A&E Flashcards
Burns management
Cool the burn & warm the patient
Run under cold water for 10 mins
Wrap in cling film - Not around
Hartmanns fluid resuscitation using Parklands formula (4xBSAxKg)
Refer to burns unit if BSA is 15% adult/10% child
Management of shock in trauma (5)
Early haemostasis with surgery, splintage or angiopraphy
Treatment of the lethal triad (Hypothermia - Acidosis - Coagulopathy)
Reduce excessive crystalloid/colloid use
Early use of RBC, Plasma and Platlets in 1:1:1
Hypotensive resuscitation
Major haemorrhage protocol
1st Tranexamic Acid
MHP
Order and give MHP#1 blood pack (4 FFP & 4 FBC) & take bloods (Cross match, FBC, PT, APTT, fibrinogen, U+E, Ca2)
Fibrinogen low = 2 packs of cryoprecipitate
PT ratio high = FFP
Platelets low = 1 Plates
Hb low = RBC
No response give MHP#2 (4 FFP, 4 RBC & 1 platelets) & re bloods
Indicators of blood loss
Obs
Base excess
Lactate
Central venous oxygenation
Major bleeding
Where
Management
On the floor and four more Chest Pelvis Abdomen/retroperitoneum Thigh
ACTIVATE MAJOR HAEMORRHAGE PROTOCOL
Split long bones and pelvis is suspected
Ultrasound FAST scan
Primary survey ALS (5Hs 4Ts)
Hypoxia Hypovolaemia Hypo/hyperkalaemia Hypothermia H+ ions - acidosis
Thrombosis (coronary or pulmonary)
Tamponade (cardiac)
Toxins
Tension pneumothorax
Chest trauma
ATOM FC
Airway obstruction - Noisy breathing, likely to aspirate.
Tension pneumothorax - Penetrating injury, collapesed affected lung, mediastinal and tracheal shift. LBC into 2nd intercostal space mid clavicular line
Open pneumothorax - Sucking chest wound. Managment 3 sided taped dressing to create a valve
Massive haemothorax - Needs chest drain
Flail chest - Floating ribs causing distorted chest movements. Assess Pa02/resp distress for intubation
Cardiac tamponade - Becks triad may help (Rising JVP, falling BP and muffled heart sounds)
Anaphylaxis management
Airway managment & 100% O2 Remove the cause & raise legs Adrenaline 0.5mg IM 1:1000 Iv access - Chlorenphenamine 10mg & Hydrocortisone 200mg Fluids 500ml/15mins If wheeze treat for asthma
Definition of SIRS
2 or more from: Temp <36 or >38 HR >90 RR >20 WBC <4x10^9 or >12x10^9
Sepsis
Severe sepsis
Septic shock
SIRS in the presence of infection
Sepsis with organ hypoperfusion
Severe sepsis with hypotension <90mmhg
STEMI Management
ECG, FBC, U&E, trop, glucose, cholesterol
Aspirin 300mg + Ticagrelor 180mg
Morphine + Metaclopramide
GTN
O2
Restore coronary perfusion - PCI/Fibrinolosis
Anticoagulation. - Daltaparin
NSTEMI Management
02
Morphine + Metaclopramide
GTN
Aspirin 300mg + tiagrelor 180mg
Metoprolol - If containdicated give Verapamil
Anticoagulation. - Daltaparin
If trop progression/ECG changes give tirofiban
Pulmonary oedema management
Sit patient upright O2 100% Iv access and ECG Diamorphine Frurophine 40-80mg GTN/Nitrate infusion
Broad complex tachycardia management
If in doubt treat as VT (>3 in a row) as most common
Shock
Amiodarone
Correct K and Mg
Torsades de points = Irregular polymorphic complexes - Give Mg IVI
Narrow complex tachycardia management
ECG + O2 - Rhythm irregular = AF treat appropriately
Rythum regular = Perform vagal manoeuvres
Adenosine 6mg, 12mg, 12mg
Adverse signs - Hypotension, HF, Impaired consciouesness, HR >200 - Shock
No adverse signs
B Blocker IV, Amiodarone, Digoxin.
