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Year 3 - Exams > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q
  • •24 year old male
  • •Acutely short of breath
  • •HR 120
  • •BP 129/87
  • •RR 35
  • •SpO2 98% on 15LO2
  • •GCS 15

What are the differentials?

A
  • •Pneumothorax
  • •Anaphylaxis
  • •Asthma
  • •Pneumonia
  • •Cardiac failure
  • •ARDS
  • •Pleural effusion
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2
Q

History:

  • Known asthmatic
  • •Acute SOB today
  • •No chest pain
  • •SPO2 92% on arrival- 98% with O2
  • •Chest- bilateral wheeze
  • •No other PMH
  • •Able to say a few words

What is the diagnosis?

A

Likely asthma attack

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3
Q

What is the examination in an effusion?

A

Stony dullness to percussion

Absent or reduced breath sounds

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4
Q

What should you ask an asthmatic having an acute asthma attack?

A
  • Previous ITU - Must ask if they have ever been intubated; If yes then will most likely need admission.
  • Other medical conditiosn
  • Allergies
  • Any infective symptoms
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5
Q

What is the pathophysiology of acute asthma?

A
  • •Reversible airway disease
  • •Hyper reactivity
  • •Airflow limitation
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6
Q

What are the treatments?

A
  • •Nebulised salbutamol
  • •IV salbutamol
  • •Nebulised adrenaline
  • •Nebulised magnesium
  • •Oral steroids
  • •IV steroids
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7
Q

If acute asthmatic is getting worse what must you do?

A

Give IV medication

Call for specialist help

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8
Q

What is the difference between severe vs life threatening asthma?

A
  • Decompensating - unable to maintain adequate PO2 and PCO2
  • Drowsy due to rising PCO2, hypotension or exhaustion
  • Need intubation
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9
Q

What is a non-blanching rash characteristic of in someone who is acutely unwell?

A

Meningitis

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10
Q

What is an uricarial rash characteristic of?

A

Anaphylaxis - it is raised, itchy and blanching.

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11
Q

What are the differentials?

  • •34 year old female
  • •Suddenly felt unwell
  • •Widespread urticarial rash
  • •HR 130
  • •BP 75/40
  • •Collapsed
  • •Wheezy
A
  1. Ectopic pregnancy
  2. Acute severe asthma
  3. Sepsis
  4. Anaphylaxis
  5. Pneumonia
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12
Q

Pathophysiology of anaphylaxis.

A

Capillaries become leaky and fluid goes everywhere

Body learns to react quickler next time you are exposed to the antigen.

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13
Q

What does and medication is given in anaphylaxis?

A

Adrenaline 500mcg

0.5ml 1:1000 IM (slowly goes into cells and doesn’t have massive effects on the heart)

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14
Q

Why do we put legs in the air in anaphylaxis?

A

To increase blood flow to heart

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15
Q

What are the effects of adrenaline on receptors around the body.

A
  • α1 – vasoconstriction and relaxation of GI tract
  • α2 – platelet aggregation and reduction in noradrenaline release from nerve terminals
  • β1 – inotropic and chronotropic cardiac effects and relaxation of GI tract
  • β2 – bronchodilatation, increase in noradrenaline release from nerve terminals, increase in intracellular cyclic adenosine monophosphate (cAMP) production in mast cells and basophils, reduction in the release of cellular mediators
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16
Q
A

Tombstoning ECG

Mostly anterior but all around

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17
Q

Which pulse would you measure?

A

With low BP you can lose all your peripheral pulses si it is always better to measure the central BP

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18
Q

What are the two types of cardiac arrect rhythm

A

Shockable:

  • VT
  • VF
  • pulseless VT

Non-shockable rhythms

  • Asystole
  • PEA (pulseless electrical activity)
19
Q

What are the reversible causes of H?

A
  • Hypoxia
  • Hypovolaemia - measure NA by doing ABG
  • Hyper/hypokalaemia (& other electrolyte disturbance)
  • Hypothermia
20
Q

What are the reversible causes of T?

