Emergencies Flashcards by Jacob Whatmore

Narrow Complex Tachycardia - with Adverse signs

O2, Iv access, 12-lead ecg

Expert help
Sedation
Up to 3 synchronised DC shocks
Correct any electrolyte disturbances
Amiodarone 300mg IV over 20 min, 900mg over 24 h via central line

How well did you know this?

Not at all

Perfectly

Narrow Complex Tachycardia - No adverse signs - regular rhythm

O2,

IV access, 12 lead

Vagal manoeuvres (think about digoxin toxicity, ischaemia, carotid bruit)

If fail, give Adenosine 6mg bolus IV, then 12 mg if necessary.

How well did you know this?

Not at all

Perfectly

Narrow Complex Tachycardia - No adverse signs - regular rhythmSinus rhythm not achieved by adenosine/verapamil

Possible Atrial Flutter

Seek expert help - possible rate control with beta-blocker

How well did you know this?

Not at all

Perfectly

Narrow Complex Tachycardia - No adverse signs - regular rhythmSinus rhythm achieved

Probable paroxysmal re-entrant SVT

ASSESS ECG for WPW

if recurrent consider referall

How well did you know this?

Not at all

Perfectly

Narrow Complex Tachycardia - No adverse signs - regular rhythm
Irregular

Probable AF

Anti-coagulate - warfarin or DOAC

Rate control - Beat blocker eg metoprolol 1-10mg IV

Rhythm control – if definitely under 48 or coagulated over 3 weeks consider DC cardioversion

Can cardiovert with Flecanide 300 mg PO or Amiodarone 300 mg IVI over 20-60 min

How well did you know this?

Not at all

Perfectly

Function of adenosine in Narrow complex tachy

Transient AV block

Slows ventricles to show underlying atrial rhythm

can cardiovert junctional tachycardia to sinus rhythm

How well did you know this?

Not at all

Perfectly

Broad complex tachycardia with adverse signs

Sedate
3x synchronised DC shock

Correct electrolyte disturbances

Amiodarone 300mg IV over 20 in, consider repeat shock then 900mg over 24hFurther cardioversion

Consider procainamide or overdrive pacing

How well did you know this?

Not at all

Perfectly

Broad complex tachycardia without adverse signs - regular

If VT or uncertain rhythm - Amiodarone 300mg IV 20 min, then 900mg over 24 hrIf known SVT or BBB treat as narrow complex tachy (i.e. adenosine)

How well did you know this?

Not at all

Perfectly

Broad complex tachycardia with adverse signs - irregular

Usually one of :

AF - with BBBP

re-excited AF - amiodarone

Polymorphic VT - Torsade de pointes - Mg 2g IVI

How well did you know this?

Not at all

Perfectly

Broad complex tachycardia with adverse signs but cannot stabilise

Sedate

Synchronised DC shock

How well did you know this?

Not at all

Perfectly

Bradycardia with Adverse signs

Atropine 500 mcg IV

How well did you know this?

Not at all

Perfectly

Bradycardia with Adverse signs - no response to original therapy

repeat atropine every 3-5 mins (max mg)

Transcutaneous pacing

Isoprenaline 5 mcg/min

Adrenaline 2-10mcg/min

How well did you know this?

Not at all

Perfectly

Bradycardia with risk of asystole

Atropine 500 mcg every 3-5 mins max 3mg

Transcutaneous pacing

Isoprenaline

Adrenaline

How well did you know this?

Not at all

Perfectly

Management of Acute STEMI

12 lead ECG

IV ACCESS - FBC, U&E, glucose, Lipids, Troponin

I/O - CVS disease, pulse, BP, JVP, murmurs, CI to PCI or fibrinolysis?

Aspirin 300mg

Ticagrelor 180mg (or alt. antiplatelet)

Morphine 10 mg plus anti-emetic like metoclopramide 10mg IV

Reperfusion therap

yBeta blocker if no HF/Asthma/BBB

How well did you know this?

Not at all

Perfectly

Management of Acute STEMIwithin 120 min, already had aspirin

primary PCI

How well did you know this?

