Advice/EPIC Flashcards
(108 cards)
1
Q
Mental health
A
CDD (capacity, drugs, dependants) Capacity: weigh Risk: - green/amber/red Nursing 1:1? Frisked? Sharps/drugs Dependents Cause for concern form Drugs/alcohol MSE: psychosis/manic Section
2
Q
Calls for help
A
ED Consultant Major haemorrhage; code red Trauma Adult cardiac arrest MET/ Cardiac, Peri arrest Obstetric emergency Paediatric emergency Neonatal emergency Security (A+V)
Fast bleep
Intensive care
Anaesthetic
3
Q
TIA
A
CT head -> Aspirin 300mg High risk factors: ABCD2 >4 Crescendo TIA (>1/week) On anticoagulant In AF?
4
Q
TLoC
Reasons to admit
A
During exertion or supine
Family history <40
>65 w/o prodrome
Abnormal ECG
Heart murmur
Heart failure New SOB (?PE) Abdominal pain (?AAA)
5
Q
?Seizure
Signs
A
Eyes open Snoring/grunting Foaming/biting Blue Synchronous limb movement Partial seizure Lateral tongue bite
6
Q
Signs NEAD
Pseudo seizure
A
Fluctuating course Closed eyes Asynchronous movements Pelvic thrust Side to side head/body movement Ictal crying Absence postictal confusion
7
Q
?aortic dissection
A
Pulse deficit
Bilat BP
Focal neurology
ECG
CXR
8
Q
ECG ?HOCM
A
Dagger Q waves
(Deep and narrow)
- lateral and inferior
+- signs LVH
9
Q
ECG ?LV hypertrophy
A
R wave lead I
+
S wave lead III
>25mm
Or R wave in aVF>20mm
10
Q
Investigations to check
A
BED, obs, scan
- Blood and VBG
(Blood glucose)
- ECG +/- monitor
- Urine + bHCG
11
Q
Sedation
Overnight Qs
A
Department safe Time critical? Comorbidities Starved? Reflux? Airway
12
Q
Cardiac arrest Qs
Pre alert
A
Time onset/ duration arrest Bystander CPR Initial rhythm Treatment Cause of arrest? AMP QT
13
Q
Paeds GCS
V1-5
A
V5: coos babbles
V4: irritable cry, confused
V3: cry in response to pain, inappropriate words
V2: moans in response to pain, incomprehensible words/sounds
V1: no response
14
Q
Paeds GCS
M to 1-6
A
M6: purposeful movement (Obey command) M5: withdraw to touch (Localise pain) M4: withdraw to pain M3: abnormal flexion M2: abnormal extension M1: no response
15
Q
Acute liver injury
Dx and Mx
A
ALT>500 PT>17 ?paracetamol OD IVF and lansoprazole -> Medical referral
?Encepahlopathic
-> IV Abx +/- ICU
16
Q
Encephalopathy
Grade
A
1: abnormal behaviour
2: disorientated, drowsy, flap
3: confused, incoherent, drowsy
4: comatose
17
Q
Fracture description
A
Open/closed Neurovascular status Stable/unstable Displaced/angulated/shortened Comminuted
18
Q
Spinal shock
Vs
Neurogenic shock
A
Spinal concussion
- transient loss of function
19
Q
Sign of tamponade/ effusion
on ECG
A
Electrical alternans
Low voltage criteria
20
Q
Self discharging patient
A
Attempt to persuade
- concerns, risks, plan in ED
- safety net
Capacity? Mental health?
Self discharge papers
Document
Against medical advice
21
Q
Does person have capacity?
A
- Is there impairment/ disturbance of brain or mind?
