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Flashcards in Emergency Deck (79):
1

% oxygen given by different masks / nasal specs

Venturi - 24 - 60% depends on colour
Nasal specs - 28% @ 2L/min
- 35% @4L/min
Hudson - 50 - 60%
Reservoir mask - 80- 90%
CPAP 80%

2

Examples of crystalloids

Normal saline
Hartman's solution
Ringers lactate

3

What is a colloid

Solution containing large molecules.
Helps keep fluid in the intravascular

4

Examples of colloids

Dextran
Salt poor albumin

5

In a healthy adult what % blood volume must be lost before hypotension occurs

20%
(1.5 - 2 L)

6

Causes of cardiogenic shock

Acute MI
HF
Tension pneumothorax
Cardiac tamponade
PE
Aortic dissection

7

Symptoms of anaphylaxis

Urticaria
Angioedema
Hypotension
Tachycardia
Bronchospasm + wheeze
Skin flushing
Abdo cramping
Diarrhoea and vomiting
Dizziness, syncope, shock
Sweating
Cyanosis

8

Management of anaphylaxis

Secure airway - 100% O2
Remove cause
Elevate feet
IM adrenaline 1:1000 0.5ml
IV hydrocortisone 200mg
IV chlorphenamine 100mg
IV saline
Salbutamol nebuliser for wheeze

9

Signs of SIRS

2 or more of:
Tachycardia >90
Tchypnoea >20
Pyrexia >38
Hypothermia < 36
WBC >12 or <4

10

What is sepsis

SIRS + confirmed infection

11

What is severe sepsis

SIRS + source of infection + organ dysfunction

12

What is septic shock

Severe sepsis where hypotension is unresponsive to fluid challenges.
Inotropic support needed to maintain BP

13

What is the sepsis 6

Done within 1 hour
1) high flow 02
2) blood culture
3) IV antibiotics
4) fluids
5) check Hb + lactate
6) urinary catheter + output monitor

14

Symptoms of opiate overdose

Euphoria
N+V
Constipation
Anorexia
Hypotension
Respiratory depression
Tremor
Pin poin pupils
Erectile dysfunction

15

Management of opiate overdose

ABC
Naloxone IV or IM

16

Symptoms of opiate withdrawal

Dilated pupils
Lacrimation
Sweating
Diarrhoea
Insomnia
Tachycardia
Abdo cramps
N+V

17

Syx of cocaine intoxication

Formication = coke bugs
Tachycardia
Mydriasis
Hypertension
N+V
Euphoria
Increased libido

18

Syx of alcohol withdrawal

12 hrs after last drink
Anxiety
Insomnia
Sweating
Tachycardia
Tremor
Seizures
Delirium tremens

19

Duration of action of lignocaine

20min

20

Syx of lignocaine toxicity

Perioral tingling
Metallic taste
Dizziness
Light headedness
Tinnitus
Difficulty focusing

21

Duration of bupivicaine

6-8 hours

22

8 reversible causes of cardiac arrest

Hypoxia
Hypovolaemia
Hyper/hypokalaemia/hypocalcaemia
Hypothermia
Tension pneumothorax
Tamponade
Toxins
Thromboembolism

23

Signs of tension pneumothorax

Hypotension
Respiratory difficulty
Raised JVP
Decreased breath sounds
Trachea deviated away

24

Treatment of tension pneumo

16 or 14 G cannulae, 2nd ICS, MCL
Replace with chest drain

25

Signs of open pneumothorax

Open chest wound
Loss of breath sounds
Reduced chest expansion
Hyper-resonance
Surgical emphysema

26

Signs of cardiac tamponade

Shock
Increased JVP
Muffled heart sounds
ECG voltage may be decreased
Increased cardiac shadows

27

Define minor head injury

GCS >/= 13
+/- amnesia
+/- LOC

28

Indications for CT in minor head injury

>65
Vomiting > once
Seizure
Warfarin or coagulopathy
GCS <15 after 2 hrs
Skull fracture
Neurological deficit

29

Appearance of SAH on CT

Blood in sulci + fissures

30

Features of extradural on CT

Bi-concave shaped
Doesn't cross suture lines

31

Features of subdural haematoma on CT

Concave shape
Crosses suture line

32

Syx of Odontoid peg fracture

Pain
Inability to move neck
Instability of neck

33

Types of wound closure

Primary - immediate within 24 hrs
Delayed primary closure - clean + antibiotics for 2-5d then close
Secondary healing - wound heals alone - slower - more scarring

34

Management of burns

C-spine ABC
morphine, entonox
Fluids -parkland formula
Blood if deep burns
Tetanus
Burns unit
Cling film
Sterile sheet
Humidified 02

35

Define hypothermia

<35 degrees

36

CI to entonox

Pneumothorax
Decreased LOC
pneumocranium
Intestine obstruction
Facial injury

37

Management of compound fracture

ABC
Analgesia
Clean + dress sterile dressing
Immobilise limb
Antibiotics
X-ray
Surgery
Tetanus

38

Treatment of salicylate OD

Activated charcoal within 1 hr
Urinary alkalinization

39

Treatment of beta-blocker OD

IV atropine
Glucagon

40

Antidote for benzodiazepines

Flumazenil

41

Risk factors for PE

Immobilisation
Pro-coagulant states - pregnancy / obesity
COCP
genetic thrombophilia
Cancer
Smoking