Not at all

Perfectly

Management of Acute STEMI>120 min

Fibrinolysis - alteplase Ideally <30 min from admission

If not done within 12h or stemi, fonduparinux or enoxaparin

Anaphylaxis

A-Secure Airway

B-100% oxygen

Remove any known causeC-Raise feet to help restore circulation

Adrenaline IM 0.5mg (0.5mL 1:1000)Repeat every 5 min

Secure IV access

IVI 0.9% saline 500 mL over 15 mins

May need neb Salbutamol, hydrocortisone IV later

Tonsillitis

Infection of the palatine tonsils

pain, fever, dysphagia and cough

a frequency of more than 7 episodes per year for one year, 5 per year for 2 years, or 3 per year for 3 years, and for whom there is no other explanation for the recurrent symptoms), referral to an ear, nose, and throat specialist is advised as this cohort may benefit from tonsillectomy.

Quinsy

Comp of bacterial tonsillitis

deviating the uvula away

Trismus (difficulty fully opening the jaw), unilateral symptoms and a ‘hot potato’ voice

Admission,

IV abx, drainage

Epistaxis

Anterior or posterior plexus - 90% anterior (Little’s area)

Greater palantine artery in older

Epistaxis emergency management

A-E
Pinch cartilage, 20 mins

Cuaterise with silver nitrate

Pack nose anterior (rapid rhino) or posterior (foley catheter) depending on where bleed is - tamponades

may require surgical ligation

Emergency airway obstruction - causes

Cancers
Oropharyngeal

Laryngeal

Base of tongue

Infections
Epiglottitis

Deep neck space infections

Foreign body
Mostly seen in children

Emergency airway obstruction - red flags

Stridor/Stertor
Cyanosis
Agitation
Respiratory distress
Wheeze
Decreased breath sounds on auscultation

Emergency airway obstruction - management

Call for help

Nebulised adrenaline/salbutamol

Intubation

tracheostomy

Emergency- epiglottitis

supraglottic tissue infection Haemophilus Influenza type B infection usually

Emergency - epiglottitisKey symptomsManagement

3 D's are the key symptoms: Drooling Distressed Dysphagia IV abx Laryngoscopy - lateral neck radiograph O2, Steroids - dex, 0.08-0.3 mg/kg/day

Asthma exacerbation - grading

Moderate - PEF 50-75% Severe - PEF 33-50%, RR 25, HR 110, inability to complete sentences in one breath Life-threatening - PEF <33%, SpO2 <92%, PaO2 <8 kPa, Normal PaCO2, Altered GCS, cyanosis, hypotension, arrythmia, silent chest, poor respiratory effort Near fatal - raised PaCO2 or requirement of mechanical ventilation

Asthma exacerbation Management

``` Sit up 15L O2 Salbutamol neb 5 mg +/- ipratropium 500 micrograms Prednisolone 40mg PO (or hydrocortisone 200 mg IV) ``` repeat 2.5mg Salbutamol every 10-15 min, reasses PEFR and sats reg BIPAP in COPD COnsider aminophyline 0.5-0.7 mg/kg/h Mg sulfate 2g IV over 20 min

Croup symptoms

Barking cough Inspiration stridor Increased WOB May have widespread wheeze

Croup treatment

0.3 mg/kg dex or 1mg/kg Pred Vomiting? Budesone 2mg AND nebulised adrenaline 0.5 ml/kg (max 5 ml) repeat every 5 min

Stevens-Johnsons syndrome - management

Cease medications, IV fluids, NG access

Flail chest

Multiple rib fractures with > or = 2 rib fractures in more than 2 ribs

Diaphragmatic rupture

CXR changes include non visible diaphragm, bowel loops in the hemithorax and displacement of the mediastinum. In most cases direct surgical repair is the best option.

Syringomyelia

Associated with Arnold-Chiari malformation - fluid filled cyst, expands over time

Buerger's disease

Young male smoker with symptoms similar to limb ischaemia - inflammatory vasculitis

CREST syndrome

systemic sclerosis comprising calcinosis, Raynaud's phenomenon, oesophageal dysmotility, sclerodactyly and telangiectasia. - CCB, Prostaglandins

Paediatric Sepsis 6

O2, fluids, ABx, IV access, inotrope support, senior clinician early

Pneumonia follow up

All cases of pneumonia should have a repeat chest X-ray at 6 weeks after clinical resolution

Hepatorenal syndrome mx

vasopressin analogues, for example terlipressin, have a growing evidence base supporting their use. They work by causing vasoconstriction of the splanchnic circulation volume expansion with 20% albumin transjugular intrahepatic portosystemic shunt