- Does that impairment make them unable to make a specific decision
Test
- understanding, weigh, retain, communicate
22
Q
Personality disorder
Depression
And capacity
A
BPD: fluctuating capacity
Emotional dysregulation
Depression:
Pathological lack of care about ones own interests
Manifestation of the disorder
23
Q
How long to observe anaphylaxis after treatment? (2021 RCUK guideline)
A
2h if:
- 1 dose adrenaline
- has autoninjector
6h if:
- 2 doses adrenaline
- previous biphasic
12h if
- >2 adrenaline
- continuing allergen release
- unsafe
24
Q
65 year old with abdo pain
Ix
A
?AAA : USS ECG Bloods, VBG, amylase CXR CT abdo Surgical review
25
?orbital cellulitis
| Signs
Proptosis
Opthalmoplegia
```
Pain on eye movement
RAPD
Orbital pain
Conjunctival chemosis
Purulent nasal discharge
```
26
Escalation problems in ED
- Demand exceeding capacity
- Exit block
- Support process breakdown
27
Handover
| ABCDE
```
Areas and acuity
- resus, corridor
Beds
- medics, surg, ortho
Colleagues
- sickness
Deaths, disasters, deserters
Equipment, events
- blood gas
```
28
Night huddle
```
Introductions
Number in Dept, wait TBS
Area (resus)
Acuity (Unwell patients)
Specialty take lists
- theatre planned?
Beds - flow
Colleagues - fully staffed?
Disasters;
Resus/Trauma call overnight
- roles
```
29
Eye pH
7.2
| Equal bilat
30
Asymptomatic Electrical injuries
| Ix and plan
ECG
Urine dip; myoglobin
U+E, CK
Home if normal
31
Diameter of abdominal aorta
2-3cm
32
Syncopal episode
| Consider unusual causes;
PE
AAA
dissection
33
High risk groups
```
Paeds
Pregnant
Elderly abdo/back pain
Atraumatic CP
Elderly trauma
Syncope
Immunosuppressed
```
34
Things to consider as EPIC
Patients
Incoming
Department
Staff
35
General aspects procedure
```
Consent
Equipment
Position
Aseptic; field/gloves/apron
Clean
```
36
USS Doppler colours
Red
= blood moving toward probe
Red artery
Blue
= moving away from probe
Blue vein
37
Rhabdomyolsis defined by
Raise in CK 5x baseline
38
Contraindication
| Propofol
Soy or egg allergy
39
Nasty rash
| Check
Mucosal membranes
?Steven Johnson’s syndrome
?TEN
Eczema ?herpeticum
40
Gentamicin dosing
3-5mg/kg
Based on ideal body weight
3mg if over 65
Max 80mg OD if on dialysis
41
Rotator cuff injuries
| Tests
```
Empty can - supraspinatus
Ext rotation - infraspinatus
Lift off test (small of back)
- subscapularis
No test teres minor
```
42
Teenager social Qs
```
HEADSSS
Home
Education
Activities
Drugs
Sex
Safety
Suicide
```
43
Pericarditis findings
```
Pleuritic CP
Worse on lying flat
Better on sitting forward
Friction rub
ECG change
Troponin
```
44
Inferior ST elevation and back pain
| Consider
Dissection
| Flap covering R coronary Ostia
45
Drugs causing dystonia
```
Dopamine antagonists
Antipsychotics
Metoclopramide
Antiepileptics
Amphetamines
Antihistamines
```
46
Volar plate injury
Hyperextension fingers
Avulsion at PIPJ
Tx buddy strap + F/U
47
Mallet finger
Axial load or flx on finger
Unable to extend finger
Avulsion DIPJ
Tx mallet splint + F/U
48
Bennett fracture
```
Forced abduction thumb
Fracture at base of 1st MTC
Tx
Reduce and thumb spica POP
Refer to on call Ortho
```
49
Maisonneuve fracture
Tailor shift
+/- # medial malleolus
+ proximal fibular #
50
Taylor shift but no fracture
Maisonneuve fracture
Proximal fib fracture
Talofibular disruption
Deltoid ligament disruption
+\- medial malleoulus #
51
Hyperemesis gravidum
Prolonged N+V
Dehydration
Electrolyte disturbance
>5% pre-pregnancy weight loss
