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finals > Emergencies > Flashcards

Emergencies Flashcards

1
Q

metabolic causes of coma?

A 
Drugs e.g. CO poisoning, alcohol, tricyclics
Hyper/hyperglycaemia
Hypoxia
Septicaemia
Myoxedema/Addisonian crisis
Hepatic/uraemic encephalopathy
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2
Q

neurological causes of coma?

A

Trauma
Infection- meningitis, encephalitis, malaria
Tumour
Vascular- stroke, SAH/SDH, hypertensive encephalopathy
Epilepsy

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3
Q

immediate mx of coma?

A

ABC
Check BG- give 50ml 20% glucose IV stat if needed
IV thiamine if suggestion of wernicke’s encephalopathy
IV naloxone for opiate intoxication

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4
Q

Ix of coma?

A 
ABG
FBC, U&E, LFT, ESR, CRP
Ethanol
Toxic screen
Drug levels
Blood cultures
Urine culture
CXR
CT head
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5
Q

signs of shock?

A 
low GCS/agitation
pallor
cool peripheries
tachycardia
slow capp refill
tachypnoea
oliguria
lactate
reduced BP
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6
Q

2 physiological causes of shock?

A

MAP = CO x SVR

reduced CO or reduced SVR

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7
Q

causes of inadequate CO?

A
  1. hypovolaemia- bleeding or fluid loss

2. pump failure- cardiogenic shock, PE, tension pneumothorax, cardiac tamponade

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8
Q

causes of peripheral circulatory failure?

A
  1. sepsis
  2. anaphylactic
  3. neurogenic e.g. spinal cord injury
  4. endocrine failure
  5. drugs e.g. antihypertensives
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9
Q

signs and symptoms of anaphylaxis?

A
  • itching, sweating, D&V, erythema, urticaria, oedema
  • wheeze, laryngeal obstruction, cyanosis
  • tachycardia, hypotension
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10
Q

mx of anaphylaxis?

A
  • secure airway
  • give 15L O2 non-rebreathe mask
  • remove the cause
  • adrenaline IM 0.5mg (0.5mL of 1:1000)
  • secure IV access
  • chloramphenamine 10mg IV and hydrocortisone 200mg IV
  • IV saline
  • if wheeze, treat for asthma
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11
Q

tests on admission if suspected STEMI?

A

12 lead ECG, U&E, troponin, glucose, cholesterol. FBC. CXR

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12
Q

initial treatment of STEMI?

A

Aspirin 300mg PO
Morphine 5-10mg IV with metoclopramide 10mg IV
O2 if sats <95%
GTN spray

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13
Q

when should PCI be performed?

A

within 120 mins of admission

if not possible fibrinolysis should performed and if unsuccessful, transfer for rescue PCI or angiography

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14
Q

main choice of agent for thrombolysis?

A

tissue plasminogen activator e.g. alteplase or tenecteplase

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15
Q

what med needs to be given in primary PCI?

A

IV anticoagulant e.g. bivalirubin

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16
Q

contraindications to thrombolysis?

A 
prev intracranial haemorrhages
ischaemic stroke <6 months
cerebral malignancy 
recent major trauma or surgery (<3 weeks)
GI bleeding (<1 month)
known bleeding disorder
aortic dissection `
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17
Q

ECG criteria for thrombolysis?

A

ST elevation
LBBB
Posterior changes e.g. deep ST depression and tall R waves in leads V1 to V3

18
Q

complications to STEMI?

A 
recurrent ischaemia
stroke
pericarditis
cardiogenic shock
HF
19
Q

brief history questions in NSTEMI?

A

prev angina
relief with nitrates/rest
hx of cv diseaase
RFs for IHD

20
Q

brief examination in NSTEMI?

A 
pulse
BP
JVP
cardiac murmurs
signs of HF
peripheral pulses
scars from prev cardiac surgery
21
Q

acute management of NTEMI?

