Ax Emergency Flashcards
(46 cards)
What causes Irukandji syndrome
Jelllyfish sting. ( box jelly fish )
After 20-30mins catacholamine surge causes tachycardia,hypertension and agitation..it will develop into pulmonary edema and possibly Lethal cardia anomalies.
What’s post transplant fever in bone marrow transplant
Before BMT Chemo and radiotherapy done to destruction of bone marrow. So it takes some time for new cells production.—-> there will be all 3 cells deficiency—-> risk of infection due to leukopenia and risk of bleeding due to thrombocytopenia.
Seen after 4-5 days of bone marrow transplant , resolves by 6-7 days.
But since infection is common in post transplant patients , they have to be thoroughly investigated—-> get CXR and do blood culture.
How to manage a gunshot wound
If stable -
1.. Complete neurovascular examination
2. Compartment syndrome
3. Plan chest X-ray
4. Abdominal X-ray with 2 views.
5. Ct scan
What could be the cause of post carotid endarterectomy post op day 4 progressive sob
Man falling from 3 meters height and landing on his feet and complains of severe pain,bruising and swelling of left heel. What’s the work up
AXIAL LOADING following a fall is the mechanism of injury to calcaneus fracture.
A fall that’s significant enough to produce calcaneus fracture could be associated with other injuries as well. Such as spinal,internal injuries ,knee injuries, hip injuries.—-> therefore X-ray series is the best management.
How to manage a victim of a closed space fire ( not a burn victim)
How to manage human bites
What are indications for anti venom administration
What are itial steps in snake bite
Causes of postoperative chest pain
Initial step in jelly fish sting
Causes acute sharp pain and inflammatory response at the site of sting.
I severe envenomation cardiopulmonary collapse may occur.
Initial step is applying vinegar to neutralize nematocysts discharge.
After neutralization pain control by immersion in a hot water bath and may need more analgesics like morphine even.
Post insertion of permanent pacemaker, patient develops chest pain, raised JVP, CLEAR LUNGS, muffled heart sounds. What the diagnosis
Permanent pacemaker insertion done via venous access under local anesthesia.
But common complications can occur - bleeding, infection, pneumothorax ( commonest complication) , hemothorax, myocardial perforation.
Above scenario shows cardiac tampon are due to myocardial perforation.
Next step- even if it’s a clinical diagnosis , 2D echo is important for identification and also helps as a guide in pericardiocentesis ( WHICH IS THE IMMEDIATE TREATMENT )
What are tetanus prone wounds
How to consider tetanus vaccination for wounds
For patients who have no documented history of primary vaccination should receive course of catch-up vaccination as well.
Elderly patient with agitation following major surgery. Confused and delirious and difficult to deal with. What’s the diagnosis and next best step
Delirium following major surgery.
( cause could be hypoxia due to anesthesia or analgesics , electrolyte Imbalance, hypoglycemia, infections )
—-> management depends on u deleting etiology—-> ABG is the initial step to diagnose hypoxemia but difficult as patient is agitated—-> can give HALOPERIDOL for sedation —-> as second line can give RISPERIDONE OR OLANZEPINE. ( pharmacological measures taken only for severe disturbance by the patient )
What’s the management of post appendicectomy ,tender erythematous fluctuant swelling at surgical site
Suggests abscess formation.
Initial mx is incision and drainage - IV antibiotics can be given as adjunct management.
Commonly wound infection on post op 7th day but could occur on any day.
Management of atelectasis
Chest physiotherapy, deep breathing, active coughing , incentive spirometry followed by supplemental oxygen.
Sometimes these measures fail due to mucus plus blockage—> to remove that bronchoscopy should be done —-> while doing that CPAP should be started.
Post of day 1 fever sob tachycardia in cholecystectomy patient. He was a smoker. What’s the diagnosis
Atelectasis is a common cause of fever in first 24hrs post op.particularly in smokers.
Other symptoms - pleuritic chest pain and sob.
Wound infection takes about 7 days
Post op pneumonia due to Atelectasis on day 3
Biliary leakage won’t show SOB. Also abdominal pain would be prominent.
PE commonly around 5th day
Treatment method in post op atelectasis
Chest physiotherapy —-> oxygen supplementation to maintain spo2 >90% —-> postural drainage to clear the secretions —-> bronchoscopy indicated if cheat physiotherapy fails ( not done routinely)
Antibiotics are not indicated in atelectasis UNLESS infection follows.
Commonest cause of post op confusion
One of the serious complications.
Commonest cause is hypoxia—> must be excluded by ABG.
( commonly due to hypoventilation as a result of sedative drugs and analgesics)
Other causes should be excluded as well
Electrolyte imbalances( commonly hypo and hypernatremia )
Chest X-ray should be done after confirming hypoxia for atelectasis and pneumonia features.
What’s post op oliguria and how to manage it
Oliguria is a common post op problem. It’s considered if <500ml of urine within first 24hrs post op.
Could be caused by pre renal( hypoperfusion) , renal failure ( AKI) or post renal ( obstruction) causes
Commonest cause among those is HYPOVOLEMIA —-> so initial step is a FLUID CHALLENGE.
What’s the management of pneumothorax
Stab wound to left side chest , laboured breathing, reduced saturation , dullness over affected lung.. what’s the management
Mild hypoxia should be corrected initially—> supplementation of oxygen—-> followed by inediate chest tube insertion as definitive Rx.
After RTA unconscious, hypotension, tachycardia, respiratory strider heard, saturation 88%, X-ray shows fractures and dislocated cervical spine. How to manage
Compromised airway and spinal injury noted.
OROTRACHEAL INTUBATION IS THE PREFERRED METHOD OF AIRWAY MANAGEMENT FOR TRAUMATIC CARDIOPULMONARY ARREST , even with CERVICAL SPINAL INJURY. L
Rapid sequence intubation protocol is started for intubation along with in-line spinal stabilization.
