Emergencies Flashcards
(113 cards)
1
Q
Anaphylaxis
Adult
A
ABCDE
Remove causitive agent
Lie flat, legs up
15L non rebreathe
0.5mg IM adrenaline (1:1000)
1 L IV fluid STAT
? Salbutamol/adrenaline Neb
After 2 doses IM
1mg adrenaline in 100ml
1ml/kg/hr then titrate
2-6h observation
2
Q
Anaphylaxis
Child doses drugs
Adrenaline and IVF
A
Adrenaline:
>12 = 500mcg
6-12 = 300mcg
<6 = 150mcg
IVF = 20ml/kg
3
Q
Choking
Adult
A
Effective cough
- encourage cough
Ineffective cough Conscious: - 5 back blows - 5 abdominal thrusts Unconscious - start CPR
4
Q
Pre alert Adult Cardiac arrest
Actions
A
Check pulse (Trolley) Roll, Transfer
Start CPR and clock
Pads and rhythm check
Airway and capnography
IV access and VBG
2 minute cycle; time
Hx
Arrest time, CPR start time, PMH, QoL
5
Q
Unresponsive patient
Unconscious patient
A
Stimulate: verbal/pain
Signs of life: Pulse check
Pads and BVM
ABCDE
6
Q
Cardiac arrest
Drug doses
A
Adrenaline 1mg IV (1:10000)
Amiodarone 3rd and 5th shocks
- 300mg IV
- 150mg IV
7
Q
Bradycardia
Signs of decompensation
A
Shock, syncope, angina, HF
Risk of asystole:
Mobitz II, CHB, ventricular pause >3s
Consider High ICP, hypoxia
8
Q
Bradycardia
Treatment
A
Atropine 500mcg IV
Isporenaline 5mcg/min
Adrenaline 2-10mcg/min
Glycopyrronium 200-400mcg
Transcutaneous pacing
9
Q
Stable Tachycardia
Dx
A
Narrow complex - irregular: AF - regular: SVT Broad complex - regular: VF ?SVT + BBB - irregular: AF + BBB
Other:
Polymorphic VT
WpW
10
Q
WpW
Tx
A
Electrical cardioversion
Consider amiodarone
Do not give
Adenosine, beta/Ca blocker
(Block AV node)
11
Q
Polymorphic VT
Torsades de pointes
A
Magnesium 2g IV (over 10 mins)
Do not give amiodarone
Prolongs QT
12
Q
Fast AF
Tx
A
Stable Rhythm control? Rate control: Bisoprolol 5-10mg IVF bolus Digoxin 500mcg Amiodarone 300mg (30-60min)
13
Q
SVT
Treatment
A
- Modified valsava
- Adenosine (?WpW?asthma)
6,12,18mg - Sync shock
14
Q
VT
Treatment
A
Unstable
Sync shock
Stable
Amiodarone 300mg (20-30mins)
Then 900mg over 24h
15
Q
Unstable tachycardia
Treatment
A
Sync shock (x3)
- Sedation
- 100,150,200
Amiodarone 300mg (20min) - repeat shocks
16
Q
Adenosine
Contraindications
A
WpW
Asthma
17
Q
Adenosine
Consent
A
Flushing and chest pain
18
Q
Massive PE
Dx
A
Hypoxia, tachycardia Hypotension Signs of Right HF - raised JVP - TWI (V1-4 +/- inferior leads) - S1Q3T3 - right axis deviation - dominant R wave V1
19
Q
Neutropaenic sepsis
Suspect in these groups…
A
- Any unwell haematology patient (regardless of treatment or not)
- Any unwell oncology patient within 6 weeks of systemic anti cancer Tx
20
Q
STEMI
Dx
A
ST elevation in 2 contiguous leads >2mm chest leads >1mm limb leads ST depression V1-2 \+\-Wellens syndrome (Biphasic TW or deep inversion V1-3)
21
Q
STEMI
Tx
A
MONA
Aspirin 300mg
Ticagrelor 180mg PO
?GTN 1-10mg/hr
22
Q
HHS
(Hyperosmolar hyperglycaemic)
Dx
A
BG>30
Serum Osmolality>320
Treat as per DKA if:
pH <7.3
HCO3< 15
Ketones >3(b) or 2(u)
23
Q
Meningitis/ meningococcal sepsis
Tx
A
Blood cultures Dex 10mg IV Ceftriaxone 2g IV BD \+\- Amoxicillin (Low immune, EtOH, DM, pregnant)
24
Q
Rhesus negative woman
Sensitising event
A
- Complete and incomplete miscarriage after 12 weeks
- Threatened miscarriage with heavy or recurrent bleeding
25
Primary pneumothorax
| Dx and Tx
Breathless +/- rim of air >2cm at level of hilum
Tx
Aspirate 16-18G canula
>2.5L aspirated or unsuccessful
-> intercostal drain
26
Secondary pneumothorax
| Dx and Tx
Any of:
>50yrs, smoker, underlying lung disease
With:
Breathless +/- Tim of air >2cm (hilum)
Tx
Intercostal drain
27
Neutropaenic sepsis
| Tx
Tazocin 4.5g QDS
+
Gentamicin 3-5mg/kg
If
Penicillin allergy
Or myeloma
See protocol
28
Encephalitis
| Tx
Aciclovir 10mg/kg IV TDS
29
Upper GI/ Variceal bleeds
| Abx
<64yr
Ceftriaxone 1g IV OD
>65
Ciprofloxacin 400mg IV BD
Penicillin allergy = cipro
30
Gentamicin dose
<65
5mg/kg
>65
3mg/kg
eGFR 10-30
2-3mg/kg
eGFR 5-10
2mg/kg
31
Metastatic spinal cord compression
Suspect if...