A
  • Tension pneumothorax
  • Cardiac tamponade/pericardial effusion (ECHO - fluid around the heart)
  • Toxins
  • Thromboembolic
21
Q

How do you treat cardiac tamponade in an emergency?

A

Pericardiocentesis

22
Q

Assess:

  • •38 year old male
  • •Motorcycle vs car
  • •Bullseye windscreen
  • •LOC initially then GCS 15/15
  • •HR 100 BP 145/78
  • •GCS 9/15
A

Bullseye winscreen - head hits windscreen

LOC initially then GCS15/15 and then 9/15 so head injury

23
Q

What should you check for in any peripheral injuries e.g. inverted foot?

A

Pulse

Sensation

24
Q

Which drug is used for sedation when readjusting a displaced ankle/wrist?

A

Penthrox

25
Q
A
26
Q

What does the primary survey consist of?

A

Structure approach:

  • Airway with c spine control
  • Breathing
  • Circulation
  • Disability
  • Exposure

C-ABCDE

27
Q

What is the cause of a dilated pupil in trauma?

A
  • So much blood/swelling that pons is going through forament magnum and then you lose function (usually in one eye to begin with)
  • Can give mannitol (hypoosmolar saline)
28
Q

What does an extradural look like on CT?

A

Concave

Like a banana

29
Q
A

Sulci lost

Midline shift

  • 1.Subarachnoid haemorrhage
  • 2.Subdural haemorrhage
  • 3.Extradural haematoma
  • 4.Tumour
30
Q

How do you manage a head injury in ED?

A

Optimise oxygenation

  • –A, B, C

Keep CO2 normal

  • –A,B

Maintain cerebral perfusion

  • –(CPP= MAP-ICP)

Make sure nothing more life threatening takes priority

  • –Primary survey

Neurosurgical input & theatre

31
Q

What is the strongest predictor of injury from a history?

A

Mechanism of injury

  • –Applies to all trauma- minor and major
  • –Create a mental picture of events in your head
32
Q

How do you assess GCS?

A
33
Q

What are the different types of airways?

A
  • oropharyngeal.
  • nasopharyngeal.
  • endotracheal.
  • laryngeal mask airway.
  • cricothyroidotomy.
  • tracheostomy.
34
Q

What is a definitive airway?

A

Breathing is protected

Cuffed tube (with balloon at end) and able to provide oxygen

Nasopharyngeal is not a definitive airway.

35
Q

What might you feel in relation to breathing on palpation of the chest?

A

Surgical emphysema - feels like bubble wrap.

36
Q

How do you manage a tension pneumothorax?

A

In non trauma cases put a cannula to release pressure in the second intercostal space lateral to the sternum. Eventually a chest drain will be required.

In trauma –> thoracostomy - scalpel making hole. In the same position as a chest drain.

37
Q
A

Multiple rib fractures

Haemothorax

Surgical emphysema

38
Q

How do you assess circulation?

A

•Assessment

  • –Pulse, BP, capillary refill time
  • –General appearance

•Source of haemorrhage

  • –‘ on the floor & 4 more’
  • –Chest/Abdo/Pelvis/Long bones

•Treatments

39
Q
A
40
Q

What is the mnemonic for sources of haemorrhage?

A
  1. External sites and scalp
  2. Occult Traumatic Hemorrhage sites
    • Chest
    • Pelvis
    • Abdomen (and Retroperitoneum)
    • Thigh and long bones
41
Q

What should you give when someone in hypotensive in trauma?

A
  • Blood
  • Platelets and FFP
  • TXA
  • Warfarin
  • Correct caogulopathy with clotting factors
  • Damage control surgery
42
Q

How do you assess disability?

A

•GCS- Glasgow Coma Score

  • –level of consciousness
  • Pupils
  • Blood sugar
  • Limb movements
43
Q

Would you be worried if a 17 year old had a BP of 90/60 in trauma case?

A

Yes, usually young people can hold their blood pressure well

44
Q
A

Year 3 - Exams (25 decks)

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