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Sheff 3b > a&e > Flashcards

a&e Flashcards

1
Q

Talk through the ABCDE and things you might do in each

A

A
Secure airway: guedel, NP airway, ET tube, LMA

B
RR. Oxygen, nebulised salbutamol/ipratropium bromide
Sats

C
BP, HR, CRT, UO. Fluid resuscitation, vasopressors, catheterisation

D
GCS, AVPU, capillary glucose. CT, IV dex

E
Rash, burns etc

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2
Q

What is the canadian c spine score for?

Who can it be used on?

A

CT scanning post neck injury

If the patient is alert (GCS 15) and stable following trauma

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3
Q

4 types of burns

A

thermal
chemical
electrical
radiation

[EMOTIONAL]

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4
Q

where is a quick place to check for inhalation injury in unconscious pt

A

nostrils

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5
Q

Rule of 9 for burns - wallace’s

A 
Arm
9%
Head
9%
Leg
18%
Torso (front)
18%
Torso (back)
18%
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6
Q

Which chart can you use to assess burns in children

A

lund and browder

Accounts for age and growth

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7
Q

which level of burn

Pain, red, glistening, NO blisters, brisk capillary refill.

Recovery?

A

Epidermal/superficial partial thickness

Heal in one week no scarring

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8
Q

Which level of burn

Pale pink/mottled, swelling, SMALL blisters ± weeping, brisk capillary refill.

How long for recovery ?

A

superficial dermal

Heal 3 weeks minimal scarring

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9
Q

Which level of burn

Cherry red, blistering, dry, blotchy, no blanching, no capillary refill, reduced sensation.

How long recovery? mx?

A

deep dermal 3-8 weeks healing with scarring ± surgical treatment

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10
Q

Which level of burn

White/black, dry, no blisters, np capillary refill, no sensation.

Mx

A

3rd degree

Requires surgical repair/graft

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11
Q

Which level of burn

Includes subcut fat, muscle + bone.

Mx?

A

4th degree

Reconstruction ± amputation

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12
Q

burns Ix

A

Bloods
FBC, crossmatch, carboxyhaemogobin, serum glucose, U+E, ABG

CXR

Cardiac monitoring
Dysrhythmia for hypoxia and electrolyte disturbances

*Circulation
BP may be difficult and unreliable
Monitor urine hourly therefore urinary catheter

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13
Q

When should you re examine a minor burn after you’ve dressed it?

A

48 hours

burns are dynamic and can change

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14
Q

If infection of burn occurs - mx?

A
  • daily wound inspection + dressing change + 7 days flucloxacillin
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15
Q

What prophylaxis should you consider in burns?

A

tetanus

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16
Q

3 key worries in major burns

A

Direct thermal injury -> airway oedema/obstruction

Carbon monoxide poisoning

Inhalation of smoke -> pneumonia + oedema

17
Q

What things might indicate inhalation injury ?

A

mechanism of burn - fire

hoarseness
singed nostril hairs
face/neck burns

18
Q

What to do if burns pt has a stridor

A

ET intubation and ventilation

transfer to burns centre

19
Q

CO poisoning makes what result unreliable

A

PaO2

20
Q

How can you try and reduce oedema in airway of burns

A

elevate head and chest to 25 degrees

21
Q

What urine output do you want with burns

A

0.5-1ml/kg urine adults

1-2ml/kg children

22
Q

How much fluid to give in major burns

A

Parkland formula

4ml / kg / %total body area of Hartmann’s/Ringer’s lactate

= 4 x weight x %

Half in first 8 hours, half in following 16 hours

Children also receive maintenance calculated as expected 4/2/1

23
Q

Burns complications

A

Fluid loss, infection, scarring (minimised by graft in under 3 weeks)

24
Q

What is flail chest

A

life threatening injury that occurs when a segment of the rib cage (3 or more ribs) breaks due to trauma and becomes detached from the rest of the chest wall (i.e. unable to contribute to rib expansion)

25
Q

What does flail chest indicate?

A

pulmonary contusion. May puncture lung and cause pneumothorax

26
Q

Seen O/E of flail chest

A

paradoxical movement (indrawing on inspiration)

27
Q

Mx of flail chest

A

ventilation PPV (positive pressure ventilation) (n.b. Intubation and ventilation will exacerbate a pneumothorax or tension pneumothorax) +

pain control (intercostal blocks) +

pulmonary toilet (clear mucus and fluid from lungs)

28
Q

reversible causes of cardiac arrest

A 
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia
H+ ions - acidosis

Thrombosis (coronary or pulmonary)
Tamponade (cardiac)
Toxins
Tension pneumothorax

29
Q

Where does the blood go in major haemorrhage

A

Blood on the floor and 4 more… chest, pelvis, abdomen/retroperitoneum, thigh

30
Q

What can you do if bleeding of chest / abdo / pelvis

A

REBOA - resuscitative balloon occlusion of the aorta

31
Q

What is the lethal triad of major haemorrhage

A

Hypothermia, acidosis, acute coagulopathy of trauma*

32
Q

How do you stop bleeding

A

Splint, pressure, haemostatic agents (tranexamic acid IV), REBOA

33
Q

Major haemorrhage - what do you transfuse

A

RBC - 4 units
FFP - 2 units
Platelets - 1 unit

34
Q

Pt sick and on steroids whatcha do?

A

double dose of steroids

[boosts cortisol]

35
Q

Amox + chest rash

A

ebv

36
Q

Overdose - tinnitus

A

aspirin

37
Q

Overdose - yellow vision

A

digoxin

38
Q

What does the lund and browder chart do?

A

assesses burns in children. accounts for age and growth

Sheff 3b (33 decks)

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