Bone mets +
Back pain, worse on lying or moving, prevents sleep
New nerve root pain
(Do not wait for weakness or sensory level)
Ix and Tx!
32
Metastatic spinal cord compression
| Tx
16mg dexamethasone IV
With ranitidine
MRI whole spine
33
General principle
Unstable
Vs
Stable
Tachycardia
Unstable
- sync DC shock
- sedation ?conscious
Stable
- 300mg Amiodarone IV over 20-30mins
- unless TdP - IV MgSO4 2g (10min)
34
Upper GI bleed (severe)
| Tx
2222 major haemorrhage
2 large bore IV canula
Blood if Hb<10 or significant ongoing bleeding
Vit K 10mg IV
Terlipressin 2mg IV
Tazocin 4.5g
GBS score
?endoscopy
Reverse clotting?
35
Traumatic cardiac arrest
| Pre-alert -> prepare
```
Trauma team
Call Consultant
Prioritise HOT
H:
- Pelvic splint/ tourniquets
- IO kit
- Blood
- Level 1 infuser
O:
- Intubation/ Capnography
T:
- Chest drain kit
```
36
Traumatic cardiac arrest
| Algorithm
Trauma to chest/epigastrium?
- bilateral finger thoracostomy
- penetrating wound <10min down time -> clamshell
```
HOT +/- CPR
Hypovolaemia
- pelvic binder/ tourniquets
- IV/IO blood
Oxygen
- I+V
Tension PNX
- bilat thoracostomy
```
37
Stroke
```
NIHSS
IV access, VBG
ECG monitor
Blood sugar
Immediate CT head
```
?Thrombolyse
ECG
Swallow screen
Aspirin 300mg
38
Severe HTN
| Dx
Consistent BP of either
| 220/120
39
ABG (for hypoxia)
Normal bicarb and high CO2
Dx and Tx
Acute T2RF
Requires ventilation
?naloxone
40
ABG (for hypoxia)
High bicarb, high CO2, low pH
Dx and Tx
Decompensated chronic T2RF
Life threatening
Requires help ventilating
?naloxone
41
CPAP starting pressure
5-8cm H2O
42
BiPAP starting pressures
| and increases
IPAP and EPAP
10 and 5 cm H2O
If hypercapnic
- increase IPAP by 2
If Hypoxic
- increase IPAP and EPAP by 2
Max 25/15
43
Max BiPAP
25/15 cm H2O
| IPAP/EPAP
44
Suspected raised ICP
| Tx
30deg head up
sBP>100
sBP>120 in isolated HI
Analgesia
Normothermia
PaCO2 4-4.5
100ml of 5% saline over 10min
Aim Na 150-155
45
Hypoglycaemia
| Dx and Tx
<4mmol/L
(<3 neuro signs)
Give fruit juice or glucogel
1mg glucagon IM
50ml 50%, 100ml 20%, 200ml 10%
Maintenance
10% glucose 100ml/h
46
Severe hyponatraemia
| Dx and Tx
Na<120 and Sx
- seizure, low GCS, headache
```
Tx
1.8% hypertonic saline
150ml over 15min
Repeat VBG after 20min
Consider repeat bolus
```
If rapid over correction use IV dextrose
47
Signs and Tx Addisons crisis
```
Hypotension
+/-
Hyperkalaemia
Hyponatraemia
Hypoglycaemia
```
Tx
IV hydrocortisone 100mg
48
Midazolam conscious sedation
| Dose
Initial
2mg under 60
1mg over 60
Boluses: (minimum 2 min)
1mg under 60
0.5mg over 60
Max 7.5mg
49
NIHSS
```
1ABC: LOC, Qs, command
2 Best gaze
3 visual fields
4 facial palsy
5AB Power arms
6AB Power legs
7 limb ataxia
8 sensory
9 language
10 dysarthria
11 inattention
```
50
Thrombolysis
| BP control
Either >185/110
Intravenous nitrate
Or
Labetolol
51
Thrombectomy
| Inclusion criteria
```
CT angiogram:
major vessel occlusion
(M1,M2,basilar)
And
NIHSS>6
```
