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Flashcards in Emergencies Deck (53)
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1

What do you look for in 'A' of ABC assessment?

Airway safe?
Obstruction? stridor?
Aspiration risk if conscious level below 8 GCS

2

What do you look for in B of ABC?

Breathing:
Resp rate
Depth of respiration
Pattern of respiration/work of breathing
Oxygenation
CO2 elimination (hypercapnic-> bounding pulse)
Not breathing? Call 2222, use bag and mask

3

Categories of causes of swallow/airway dysfunction

Neuro vs direct

4

Name 7 neuro causes of swallow dysfunction

• Coma
• Anaesthesia
• MND
• MS
• Brainstem stroke/haemorrhage
• Congenital/genetic
• Muscular weakness/poor cough

5

Name 4 direct causes of swallow/airway dysfunction

• Injury, radiotherapy
• Malignancy
• Burns
• Infection

6

What is bad about a Guedel airway?

If person has gag reflex they may vomit
When it is too large it can close the glottis
Improper sizing can cause bleeding in the airway

7

How do you size a Guedel?

Size it by measuring mouth to angle of mandible

8

What is type 1 respiratory failure?

Type I (hypoxaemic) resp failure
PaO2< 60 mm Hg with a normal or low PaCO2
VQ mismatch (eg alveoli collapse/fluid filled)
eg pulmonary oedema, pneumonia

9

What is type 2 respiratory failure?

Hypercapnic
Ventilation failure
PaCO2>50mm Hg
eg drug overdose, neuromuscular disease, chest wall abnormalities

10

What are the 3 types of rhythm the defib will recognise?

Shockable (VF/pulseless VT)
Return of spontaneous circulation
Non shockable (PEA/asystole)

11

What rhythms are shockable?

VF
Pulseless VT

12

What rhythms are non shockable?

Asystole
PEA (pulseless electrical activity)

13

If shockable rhythm, what happens in CPR?

1 shock
CPR for 2 mins
Assess rhythm again

14

What happens when spontaneous circulation returns after CPR?

Use ABCDE approach
Aim for SpO2 94-98%
Aim for normal PaCO2
12 lead ECG
Treat cause
Temperature management

15

Reversible causes of cardiac arrest

4H's 4T's
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia
Hypothermia
Thrombosis (coronary/pulmonary)
Tension pneumothorax
Tamponade
Toxins

16

Is anything injected in CPR?

Adrenaline every 3-5mins
Amiodarone after 3 shocks
or if non shockable adrenaline every other cycle

17

Describe a good chest compression

30:2
100-120bpm
5-6cm depth or 1/3 depth of chest

18

6 emergency causes of chest pain
Symptoms that differentiate cause

• STEMI (CV risk factors, Hx, STEMI will respond to cath lab treatment, 0 r and 3 hr troponin)
• Aortic dissection (BP dropping, pallor, shock, sudden, radiates to back- CT aortogram
• Pneumonia/pleuritis
• Pulmonary embolism (d-dimer to rule out if low risk,
• Pericarditis (echo to look for tamponade)
• Mediastinal tumour (weight loss/cough)

19

6 emergency causes of headache
Symptoms that differentiate cause

• SAH (sudden onset, worst headache ever within a second of onset, can remember what they were doing, papilloedema, meningism, focal neurological deficit)
• Meningitis
• SOL: positional, progressive, night and early morning, papilloedema
• Acute close angle glaucoma: visual loss
• Temporal arteritis (ESR, palpable pain, visual loss)
• Vertebral artery dissection (neck pain)

20

6 emergency causes of SOB
Symptoms that differentiate cause

• PE (DVT?)
• Pneumonia (crackles/consolidation)
• Anaphylaxis (significant airway swelling & airway compromise, urticarial, low systolic pressure (90), wheeze).
• Heart failure (paroxosymal nocturnal dyspnoea, leg swelling, functional exercise ability)
• Asthma (control/prev hospital admissions/ITU/intubation/steroid tablets)
• Anaemia

21

Immediate treatment of anaphylaxis

IM adrenaline 1/1000. 0.5ml. (500micrograms).
Hydrocortisone
Fluids (due to distributive shock)

22

9 emergency causes of abdo pain
Symptoms/signs that differentiate cause

• AAA rupture (sudden, epigastric(?) pain. Examination, USS!
• Appendicitis (anorexia, intermittent epigastric pain->constant R iliac fossa pain)
• Ectopic pregnancy (lateralised pain, Beta-HCG (urine or blood), PID/untreated PID, previous ectopic
• Perforated peptic ulcer (erect chest x-ray
• Bowel obstruction (complete constipation, no flatus) Abdo XRay
• Toxic megacolon Abdo xray
• Pelvic inflammatory disease (fever)
• Renal colic
• Pyelonephritis (loin->groin)

23

9 causes of collapse

• Hypoglycaemia
• Acute airway obstruction
• Large PE (obstructive shock)
• Septic shock
• Arrythmia
• Valvular dysfunction
• Vasovagal
• Epileptic tonic-clonic syndrome
• Toxic syndrome (drug)

24

What is SBAR?

A way of communicating quickly and effectively with other healthcare professionals
Situation (I am__, F1 on __ ward. I am calling about pt ____ because _____)
Background (___ was admitted on __/__ with ____. They has ___, change, last obs, what is normal)
Assessment (I think problem is___ and I have given ___. But deteriorating/not sure)
Recommendation (I need you to come and see the pt, is there anything I can do in the meantime?)

25

How to treat 4H's for reversible causes of cardiac arrest

Hypoxia: open airway, ventilate patient
Hypovolaemia: trauma/upper GI bleed, sepsis. Give IV fluids, O-ve blood
Hypo/hyperkalaemia: Use ABG reading. Give replacement if hypo or insulin and glucose and calcium chloride if hyper
Hypothermia: eg drowning

26

How to treat 4T's for reversible causes of cardiac arrest

Tamponade: drain pericardial effusion
Thromboembolism: massive PE, thrombolyse/PCI if cardiac
Toxins: opioids, TCAs, Benzos.
Tension pneumothorax: trauma/central line placement. Large bore cannula 2nd intercostal space mid clavicular line

27

2 categories of shock

High flow and low flow

28

3 types of low flow and high flow shock

Low flow shock: hypovolaemic, cardiogenic, obstructive
High flow, vasodilatory: septic, anaphylactic, neurogenic

29

What needs to be assessed in shock?

Cardiac instability (pulse/BPin both arms/cap refill/temp)
Respiratory distress (airway/resp rate/o2 sats/chest pain)
Appearance (cold&clammyin cardiogenic/hypovolaemic, warm&well perfused in septic, urticarial&angiodema&wheeze in anaphylaxis)
• Conscious level
• Pain
• Anxiety/agitation
JVP (up in cardiogenic, down in hypovolaemic)

30

What 4 things make you worried about renal failure?

Uraemia
Pulmonary oedema
Acidosis
Hyperkalaemia (worsened by acidaemia)