HR > 90 RR > 20 WCC 12 temp > 38 or < 36

EM Flashcards by john terry

presentation of anaphylaxis

airway - swelling, stridor
breathing - SoB, wheeze, accessory muscle use, cyanosis
circulation: tachycardia, hypotensive, pale, clammy
skin: urticaria, erythema, angio oedema, pruritis
GI: N&V, diarrhoea, abdo pain

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management of anaphylaxis

IM 1:1000 adrenaline
IV fluids
chlorphenamine
hydrocortisone

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pathophysiology of anaphylaxis

IgE mediated: release of histamine and other proinflammatory mediators from mast cells and basophils
causes vasodilation and capillary leakage resulting in tissue swelling (airway obstruction) and volume depletion (shock)

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what are the reversible causes of cardiac arrest

hypoxia, hypovolemia, hypo/hyperkalaemia, hypothermia

thrombosis, tension pneumothorax, tamponade, toxins

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what are the shockable and non shockable rhythms is cardiac arrest

shockable
VF and pulseless VT

non shockable
Pulseless electrical activity and asystole

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management of cardiac arrest

CPR 30:2
shock if appropriate
give adrenalin every 5min
give amiodarone after 3 shocks
treat reversible causes

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qSOFA

GCS < 13
RR >22
SBP < 90 or DBP < 60

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SIRS

HR > 90
RR > 20
WCC <4 or > 12
temp > 38 or < 36

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define sepsis and septic shock

sepsis
Life-threatening organ dysfunction due to dis-regulated host response to infection

septic shock
sepsis with refractory hypotension (criteria = sepsis + need for vasopressors to maintain MAP of at least 65 + lactate > 2)

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markers of severe asthma attack

PEF < 50%
RR > 25
HR > 110
cannot complete sentences

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markers of life threatening asthma attack

SpO2 < 92
silent chest, cyanosis, poor respiratory effort
arrhythmias or hypotension
exhaustion or altered consciousness

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management of acute asthma attack

moderate = 4 puffs salbutamol then 2 puffs every 2 mins for 10 min -> reassess -> discharge/repeat salbutamol

severe = salbutamol nebs + oral prednisolone -> reassess ->discharge/repeat

life threatening = ICU input, salbutamol nebs + ipratropium nebs + oral pred/IV hydrocortisone
repeat nebs in 15 mins
consider continuous nebs or IV magnesium sulphate
patient will require admission

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management of acute COPD exacerbation

oxygen - aim of 88-92%
salbutamol and ipratropium nebs
oral pred/IV hydrocortisone
antibiotics if pyrexial 
consider aminophylline
consider IV magnesium (if wheeze is main component)

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investigations for cardiac chest pain

ECG
HSTnT
routine bloods
Lipid profile
consider: d dimer, chest x ray, glucose, ECHO

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what position and artery do each ECG leads correspond to

V1 - V4 = anterioseptal/posterior (depression) - LAD/RCA or LCx
V5 - V6 = apical - LCx
I, aVL = lateral - LCx
II, III, aVF = inferior - RCA

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pathophysiology of paracetamol overdose

paracetamol is metabolised into a toxic substance
normally this is bound to glutathione in the liver to form a non toxic compound which is excreted
however in an overdose the liver’s glutathione stores are depleted meaning the toxic metabolite builds up causing hepatic injury

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management of paracetamol overdose

if presents within 1 hour of ingestion = activated charcoal
if within 2-8 hours = measure paracetamol levels at 4hrs, NAC if over the normal
with in 8-24 hours = give NAC, measure paracetamol level, discontinue if normal with no evidence of AKI or hepatic injury
> 24 hours = NAC if jaundice, hepatic tenderness, INR > 1.3 or ALT > 2xULN

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investigations for paracetamol overdose

paracetamol levels
LFTs
U&Es - AKI
INR
ABG - lactate acidosis

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what is the toxic dose for paracetamol toxicity

> 150mg/kg over 24 hours

presentation of opioid overdose

CNS depression/coma

bradycardia, bradypnoea, hypotension, hypothermia

management of opioid overdose

A-E
observation
naloxone if RR<8, SpO2<94, type 2 resp. failure

presentation of sedative overdose

confusion/coma

bradycardia, bradypnoea, hypotension, hypothermia

management of sedative overdose

A-E
for benzodiazepines = flumazenil if resp. depression
for barbituates = charcoal hemoperfusion or haemodialysis

drugs that can cause serotonin syndrome

SSRI
lithium
triptans
MAOI
cocaine

presentation of serotonin syndrome

tachycardia, tachypnoea, hypertension, hyperthermia | sweating, flushing, tremor, D&V, agitation

management of serotonin syndrome

benzodiazepines for agitation and muscle relaxation cyproheptadine is the antidote IV fluid if rhabdomyolysis

drugs that can cause anticholinergic overdose

antihistamines antipsychotics TCA

presentation of anticholinergic overdeose

``` dry flushed skin dry mucous membranes mydriasis hyperthermia, hypertension, tachycardia, tachypnoea delirium, hallucinations ```

management of anticholinergic overdose

cooling benzodiazepine if agitated sodium bicarbonate if QRS prolonged

presentation of CO overdose

headache, dizziness, confusion tachycardia, arrhythmias abdo pain, N&V SoB

management of CO overdose

intubation if unconscious high flow oxygen cardiac monitoring consider hyperbaric oxygen

presentation of DKA

N&V, abdo pain hyperventilation, ketone breath polyuria, polydipsia, dehydration altered conscious level

investigations for DKA

VBG glucose urine ketones CXR, BC, UC, WCC, CRP ECG, troponin

management of DKA

IV sodium chloride IV insulin potassium if < 5 if glucose falls below 14mmol/l in first 4 hours start IV glucose 10% adjust insulin to maintain glucose between 9-14 if cerebral oedema IV mannitol or dexamethasone

when would one use the canadian c spine rule

for adults (>16) with a neck injury, is stable (SBP>90, RR = 10-24) and has a GCS of 15

what are the high risk factors in the Canadian C spine rule

age > 65 dangerous mechanism e.g. fall >3 feet, RTA >60mph, axial load to head numbness/tingling in limbs significant distracting injury

GCS eyes

``` 4 = spontaneously 3 = to verbal command 2 = to pain 1 = none ```

GCS verbal

``` 5 = oriented 4 = confused 3 = inappropriate words 2 = incomprehensible noise 1 = nonw ```

GCS motor

``` 6 = obeys command 5 = localizes to pain 4 = withdraws from pain 3 = flexion to pain 2 = extension to pain 1 = none ```

blood investigations for a patient that has collapsed

``` Hb - anaemia WWC/CRP - infection glucose - hypo troponin - ACS/ischaemia Mg - arrhythmias U&Es - arrhymias ```

management of a massive PE

``` oxygen IV fluids morphine nor adrenaline Anticoagulation (enoxaparin/rivaroxaban/Warfarin) alteplase ```

investigations for a PE

``` well's (2 or more = CTPA, <2 = d dimer) d dimer CTPA CXR baseline bloods ```

alternatives to CTPA

ECHO (if haemodynamically unstable) | V/Q scan (renal failure, pregnancy)

presentation of a PE

pleuritic chest pain, dyspnoea, cough, haemoptysis | tachycardia, tachypnoea, fever, raised JVP

symptom/sign progression in paracetamol overdose

N&V, lethargy RUQ tenderness, hepatomegaly Jaundice, encephalopathy AKI, Lactic acidosis, coagulopathy, death