Available even if had thrombolysis
52
Pre-alert adult cardiac arrest
| Team
MET; 2222 - adult arrest
5+scribe
- CPR
- Airway: capnography
- Pads; defib, time
- IV access, VBG
- Drugs: 1L saline STAT, adrenaline
53
Gloucester 2nd line
| Anti epileptic
Phenytoin 20mg/kg (max 2g)
| Keppra 20-30mg/kg
54
Contra indication to thrombolysis
| Stroke
```
Warfarin/DOAC/TxLMWH
Recent CVA (3m)
Seizure at stroke onset
Previous intracranial haemorrhage
Recent intervention
Pregnancy
GCS<8
NIHSS>25
BP>185/110
Plt<100
BG>22
```
55
Open fracture
| Tx
- IV Abx ASAP
(?co amoxiclav)
- Tetanus cover
- Analgesia and splint
Orthopaedics ASAP
Wound >1cm -> trauma centre
56
Renal colic aged over 50
Exclude AAA
| - exam, USS, CT
57
Trauma 5 sec round
Pulse
Airway
External haemorrhage
58
Hypothermic arrest
| Changes to ALS
3shocks then No shocks until over 30C
No drugs until over 30C
Then double drug times between 30-35deg
59
Near drowning
| Observe for
4-6h
To ensure no Resp distress
Loss of surfactant and atelectasis
60
Diving emergencies
| Types and Time period
Barotrauma v decompression illness
Any symptom within 48h
= dive related until proven otherwise
61
Chest pain and syncope
| Rule out
PE
Dissection
Tension PNX
ACS
62
Chest drain insertion depth
8-16cm
| At least 4cm past last hole
63
Estimate position of chest drain
Mid axillary line
At level of nipple
Or breast crease
64
Opiate OD
| Or any unknown hypoventillation
100-400mcg IV
400mcg IM
```
IV infusion (mcg/hr)
60% resus dose that provided adequate ventilation for 15 mins
```
65
IV drugs for raised ICP
Mannitol 500ml, 20%
Hypertonic saline 150ml, 3%
Or
100ml of 5%
66
Consider AAA USS in
```
Old
Back pain
- can cause compressive neuropathy
Renal colic
Diverticula disease
```
67
GI bleed with AAA or AAA repair is
Aorto enteric fistula until proven otherwise
68
Causes of acute mesenteric ischaemia
Embolism
SMA thrombosis
Mesenteric venous thrombosis
Non occlusive ischaemia (low flow state eg HF)
69
High lactate in mesenteric ischaemia
Late sign
70
High suspicion of pancreatitis but lipase/ amylase negative
Refer and CT scan
71
Bleeding
Fibrinogen <1.5
Give
Cryoprecipitate: 2 pools
72
Bleeding
INR >1.5
Give
FFP 2-4units
73
OOHCA
| Decisions
```
Urgent cardiac catheter?
Resus in best interests?
Signs of cardiac cause?
- STEMI, cardiogenic shock, recurrent VF/VT
Significant HI? CTH+N
Other cause: CTPA/Aortogram
```
74
OOHCA
| A to E
```
A: ?RSI, CO2
B: ?ventillator, A/E, Sats
C: Defib, HR, BP (?bilat), ECG, Echo, ART line
D: BG, Pupils, ?GCS
E: ?HI
```
75
Tx OOHCA
| Likely ACS as cause
A to E
Aspirin 300mg PR
(Do not need CT head prior)
Emergency PCI
76
Causes of obstetric haemorrhage
Antepartum:
Placenta praevia, abruption
Postpartum
Tone, trauma, tissue, thrombin
77
Antidote
| Dabigatran
Praxbind
78
Antidote
| Rivaroxiban and apixaban
Andexanet Alfa
| Ondexxya
79
OOHCA
| Decisions
```
Urgent cardiac catheter?
Resus in best interests?
Signs of cardiac cause?