Consider admission if continued weight loss and ketonuria despite oral anti emetics
52
PID
| Sx
```
Lower abdominal pain
(Usually bilat)
+\- deep dyspareunia
+\- abnormal PV discharge
+/- abnormal bleeding
```
53
Contraindication to
| Beta blocker
Asthma
sBP<90
Severe HF
Phaeochromocytoma
54
Obstetric cholestasis
```
~1%
Prolonged pruritis
(Esp night including palms/soles)
Absence of rash
Abnormal LFT/bile acid
```
Comp:
Prematurity, intrauterine death
55
Lidocaine
| 10ml of 1% =mg
100mg
Max 3mg/kg
56
Causes of high anion gap acidosis
```
LTKR
Lactate
Toxins
Ketones
Renal
```
CATMUDPILES
57
Calculate anion gap
Na+K - HCO3+ Cl
Raised >30
Borderline 20-29
58
Causes normal anion gap acidosis
```
ABCD
Addisons
Bicarbonate loss (GI/renal)
Chloride excess
Diuretics
```
59
Horners syndrome and pain
Partial ptosis
Miosis
Anhydrosis
Pain in neck; cervical artery dissection
Pain in chest/arm; pancoasts tumour
60
Tripod fracture
| Facial
Inferior orbital rim
Lateral orbital rim
Zygomatic arch
61
Adequate c spine XR
Junction C7/T1
62
Central slip injury
| Test
Elsons test
Flx 90 deg then ext
Should extend with floppy distal phalanx
63
Skiers thumb
Ruptured ulnar collateral ligament
| Often associated avulsion fracture base of proximal phalanx of thumb
64
Volume of anaesthetic in digital nerve block
2-3ml per side/injection
65
ST elevation in aVR
>1mm
with recipricol changes in lateral leads
Left coronary occlusion
66
tachy and new low voltage ECG
Pericardial effusion until proven otherwise
67
Causes of Low voltage ECG
Conduction:
Effusion; Pericardial/ pleural
Fat
Air (COPD, PNX)
Low power
- cardiomyopathy
68
Locked knee Dx and Ddx
```
Unable to extend knee same as good side
Ddx
Meniscal tear
ACL injury
Loose body
```
69
Test ulnar collateral ligament of thumb
(Skiers thumb)
Fix MTC
Radial deviation of MCPJ
In extended and flexed position
Should be less than 15deg movement
70
Angles of Louis
5cm below sternal notch
Gives you 2nd intercostal space
71
Complications shoulder dislocation
Axillary nerve
Hill Sachs (top hill)
Bankart lesion (bank bottom)
72
Sub talar dislocation XR findings
Talus not aligned with navicular
73
AF management options
Unstable
Stable
- rhythm control (within 48h onset)
- rate control
74
LV vs RV strain ECG T waves
LV strain = TWI laterally
RV strain = TWI v1-3 and S1Q3T3
75
Post reduction TMJ dislocation
Soft diet 48h
Avoid wide mouth opening 2weeks
Support moth with hand during yawning
Consider Barton bandage if unable to comply or understand
76
HIV PEP
Within 72h
4 weeks of drugs
Test at 3months
77
Kawasaki diagnosis
CRASH and burn
Conjunctivitis
Rash
Adenopathy
Strawberry tongue
Hands and feet
Fever (>39) over 5 days
78
Zygomaticomaxillary injury advice
Avoid nose blowing
Do not occlude nose when sneezing
79
Malar region numbness due to
Inferior orbital nerve injury
80
Wernickes
Vs
Korsakoffs
Thiamine deficiency (acute vs chronic)
Wernickes
- triad; ataxia, confusion, opthalmoplegia
- reversible
Vs
Korsakoffs
- memory loss and confabulation
- irreversible
81
Clinical frailty score
1: very fit
2: no active disease Sx
3: managing well
4: vulnerable; Sx limit activities
5; mildly frail; help with some ADLs
6; moderately frail; help with dADLs and pADLs
7; severely frail; completely dependent for pADLs
8; very severely frail; completely dependent
9; terminally ill
82
Sudden onset sensorineural hearing loss Tx
Prednisolone 40mg OD, 1 week
PPI if indicated
83
Bell’s palsy Tx
Presnisolone 60mg OD 10 days
