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Emergencies Flashcards

1
Q

Anteroseptal MI leads and artery?

A

V1-4, LAD

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2
Q

Antereolateral MI leads and artery?

A

V4-6, 1, AvL, LAD or left circumflex artery

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3
Q

Inferior MI leads and artery?

A

II, III, AvF

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4
Q

Lateral MI leads?

A

I, AvL, V5-6

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5
Q

Lateral MI artery involvement?

A

Left circumflex artery

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6
Q

Posterior MI ECG changes?

A

Tall R waves V1-2

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7
Q

What are the reversible heart attack causes?

A

Hypoxia, hypothermia, hypovolaemia, hypokalaemia
tension pneumothorax, thrombosis, tamponade, toxins

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8
Q
  • Inferior MI mx arrythmia?
A

medical management (atropine; fatigue of AV nodal cells can be reversed)

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9
Q
  • Anterior MI mx arrythmia?
A

temporary TC pacing  permanent pacemaker

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10
Q

Dressler’s syndrome

A

(2-6 weeks), pericarditis (<48 hours)
 S/S: fever, pleuritic pain, pericardial effusion, raised ESR
 Mx: NSAIDs

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11
Q
  • Complications of an MI
A

DARTH VADER:

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12
Q

Morphine dose in MI?

A

o Morphine (5-10mg IV; repeat after 5 minutes if needed) + metoclopramide (10mg IV)

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13
Q

Management of acute pulmonary oedema?

A

o (1) Sit them up  high-flow O2 (if SpO2 decreased)
o (2) IV diamorphine (3mg) + IV metoclopramide (10mg) [caution in liver failure and COPD]
o (3) IV furosemide (40-80mg) [larger dose in renal failure]
o (4) SL GTN spray x2 [if SBP ≥100mmHg, use IV GTN] Ix: ECG  ABG, BNP  CXR
o (5) Further management:
 Further furosemide [40-80mg]
 Further nitrate infusion [maintain SBP ≥90, if it drops <100, treat as per cardiogenic shock]
 CPAP

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14
Q

Safety borders for needle compression?

A

Base of axilla, 5th ICS, lateral edge of pectoris major, lateral edge of latissimus dorsi

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15
Q

Doses of drugs in asthma acute management?

A

5mg salbutamol
0.5mg ipatropium bromide
40-50mg PO prednisolone for 5 days

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16
Q

What to measure in suspected carbon monoxide poisoning?

A

Carboxyhaemoglobin

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17
Q

Mx of carbon monoxide poisoning

A

o 100% high-flow oxygen via a NRB mask (continuing for a minimum of six hours)  target 100% SpO2
o Hyperbaric oxygen (limited evidence base)

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18
Q

Phaechromocytoma tx?

A

o 1st: short-acting alpha blockade  long-acting alpha blockade phentolamine = phenoxybenzamine
o 2nd: beta blockade
o 3rd (delayed 4-6w)  surgery (4-6 weeks after presentation to allow for full alpha blockade to occur)

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19
Q

Information about poisoning?

A

Toxbase

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20
Q

(haemodialysis indicated in overdoses of which drugs?

A

-Barbiturates
- Lithium
- Alcohol
- Salicylates
- Theophylline
Remember BLAST

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21
Q

Ix for suspected poisoning?

A

o All unconscious patient = glucose, paracetamol, salicylate levels (IN ALL POISONING)
o FBC, U&E, LFTs, INR; ABG; ECG

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22
Q

Mx of poisoning?

A

Activated charcoal > gastric lavage
 Activated charcoal (50g every 4 hours, with water): reduces absorption of drug
* Indications: paracetamol, carbamazepine, dapsone, theophylline, quinine, phenobarbital
* CIs: alcohols, metal salts (lithium, iron), petroleum, corrosives, clofenotane, malathion

 Gastric lavage: rarely used, if used after 30-60 minutes, may make matters worse
o Haemodialysis
o Antidotes (TOXBASE, Poisons Information Service)

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23
Q

o BDZ (i.e. diazepam, Z-drugs) reversing agent?

A

Flumazenil (if iatrogenic)

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24
Q

o Opiate (codeine, methadone, heroin) reversing agent?