- STEMI, cardiogenic shock, recurrent VF/VT
Significant HI? CTH+N
Other cause: CTPA/Aortogram
```
80
OOHCA
| A to E
```
A: CO2
B: A/E, Sats
C: Defib, HR, BP (?bilat), ECG, Echo, ART line
D: BG, Pupils, ?GCS
E: ?HI
```
81
Tx OOHCA
| Likely ACS as cause
A to E
Aspirin 300mg PR
(Do not need CT head prior)
Emergency PCI
82
Causes of obstetric haemorrhage
Antepartum:
Placenta praevia, abruption
Postpartum
Tone, trauma, tissue, thrombin
83
Aims in major haemorrhage care
```
Hb>10
Fibrinogen > 1.5
Severe trauma 1:1 RBC:FFP
INR< 1.5
TXA 1g 10min, 8h infusion
Platelet > 75
```
84
Intra lipid dose
1.5ml/kg 20% over 1 min
(Up to 2x)
Start infusion
15ml/kg/h
85
Tx hypoglycaemia
| <4mmol
Fruit juice
Hypostop
150ml 10% Dec
Or 100ml/hr
1mg IM glucagon
Retest in 10min
Refer to diabetes team
86
AF Sync DC cardioversion
Clexane 1.5mg/kg
200J sync DC shock
AP pad placement
87
Haloperidol contraindications
Long QT
PD or LBD
IV can cause arrhythmia
88
Restraint considerations
```
Lack capacity
Possibility of harm (self/others)
Last resort; de-escalate, oral meds
Least restrictive
Proportionate to likelihood of harm
```
89
Red flag sepsis
```
Unwell and source of infection
+
Reduced GCS
sBP<90
HR>130
RR>25
O2 requirement
Rash/mottled
Anuric
Lactate>2
Recent chemo
```
90
Place Major trauma call
| Anatomy reasons
```
A: ?airway concerns
B; ?PNX ?Flail
C: ?pelvic # ?crush injury torso
?2 or more long bone #
?Proximal limb amputation
?burns >20%
?penetrating injury torso/abdomen
D: ?spine injury + neurology
```
91
Place Major trauma call
| Physiology concerns
```
<75
RR<10 or >30
O2 >4L
HR<50 or >120
sBP<90
GCS<13
```
>75
sBP<100
GCS<14
92
Major trauma call
| consider other teams
```
Cardiothoracics
ENT
Maxfacs
Obstetrics
Paeds
```
93
Septic arthritis
| Features
Short Hx (under 2 weeks)
Decreased ROM (all directions)
+\- fever
RF other chronic ds or recent injury
94
TXA in head injuries
Give if under 3hours from injury
| CRASH 3
95
Amniotic fluid embolism
| Symptoms
```
Anaphylactoid type syndrome
- acute hypoxia
- haemodynamic collapse
- DIC
Treatment is supportive
- O2
- fibrinogen and TXA
```
96
Amniotic fluid embolism
| Diagnosis
Maternal collapse with no clear cause and any of;
C Arrest
Arrhythmia
Coagulopathy
SOB
Seizure
Premonitory sx; restlessness, agitation, numbness
97
Shoulder dystocia
| Dx and Tx
After delivery of head if baby does not deliver on next contraction
Tx
McRoberts and suprapubic pressure
98
Alteplase dose
CA
- 50mg (1 vial) push
Massive
- 10mg over 1-2min
- 1.5mg/kg (max 90mg) over 2h
99
Chemical burn antidote
Diphoterine
| Fast flow cupboards
100
Stop and summarise
```
X yo with X (PC)
A to E or H&Ts
Main issues are
1)2)3)
Plan is; immediate, 10mins, 30mins
Any other thoughts
```
101
Hyperthermia ddx
Heat stroke >40C
Heat exhaustion <40C
Malignant hyperthermia; sux/anaesthetic
Neuroleptic malignant syndrome
ABD
Serotonin syndrome; clonus
Sympathomimetic syndrome
102
Collapsed neonate
Sepsis
Cardiac
Metabolic - send ammonia on ice
NIA
103
Thyroid storm Dx
Burch Wartofsky score
Temperature
CNS effects
Gastrointestinal
HR
HF
AF
Precipitating event
Lab Dx; low TSH, high T3/4
104
Thyroid storm Tx
Cooling
Abx
IVF
Propranolol 1mg every 5min until HR<100
Propylthyrouracil
Hydrocortisone 100mg
?lugols solution
105
Collapsed patient request items
Can I get some pads and a BVM
106
After treatment hypoglycaemia recheck BG at x minutes
15 minutes
107
Age for surgical cricothyroidotomies
Under 12 needle cricothyroidotomy or tracheostomy
108
Rule of 9s
All 9% except back and legs (18% each)
109
Aortic dissection BP management
Aim sBP 100-120
Labetalol infusion
110
SCAPE
Sympathetic crashing acute pulmonary oedema
Aka
Hypertensive pulmonary oedema
Tx GTN infusion and CPAP
111
HF vs sepsis ix and signs
JVP, oedema, murmur
Ultrasound - b lines?, plethoric iVC, cardiac motility
CXR
112
HF vs sepsis ix and signs
JVP, oedema, murmur
Ultrasound - b lines?, plethoric iVC, cardiac motility
CXR
113
NIHSS LOC questions
Month and age