+|- Aciclovir 200mg OD
Eye taping
84
Manchester mandibular fracture rule ruled out if;
All negative
Malocclusion
Trismus
Pain with mouth closed
Broken teeth
Step deformity
85
Signs Ludwig’s angina
Trismus (reduced mouth opening)
Woody submandibular region
Tender submandibular region
Inability to protrude tongue
Tongue displaced superior and anterior
86
Upper airway signs of concern
Stridor
Trismus (limited opening)
Drooling
Change in voice
Tripoding
Resp distress
Limited neck movement
87
Biphasic T wave
Do not exist
Terminal portion determines if
Positive or negative
88
TWI normal variants
Isolated inversion (not in contigous leads)
aVR, V1
V2, III, aVL
Juvenile Twaves = TWI V1-3
89
RF for cerebral venous thrombosis
Third trimester
Recent oral contraceptive (oestrogen)
Coagulopathy
Recent sinusitis
90
Pregnancy drugs to avoid
Trimethoprim
tetracyclines
NSAIDS
Operates at birth
Sodium valproate
Ondanesetron under 12weeks
91
Headache in pregnancy consider
Cerebral vein thrombosis
Pre eclampsia
92
Consider neutropaenic sepsis and Dx
Chemotherapy last 6 weeks
Haematological malignancy
Stem cell transplant
Myelodysplastic syndrome
Dx
Neutrophil less than 0.5 and sepsis
93
Achilles tendon rupture signs
Palpate tender, step deformity
Active movement reduced
Simmons test
Feet hang over edge, squeeze calf, no movement shows tendon rupture
94
Normal anion gap
8-16 when not including K
10-20 when including K
95
Phaechromocytoma Tx
Alpha blockade
- phenoxybenzamine or phentolamine
Then b blockade
- propranolol
96
Lemierre syndrome
Thrombophlebitis of internal jugular vein
Secondary to oropharyngeal infection
Usually young people
Can lead to cerebral vein thrombosis and metastatic infection
97
Hereditary angioedema treatment
C1 esterase inhibitor
(Icatibant acetate)
FFP
98
SVCO Tx
? Intubation
IV steroids
IV furosemide
Endovascular stenting
Radiotherapy, chemotherapy
?surgical resection
99
Retinal artery occlusion. Tx
Ocular massage 10 sec on 5 off
Increase blood oxygen content 15L
Dilate retinal arteries; GTN
Reduce intra ocular pressure:
- acetazolamide and mannitol
Irreversible damage after 4h
100
Orthostatic hypotension Dx
30mmHg drop sBP if hypertensive
20mmHg drop sBP if normotensive
10mmHg drop dBP
101
Facial structures at risk of injury in facial lacerations
Parotid gland and duct
Lacrimal gland and duct
Facial nerve
102
DVLA medical reasons to stop driving (class1)
Ask if have class 2 licence
Arrhythmia: stop until diagnosis and controlled for 4 weeks
Seizure; 6m seizure free
LOC; undiagnosed LOC: 4w or 6m depending on low high risk and if treatment started
TIA; 1m
Menieres; until Sx controlled
Psychosis and mania; 3m
Schizophrenia; 3m if stable
Sleep apnea: until symptoms controlled
103
Test for rhinorrhea
Beta 2 transferrin
104
Carbon monoxide questions
COMA
Co-occupants similar Sx?
Outdoors better?
Maintenance; boilers and cooking appliances?
Alarm; CO functioning?
105
Indicators for liver transplant in paracetamol OD
pH <7.30 after 2 days
INR>6.5
Creatinine >300
Hepatic encephalopathy (grade 3/4)
Increasing INR on day 3 or 4
106
Consent from child
Gillick competent child or over 16
Parental consent
Court order
107
ECG in collapse - check
W - Wolff Parkinson White
O - Obstructed AV pathway
B - Bifascicular block
B - Brugada
L - LV Hypertrophy (consider AS, HOCM)
E - Epsilon wave
R - Repolarisation abnormality
108
Pseudo hyponatraemia
Normal or high serum osmolality
Due to high BG, high lipid or para protein
