Capsule: Emerg

Question 1

Criteria making anaphylaxis likely

Answer 1

Sudden onset and rapid progression of sx

Life threatening ABC problems

Skin and/or mucosal changes (flushing, urticarial, angioedema)

Exposure to a known allergen for the pt supports the dx

Most reactions occur over several minutes and quicker if an IV trigger

The patient will look and feel unwell

There may also be GI sx such as D+V

Question 2

Mx for anaphylaxis

Answer 2

Stop offender, high flow O2, early anaesthetist intervention to I+V if required, 500microg IM adrenaline, 200mg IV hydrocortisone, 10mg IV chlorphenamine, 1L Hartmann’s solution

Question 3

What is Livedo Reticularis?

Answer 3

A normal phenomenon resembling mottling of the skin caused by red blood flow

Question 4

When is Livedo Reticularis concerning?

Answer 4

DIC plus severe sepsis

Question 5

The sepsis six

Answer 5

IN
O2, abx, fluid challenge

If remain hypotensive despite fluids then crit care review for consideration of vasopressors

OUT
Lactate, cultures, urine output

Plus FBC, U&Es, LFTs, CRP, ABG

Question 6

How does sepsis cause a cardiac arrest?

Answer 6

Acute MI, hypoxia, hypovolaemia

Question 7

Mx for asystole

Answer 7

I+V, 100% O2, 0.9% saline/Hartmanns bolus, CPR w adrenaline every 3-5mins during rhythm checks

Question 8

What is the rule of nines for working out percentage total body SA involved in a burn?

Answer 8

Wallace’s Rule of Nines:

Ant Trunk - 18%

Post Trunk - 18%

Whole Leg - 18%

Whole Arm - 9%

Whole Head - 9%

Palm/Genitals - 1%

Question 9

How do you calculate the fluid requirement for the first 24h following a burn?

Answer 9

All adults w burns >15% TBSA should receive fluids using the Parkland Formula: 4ml x Wt in kg x %Burn

Question 10

Over what time period are fluids given following a burn?

Answer 10

First half of fluids given over first 8hrs and second half given over nxt 16hrs

Question 11

When do you catheterise burn pts?

Answer 11

> 20% TBSA or if they’re intubated

Consider if 15-19% TBSA or if w perineal burns

Question 12

When titrating fluids what urine output do you wish to maintain?

Answer 12

> =0.5ml/kg/hr

Question 13

What are the indications for referral to a regional burns unit?

Answer 13

Burns >10% TBSA in an adult, >5% TBSA in a child, >5% TBSA if full thickness

Burns of face, hands, feet, perineum, genitalia or major joints

Circumferential, chemical or electrical burns

Burns in the presence of major trauma or significant co-morbidity

Burns in the very young, pregnant or elderly patient

Suspicion of NAI

Question 14

Why are burns painful?

Answer 14

Air moving across exposed nerve endings hence apply cling film

Question 15

What can you give if simple analgesia is not controlling the pain from a burn?

Answer 15

One off dose of intra-nasal diamorphine

Question 16

Superficial v Partial v Full

Answer 16

Superficial burns are usually dry, sometimes with minor blistering and erythema. Painful. Often due to sunburn or minor scalds. Involve the epidermis.

Partial thickness burns are moist and red, usually with broken blisters and normal capillary refill. Involve the dermis. They are usually painful unless they are deep dermal. Deep dermal burns may also have sluggish capillary refill.

Full thickness burns are dry, charred and often white. They are painless and have absent capillary return. They have destroyed the epidermis and dermis and have begun to destroy the underlying subcutaneous tissue.

Question 17

Why should you deroof the blisters following a burn?

Answer 17

To accurately assess the depth

Question 18

Mx for epistaxis

Answer 18

Pressure to ant aspect for 15-20mins

Cautery w silver nitrate to the side bleeding

Rapid rhino into both nostrils for up to 24hrs

Foley catheter nose-oropharynx and repack nose

Question 19

What is immediately administered once cardiac arrest has been confirmed and pt does not have a shockable rhythm?

Answer 19

Adrenaline

Question 20

Diazepam OD

Answer 20

Drowsiness, respiratory depression, ataxia and hypothermia

Question 21

Sertraline OD

Answer 21

Vomiting, tremor, drowsiness, dizziness, tachycardia and seizures

Question 22

TCA OD

Answer 22

Mild-Mod: dilated pupils, tachycardia, drowsiness, dry mouth, urinary retention, confusion and agitation

Severe: hypotension, cardiac rhythm disturbance, hallucinations and seizures

Question 23

What are the indications for treating amitriptyline od?

Answer 23

Metabolic acidosis or wide QRS complexes

Question 24

What do you do after diagnosing an acute subdural haematoma, raised INR and stopping the warfarin?

Answer 24

Discuss w neurosurgery and give Octaplex w 5mg IV vitamin K

Question 25

What are the shockable and non-shockable rhythms?

Answer 25

Shockable: VF + pulseless VT -> one shock and 2mins CPR then reassess Non-Shockable: asystole + pulseless electrical activity -> 2mins CPR then reassess

Question 26

What is the toxic dose of paracetamol?

Answer 26

75mg/kg

Question 28

What are the Toxbase guidelines following a paracetamol OD?

Answer 28

>75mg/kg: bloods at 4h post ingestion, plot results on normogram, either NAC or referring to psych >150mg/kg: if unable to act on bloods within 8h post ingestion give NAC immediately

Question 29

Which bloods do you recheck after the 21h NAC infusion?

Answer 29

INR and ALT

Question 30

When should you admit a pt w burns to secondary care?

Answer 30

>3% TBSA

Question 31

What appearance of a burn suggests which depth?

Answer 31

Superficial epidermal: red + painful Superficial dermal: pale pink, painful, blistered Deep dermal: typically white but may have patches of non-blanching erythema + red sensation Full thickness: white/brown/black, no pain, no blisters

Question 32

What is the dosing of NAC?

Answer 32

150mg/kg over an hr 50mg/kg over nxt 4hrs 100mg/kg over nxt 16hrs