A

O2
morphine and metoclopramide
GTN spray
aspirin and second antiplatelet agent e.g. clopidogrel, ticagrelor
oral beta blocker if hypertensive
anticoagulant e.g fondaparinux (factor Xa inhibitor) or LMWH

22
Q

causes of severe pulmonary oedema?

A
  1. cardiovascular e.g. ususally left vetricular failure, valvular heart disease, arrhythmias, malignant hypertension
  2. ARDS caused by trauma, malaria, drugs
  3. Fluid overload
  4. Neurogenic e.g. head injury
23
Q

differential diagnosis of pulmonary oedema?

A

asthma/ COPD

pneumonia

24
Q

symptoms of pulmonary oedema?

A

dyspnoea
orthopnoea
pink, frothy sputum

25
Q

signs of pulmonary oedema?

A 
distressed
pale
sweaty
tachycardia
pulsus alternans
high JVP
fine lung crackles
gallop rhythm
wheeze
26
Q

Ix of pulmonary oedema?

A 
CXR- cardiomegaly, shadowing, small effusions at costophrenic angles, fluid in the ling fissures, kerley B lines
ECG- signs of MI
Bloods- U&amp;E, troponin, ABG
ECHO
plasma BNP
27
Q

mx of acute heart failure?

A
  1. sit the patient upright
  2. O2
  3. IV access and monitor ECG
  4. diamorphine 1.25-5mg IV slowly
  5. Furosemide 40-80mg IV
  6. GTN spray
  7. if systolic BP >100 start a isosorbide dinitrate infusion
  8. if systolic BP <100 treat as cardiogenic shock
    LOON
28
Q

long term mx of heart failure?

A 
daily weight
repeat CXR
change to oral furosemide
can add thiazide
ACEi if LVEF <40%
consider beta-blocker and spironolactone
29
Q

what is cardiogenic shock?

A

a state of inadequate tissue perfusion primarily due to cardiac dysfunction

30
Q

causes of cardiogenic shock?

A 
MI
arrhythmias
PE
tension pneumothorax
cardiac tamponade
myocarditis; myocardial depression (drugs, hypoxia)
valve destruction (endocarditis)
aortic dissection
31
Q

mx of cardiogenic shock?

A 
O2
Diamorphine 1.25-5mg IV 
investigations and close monitoring
correct arrhythmias, U&amp;E abnormalities or acid-base disturbance
look and treat reversible causes
32
Q

what is cardiac tamponade?

A

pericardial fluid collects -> intrapericardial pressure rises -> heart cannot fill -> pumping stops

33
Q

what 4 things to check in CXR if you think it’s normal?

A

apices (TB or sarcoid)
diaphragm (perforation)
bones (fractures)
behind the heart (shadowing)

34
Q

what can be seen on a CXR in pulmonary fibrosis?

A

reticulonodular opacities

35
Q

causes of cardiac tamponade?

A 
trauma
lung/breast cancer
pericarditis
MI
bacteria e.g. TB
36
Q

signs of cardiac tamponade?

A

falling BP
rising JVP
muffled heart sounds (beck’s triad)
kussmaul’s sign (JVP rising on inspiration)
pulsus paradoxus (pulse fades on inspiration)

37
Q

diagnosis of cardiac tamponade?

A

CXR- globular heart, left heart border convex or straight, right costophrenic angle <90 degrees
ECG- electrical altercans

38
Q

what is broad complex tachycardia?

A

rate >100bpm and QRS complex >120ms (>3 small squares)

39
Q

principles of mx of broad complex tachycardia?

A
  • if in doubt, treat as VT

- identify the underlying cause

40
Q

differentials of broad complex tachycardia?

A
  • VT including torsade de pointes
  • SVT with aberrant conduction e.g. AF, atrial flutter with bundle branch block
  • pre-excited tachycardia e.g. AF, atrial flutter, AVRT
41
Q

what are adverse signs of broad complex tachycardia?

A

systolic BP <90
chest pain/ischaemia on ECG
heart failure
heart rate >150bpm

finals (14 decks)

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