to tissue hypoperfusion and hypoxia
38
What are the different types of shock and how do they present?
**- Septic:**hypotensive, warm, flushed, tachycardic **- Hypovolemic:** pale, cool, tachycardic **- Neurogenic**: hypotensive, bradycardic, neurological deficits **- Cardiogenic:** pale, clammy, cool, raised JVP, basal lung creps, tachycardia or profound bradycardia **- Anaphylactic:** flushed, warm, rapid weak pulse, wheeze, stridor, urticaria, oedema
39
What are some causes of cardiogenic and hypovolemic shock?
**Cardiogenic (pump failure or inadequate filling)** - Outflow obstruction e.g aortic dissection - Dysrhytyhmia - PE - Cardiac tamponade - Tension pneumothorax **Hypovolemic** - External blood loss - Internal blood loss e.g ruptured AAA - Dehydration - Excess fluid loss e.g vomiting - 3rd space losses e.g pancreatitis
40
How do you treat non-haemorraghic hypovolemic shock?
1. Lay pt flat and elevate legs 2. 15l oxygen non-rebreathe 3. IV access and take blood 4. 1L 0.9% NaCl STAT 5. Identify likely cause 6. Catheterise and fluid balane chart
41
How do you investigate and manage cardiogenic shock? (go over causes again)
MANAGE BEFORE INVESTIGATIONS AS LIFE THREATENING **Ix:** ECG, CXR, ABG, ECHO **Mx:**15L O2 and definitive management of above
42
How should you initially treat neurogenic shock?
1. Lay flat and elevate legs (only if no spinal injury) 2. 15L O2 3. 1L 0.9% NaCL STAT 4. Involve spinal surgeons 5. If epidural stop and consult anaesthetist
43
What is the pathophysiology behind neurogenic shock?
Decrease in peripheral vascular resistance mediated by marked vasodilation due to decrease in sympathetic tone This results in decreased preload and thus decreased cardiac output (Starling's law)
44
What is the main cause of cardiogenic shock?
MI
45
What are the causes of a normal anion gap metabolic acidosis?
46
What are the causes of a raised anion gap metabolic acidosis?
47
How is haemoraghic shock managed?
1. Lay pt flat and elevate legs 2. Apply direct pressure to bleeding 3. 15L O2 4. IV Access and blods (FBC, clottinh, urgent cross match) 5. 1L 0.9% NaCL 6. O -ve blood, do not give lots of fluid resus as will dilute clotting factors. Permissive hypotension allowed initially
48
How do you treat hypoglycaemia?
Don't forget the long acting carbohydrate afterwards
Y5 Emergency Medicine
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