42

When may rigors occur

Lobar pneumonia
Pyelonephritis
Cholangitis
Empyema
Abscess
Malaria
Typhoid

43

What is a trauma series

CXR
Pelvic XR
C-spine X-RAY

44

Indications for referral to burns specialist

Airway burn
Full thickness burn
>10%
Hands,feet, face, perineum or genitalia

45

Treatment of anaphylaxis

1 in 1000 adrenaline IM 0.5ml

IV chlorampheniramine
IV hydrocortisone
IV fluids
02

46

Symptoms of CO poisoning

Headache
N+V
Not detectable on pulse oximeter

47

Causes of chemical burns

Alkalis - cement, drain cleaner

Acids

48

Features of a full thickness (3rd degree) burn

Dry
Painless
No blisters
Black / white / brown
Charred skin
Leathery/waxy

49

Features of partial thickness burn (2nd degree)

Painful
Red
Swollen
Blistered
Dry or weepy

50

Features of a superficial burn (1st degree)

Red
Painful
No blisters
Sensitive to touch
Heals in 2-5d

51

Features suggesting inhalation injury in burns patient

Facial burn
Singed nose hair / eyebrows / eyelashes
Hoarse voice
Sooty sputum
Oropharyngeal soot / redness / swelling
Flared nostrils

52

Management of acute neck sprain (whiplash)

Analgesia
Maintain mobility
Do not use a collar - delays recovery

53

Symptoms of acute neck sprain (whiplash)

Neck pain
Neck stiffness
Jaw pain
Dizziness
Paraesthesia
Headache
Back pain
Shoulder / arm pain

54

Define coup and contre coup injury

Cerebral contusions
Coup = site of blunt force
Contre coup = opposite side to impact

55

Epigastic pain radiating to back suggests what

Acute pancreatitis
Check serum amylase

56

Types of shock

Anaphylactic
Cardiogenic
Hypovolaemic
Neurogenic
Septic

57

Features of acute alcohol withdrawal

Low BP
raised HR
Visual hallucinations
10-72 hours after last drink

58

Features of wernickes

Opthalmoplegia
Ataxic gait
Confusion

59

What is battles sign?

Bruising over the mastoid process
Base of skull fracture

60

Management of an open pneumothorax

Occlusive dressing over wound - tape down 3 sides to create a one way valve.
Chest drain insertion at a different site

61

GP management of a child with suspected meningitis

IM benzylpenicillin
Call an ambulance

62

Emergency management of a fitting patient in A+E

ABC
Secure airway
15L O2 NRB
IV lorazepam
If no IV access - rectal diazepam or Buccal midazolam
If benzos fail - IVI phenytoin

63

Features of anaphylaxis

Sudden onset
rapid progression.
Life-threatening airway/breathing/circulation problems.
Skin/ mucosal changes - flushing, urticaria, angio-oedema

64

Management of anaphylaxis

Airway:
Breathing
Circulation
Disability
Exposure

high-flow oxygen
Lie the patient flat
Adrenaline IM 0.5 mg IM (0.5 mL of 1:1000)

Fluid challenge - 500 mL 0.9% saline in 10 min

Chlorphenamine - 10 mg IM or slow IV.
Hydrocortisone - 200 mg IM or slow IV.

65

Features of MDMA (ecstasy) overdose

CNS
-Change in mental status / Anxiety, paranoia
- seizures / syncope
- restlessness / ataxia
- Hyperthermia,
- Headache / blurred vision

Cardiovascular
- Palpitations / Chest pain

Gastrointestinal
- Dry mouth / Nausea / vomiting
- Abdominal cramping
- Anorexia

Skin
- Sweating / hair standing on end

- Urinary retention

- Bruxism (jaw clenching)

66

Symptoms of theophylline overdose / toxicity

Nausea
Vomiting - Severe and protracted,
Abdominal pain
Mild metabolic acidosis
Hypokalemia
Hypophosphatemia
Hypomagnesemia
Hypocalcemia/hypercalcemia
Hyperglycemia
Tachycardia

Seizures, hypotension, and significant dysrhythmias when serum levels approach 80 mcg/mL.

67

Symptoms of aspirin overdose

Upset stomach
stomach pain
Nausea
Vomiting

Large overdoses may also cause:

Tinnitus
Tempoary deafness
Hyperactivity
Dizziness
Drowsiness
Seizures
Coma

68

Management of aspirin overdose

Activated charcoal
IV fluids
Alkalinization of the urine - with IV sodium bicarb

69

Symptoms of NSAID overdose

nausea,
vomiting,
epigastric pain,
diarrhoea.

Possible - Tinnitus, headache, GI bleeding

70

Management of NSAID overdose

ABC

Activated charcoal

Stop seizures with lorazepam

71

Symptoms of beta blocker overdose

Dizziness
Bradycardia
Hypotension
Decreased consciousness
Wheezing (in asthmatics)
Seizures

72

Management of beta blocker overdose

ABC
Fluid challenge
Ionotropes and chronogropes
Glucagon
Activated charcoal
Haemodialysis in severe cases

73

When may aortic disruption injuries occur

Rapid deceleration injury
90% fatality

74

Features of splenic rupture

Haemorrhagic shock - Hypotension, tachycardia, peripheral vasoconstriction
Abdominal pain
Abdominal distension
Shoulder Tip pain

75

How may solvent abuse cause death

Cardiac arrhythmia

76

Feathers of septic shock

Warm skin
Pyrexia
Tachycardia
Bounding pulse
Hypotension

78

Investigations in paracetamol OD

Paracetamol level: @ 4 hrs
U&E, creatinine - renal failure .
LFTs: ALT >1000 IU/L indicate hepatotoxicity.
Glucose hrly - hypoglycaemia common in hepatic necrosis
Clotting screen: 12-hourly.
Arterial blood gas

79

Antidote to benzodiazepine OD

Flumenazil

80

At what time do you measure paracetamol levels after an OD

4 hours
Or as soon as arrived if >4 hrs or a staggered OD