A

Naloxone

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25
o Paracetamol reversing agent?
N-acetylcysteine
26
o Aspirin reversing agent?
Sodium bicarbonate
27
o TCA (amytriptyline; w/ long QT/arrhythmia) reversing agent?
Sodium bicarbonate
28
o Beta blockers reversal agent?
Atropine (low HR), glucagon (low BP)
29
o Ethylene glycol (antifreeze) reversal agent?
Fomepizole
30
o Iron reversal agent?
Desferrioxamine
31
o Cyanide reversal agent?
100% O2 + sodium nitrite/thiosulphate
32
o Organophosphates (inactivate AChE) reversal agent?
Atropine
33
o Digoxin reversal agent?
Digifab (Digoxin-specific antibody)
34
Paracetamol overdose treatment
 ≤2 hour  activated charcoal  Ix: paracetamol level ≥4 hours after ingestion  NAC if indicated  ≥2 hour  Ix: paracetamol level ≥4 hours after ingestion  NAC if indicated  ≥8 hours (+ ingested amount >75mg/kg)  NAC  Ix: paracetamol level  If ingestion time unknown or staggered overdose (taken over ≥1 hour)  NAC
35
Transplant crtieria post-paracetamol overdose
 Arterial pH <7.3, 24 hours after ingestion; OR  PT >100s (INR >6.5) AND creatinine >300mol/L AND grade 3 or 4 HE
36
S/S of salicylate overdose?
 Specific  Tinnitus, hyperventilation, vertigo  Non-specific  vomiting, dehydration, sweating
37
o Dose-related response to salicylate overdose?
150mg/kg (mild); 250mg/kg (moderate); >500mg/kg (severe); >700mg/kg (fatal)
38
Mx of salicylate OD?
o ≤1 hour  activated charcoal: further ix:  Bloods: paracetamol level, salicylate level, glucose, FBC, U&Es, LFTs, INR, clotting, ABG  Urine: catheterisation  Acidosis: if >500mg/L salicylate OR severe metabolic acidosis  alkalinisation of urine (IV NaHCO3)  Dialysis: if >700mg/L salicylate OR AKI, HF, pulmonary/cerebral oedema, seizures, etc
39
Mx of hypopituirary coma?
o 1st  Hydrocortisone o 2nd  T3 o 3rd  prompt surgery (if cause is apoplexy)
40
Addison's criteria?
o Initial management:  1st  IM hydrocortisone (100mg, STAT)  2nd  IV fluid bolus (0.9% saline, >90 SBP) ± glucose o Continuing management:  IV fluids  IV/IM hydrocortisone (100mg/8h)  PO dexamethasone after 72 hours (consider fludrocortisone)
41
Hydrocortisone delivery is addison's criteria?
Hydrocortisone = IM  IV  PO
42
Myxoedema coma s/s?
 Hypothyroid signs (bradycardia, coma, seizures, psychosis)  Hypothermia  Hyporeflexia [LMN sign – less likelihood of head trauma or brain tumour]
43
Mx of myxoedema coma?
 IV T3 (5-20mcg/12 hours) – T3 acts faster than T4 (as T4 is just converted into T3 in the body)  IV hydrocortisone (100mg/8 hours)  Further as needed: warming blanket, fluids (caution), ABx (if infection suspected)
44
S/s of thyroid storm?
hyperthyroidism (fever, agitation, confusion, coma, tachycardia, AF, D&V, goitre, HF)
45
Management of thyrotoxic storm?
 1st = Propranolol (60mg, QDS, IV) ± digoxin use diltiazem if beta-blockers contraindicated  2nd = Carbimazole (inhibits TPO; 15-25mg, QDS, PO)  3rd = Hydrocortisone (100mg, QDS, IV) OR dexamethasone (2mg, QDS, PO)  Other  treat precipitant (i.e. infection, ABx), IV fluids, cooling
46
HHS criteria?
BM >33.3mmol/L Hyperosmolar >330mmol/kg Volume deplete
47
Mx of HSS?
LMWH (VTE risk high) Slow rehydration (over 48hrs) ½ RATE OF FLUIDS OF DKA Deficit = 8-15L for 70kg adult Replace K+ when UO increases
48
Criteria for DKA?
BM > 11mmol/L Ketones >3 Acidosis pH <7.3
49
Hypoglycaemia treatment, unconsciousness/no swallow
IM glucagon (community, no IV) OR Glucose 20%, 100mL, IV, over 10 mins
50
Hypoglycaemia >4, conscious
Long-acting CHO (two biscuits, one slice of bread, 200–300 mL of milk)
51
Hypoglycaemia <4, conscious
Glucotabs (4-7) * OR 150-200mL fruit juice OR 4 teaspoons sugar dissolved in water
52
When to use glucogel?
capable but uncooperative, can swallow
53
Warfarin requires daily INR monitoring until INR stable with:
Antibiotics Regular tramadol Fluconazole AND Omeprazole Amiodarone Corticosteroids (high dose)
54
Adenosine dose for narrow complex tachycardia?
