Flashcards in ABCDE Deck (29)
In all emergencies, what should be considered to be the primary cause of shock (until proven otherwise)?
If a patient has cool peripheries and tachycardia, what should you give them?
How do you measure Capillary refill time?
What is the target CRT?
If the CRT is prolonged, what does this indicate?
Squeeze a digit for 5s, at heart level.
Let go and time how long it takes for the skin to return to the colour of the surrounding skin - should take < 2s.
It indicates poor peripheral circulation.
What does a low diastolic pressure suggest about the arteries?
Name 2 types of distributive shock that can have this effect.
Suggests arterial dilation.
Anaphylaxis or Sepsis
What is the normal range for pulse pressure?
What does a narrow pulse pressure suggest about the arteries.
Give two types of shock that can have this effect.
It suggests arterial vasoconstriction which can be caused by Hpovolaemia (severe burns, haemorrhage) or Cardiogenic shock (MI, heart failure).
What 4 steps are involved in the immediate treatment of Acute Coronary Syndrome?
How are they given?
1. 300mg Aspirin given orally (chewed or crushed) *ASAP*
2. GTN spray or tablet given sublingually
3. Oxygen - only if their SpO2 is below 94% breathing air alone
4. Morphine titrated i.v. (- to prevent sedation and respiratory depression)
What drugs are given in the later treatment of Acute Coronary Syndrome?
(They are split into 4 groups)
Aspirin (75mg) and Clopidogrel (for 1st 12 months post ACS)
Statin (high dose)
What is Cheyne-Strokes respiration?
CHORPS stand for 5 causes of Cheyne-Strokes respiration. Name all 5.
Cyclical form: Increase in breathing, followed by a decrease in breathing, followed by breathing cessation (apnoea)
Kussmaul’s respiration is a type of hyperventilation.
What condition is it associated with?
(Deep, sighing respiration)
You are in A and E, a patient comes in with pin point pupils.
What is your 1st differential?
You are in A and E, a patient comes in with dilated pupils.
Name 4 possible differentials
Tricyclic antidepressant overdose
Amphetamines (used for ADHD, Obesity and Narcolepsy)
If you see a pregnant woman seizing, what do you give them?
What are 6 signs seen in a tension pneumothorax?
1. Difficulty breathing
3. Tracheal deviation to opposite side of affected lung
4. Absent breath sounds on affected side
5. Hyper-resonance on percussion of affected chest side
6. DISTENDED NECK VEINS
If a child comes in with stridor and you can do a handover/transfer them quickly, what do you give them?
If you can’t do a rapid transfer/handover, what do you give them?
Rapid: Nebulised Adrenaline
Slow: IM Adrenaline
If a child has low blood pressure, what is this an emergency sign of?
(The shock is in the SEVERE state because children in shock have a normal blood pressure for a long amount of time and the blood pressure only rapidly deteriorates when in the severe stage)
Use a word to describe oesophageal reflux pain
Give a description of the pain in aortic dissection
In diabetic ketoacidosis of a child what is the amount of the initial crystalloid bolus?
Why is it this value?
10ml/kg. Intraosseous. To prevent cerebral oedema.
How do you treat hypoglycaemia?
Give 2ml/kg 10% glucose IV or IO (intraosseous) then give a glucose infusion (to prevent recurrence)
How do you measure the temperature of a:
1) Less than 4 week old (1)
2) 4 week - 5 year old (3)
1) electronic thermometer in the axilla
2) electronic thermometer in the axilla, chemical dot thermometer in the axilla or infra-red tympanic thermometer
What is the other name for Kawasaki disease?
*this disease is rare and mainly affects children under the age of 5*
*there is no known cause and it is not contagious*
Give 7 features that are likely to be present with this disease.
Mucocutaneous lymph node syndrome
- cervical lymphadenopathy
- erythema and cracking of lips
- erythema of oral and pharyngeal mucosa
- strawberry tongue
- polymorphous rash
- erythema and oedema of hand and feet
- bilateral conjunctival infection with no exudate formation
Discuss the treatments for Kawasaki disease (3).
*need IMMEDIATE hospital admission*
Aspirin: high dose - anti inflammatory, anti pyretic and pain relief. Once symptoms have gone may still need 6-8 weeks low dose Aspirin: anti-platelet to prevent clot formations.
IVIG: should see improvement within 36 hours of it being given. If not, give another dose.
Corticosteroid: if second dose of IVIG is ineffective or if there is high chance of the disease causing heart problems. (Infants <1 typically get heart problems as a result of the disease so may go straight to steroid treatment).
In anaphylaxis, itching of the palate and/or external acoustic meatus can be a sign on?
Discuss how you would administer an IV fluid challenge in an:
B) Adult with cardiac failure
Adult: 500mL of warmed crystalloid (Hartmann’s or 0.9% saline) over 5-10 minutes
Adult with cardiac failure: 250mL of warmed crystalloid (Hartmann’s or 0.9% saline) over 5-10 minutes
What antihistamine do you give in anaphylactic shock?
Give 3 signs of pericardial tamponade
Muffled heart sounds
Distended neck veins
If a non-pregnant patient is seizing, what drug should you give them?
When examining the patients pupils with a light, if they are unequal what does this indicate?
And what should you do?
Lift their head 30 degrees off the bed (only do this if no ?neck/spinal cord trauma) + emergency referral to surgery