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A2: Acute Emergencies and Pre-hospital Care > ABCDE > Flashcards

Flashcards in ABCDE Deck (29)
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1

In all emergencies, what should be considered to be the primary cause of shock (until proven otherwise)?

Hypovolaemia

2

If a patient has cool peripheries and tachycardia, what should you give them?

i.v. fluid

3

Circulation:

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.

4

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

5

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.

35-45 mmHg.

It suggests arterial vasoconstriction which can be caused by Hpovolaemia (severe burns, haemorrhage) or Cardiogenic shock (MI, heart failure).

6

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)

7

What drugs are given in the later treatment of Acute Coronary Syndrome?

(They are split into 4 groups)

ACEi/ARB

Beta blocker

Aspirin (75mg) and Clopidogrel (for 1st 12 months post ACS)

Statin (high dose)

8

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)

CO poisoning
Hyponatraemia
Opioid toxicity
RICP
Pulmonary oedema
Stroke

9

Kussmaul’s respiration is a type of hyperventilation.

What condition is it associated with?

(Deep, sighing respiration)

Diabetic ketoacidosis.

10

Disability:

You are in A and E, a patient comes in with pin point pupils.

What is your 1st differential?

Opioid overdose

11

Disability:

You are in A and E, a patient comes in with dilated pupils.

Name 4 possible differentials

Tricyclic antidepressant overdose
SSRIs (antidepressants)
Ketamine
Alcohol
Cannabis
Amphetamines (used for ADHD, Obesity and Narcolepsy)

12

Disability:

If you see a pregnant woman seizing, what do you give them?

Magnesium sulphate

13

Breathing:

What are 6 signs seen in a tension pneumothorax?

1. Difficulty breathing
2. Hypotension
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

14

Breathing:

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

15

Circulation:

If a child has low blood pressure, what is this an emergency sign of?

Severe shock

(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)

16

Use a word to describe oesophageal reflux pain

Burning

17

Give a description of the pain in aortic dissection

Tearing sensation

18

Paediatric Circulation:

In diabetic ketoacidosis of a child what is the amount of the initial crystalloid bolus?

What route?

Why is it this value?

10ml/kg. Intraosseous. To prevent cerebral oedema.

19

Paediatric Disability:

How do you treat hypoglycaemia?

Give 2ml/kg 10% glucose IV or IO (intraosseous) then give a glucose infusion (to prevent recurrence)

20

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

21

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

22

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).

23

In anaphylaxis, itching of the palate and/or external acoustic meatus can be a sign on?

Airway blockage

24

Discuss how you would administer an IV fluid challenge in an:

A) Adult

B) Adult with cardiac failure

C) Child

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

Child: 20mL/kg

25

What antihistamine do you give in anaphylactic shock?

Chlorphenamine

26

Circulation:
Give 3 signs of pericardial tamponade

Muffled heart sounds
Distended neck veins
Hypotension

27

Disability:

If a non-pregnant patient is seizing, what drug should you give them?

Iv Benzodiazepine

28

Disability:

When examining the patients pupils with a light, if they are unequal what does this indicate?

And what should you do?

Indicates RICP

Lift their head 30 degrees off the bed (only do this if no ?neck/spinal cord trauma) + emergency referral to surgery

29

Hospital:

What are the 2 treatment options for Bell’s palsy that has a presentation within 72 hours

1. Oral 25mg Prednisolone bd x 10 days

2. Oral 60mg Prednisolone once daily for 7 days then decrease dose by 10mg each day (after the 7th day)