6mg, go up to 12mg
55
Treat for stable broad complex tachycardia?
Amiodarone 300mg IV or 20-60 mins then 900mg over 24 hours
56
Treatment for meningitis?
Cefotaxime IV + ampicillin if immunocompromised or >55 y/o
57
Dose of benzylpenicillin
1.2g IM
58
Treatment for acute ischaemic stroke?
Aspirin 300mg, oral, once only
59
Treatment for secondary pneumothorax??
<2cm = aspirate >2cm or SOB or >50 y/o = chest drain
60
Treatment for primary pneumothorax?
<2cm and no SOB = dishcarge and f/u in 4 weeks >2cm or symptomatic = aspirate
61
Acute GI bleed tx?
ABC + O2 Hx and o/e 2 large bore cannula Catheter + fluid monitoring Crystalloid bolus Cross-match 6 units of blood Correct clotting abnormalities Endoscopy Stop culprit drugs (NSAIDs, aspirin, warfarin, heparin) Call the surgeons if severe
62
CURB-65 Criteria?
Confusion (AMTS<8) Urea > 7.5mmol R = respiratory rate >30/min Blood pressure systolic <90mm hg > 65 y/o
63
Hypoglycaemia treatment unconscious
Glucagon 1mg IM
64
Acute poisoning tx?
-ABC -History -Cannula and catheter (strict fluid balance) -supportive measures (fluids and analgsia) -Correct electrolyte disturbance -Reduce absorption (charcoal, lavage) -Increase elimination (N-acetylcysteine etc) -Psychiatric assessment by liasion pysch
65
Benzodiazepine reversal agent?
Flumenazil
66
Drug for DVT/PE?
Use enoxaparin (easier to prescribe)
67
Where to find warfarin INR info?
Oral anticoagulants – warfarin INR stuff here
68
Good treatment summaries?
Medical emergencies in the community Prescribing in palliative care Constipation Fluids and electrolytes Venous thromboembolism
69
Enzyme inducers?
Phenytoin, carbamezapine, rifampicin, alcohol, sulphonylureas, St John's wort, smoking, phenobarbital
70
Enzyme inhibitors?
Z Azoles G DEVICES Sodium valproate, isoniazid, macrolides, metronidazole, grapefruit juice, omeprazole, ciprofloxacin, sulphonamides,
71
What not to give with clopidogrel?
Omeprazole
72
Patients in a fluid deficit; give fluids at what rate?
1L over 4-6 hours
73
Emergency hypoglycaemia fluids?
10% glucose 150ml over <15 minutes
74
Emergency hypercalcaemia fluids?
0.9% sodium chloride 1000ml over 4 hours
75
Maintenance fluids with no deficits?
0.9% sodium chloride + 0.3% potassium chloride 1L over 8-12 hours
76
Fluids in someone with fluid deficit?
0.9% sodium chloride + 0.3% potassium chloride 1L over 4-6 hours
77
Common prescription errors?
-Levothyroxine is prescribed in mcg -Methotrexate is given weekly with folic acid -Wrong indication -Incorrect dose
78
Which drugs can affect the liver?
Statins
79
Drugs to stop in AKI?
Diuretics, ACEi, NSAIDs, vancomycin, gentamicin, antifungals, cyclophosphamide, contrast
80
When to give loop diuretics?
Earlier in the day
81
What does 1% mean?
* 1 g in 100 mL (or 10 mg in 1 mL) for weight/volume (w/v) calculations; or * 1 g in 100 g for weight/weight (w/w) calculations
82
Metabolic alkalosis causes?
Vommitting, diuretics and conn's syndrome
83
Metabolic acidosis causes?
DKA, renal failure, methanol/ethanol intoxication
84
Most common cause of leg cellulitis?
Streptococcus pyogenes
85
To what regional lymph nodes is ovarian cancer most likely to spread initially?
Para-aortic nodes
86
Management of gallstones?
Laparoscopic cholecystectomy
87
Treatment for venous ulcers?
Compression stockings
88
S/S uveitis?
red eye, headache and visual disturbance and is associated with a small pupil.
89
A 65 year old man has sudden pain and redness in his ﾠright eye. He also has a headache and nausea. Visual acuity isﾠ 6/60 ﾠin the right eye. The eye is congested, with a hazy cornea and mid-dilated pupil.
Acute glaucoma
90
Ix for probable stroke?
Non-contrast CT head is the most rapid investigation to exclude intracranial haemorrhage and allow thrombolysis.
91
DPP4 inhibitor drug names?
"gliptins" sitagliptin, saxagliptin, linagliptin, and alogliptin.
92

Year 6 (26 decks)

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