Emergency Flashcards Preview

CP3 Medicine > Emergency > Flashcards

Flashcards in Emergency Deck (19)
Loading flashcards...
1

What is the antidote for:
Paracetamol
B-blockers
TCAs

Para: N-AC

B-blockers: IV atropine / IV glucagon + dextrose

TCAs: sodium bicarbonate (if VT/SVT)

2

What are the features of salicylate (aspirin) overdose?
What is seen on ABG

Tachypnoea
Vomiting
Sweating
Tinnitus/vertigo
ABG: resp alk → metab acid

3

What are the features of TCA overdose?
What is seen on ABG

Dilated pupils / blurred vision
Urinary retention
Seizures / Reduced GCS
Dysrhythmia / Tachycardia
ABG: metal acid
ECG: wide QRS

4

What are the features of digoxin toxicity? (3)

Nausea / anorexia
Confusion
Hallucinations (yellow haloes over lights)

5

How is opioid overdose managed?

400ug IV naloxone
1min fail: 800ug
2min fail: +800ug (repeat until breathing adequate)
NB short t1/2 (needs repeating)

6

What are the features of BZD overdose (6)
How is it managed?

↓GCS / ↓Tone / ↓Reflexes
↓BP
Ataxia
Dysarthria

Flumenazil 200ug (in 15s) (+100ug every 1min)

7

What are the features of stimulant overdose (E/Cocaine/Amphetamine)
What is seen on ABG
How is it managed

Thirst
Dilated pupils
Agitation / confusion / tremor
↑HR / ↑BP / ↑Temp
ABG (cocaine): metab acidosis

IV diazepam (if halluc/convulsing)
External cooling

8

What are the complications of acute alcohol intoxication?
How is it managed?

Hypoglycaemia** (esp children)
Severe: resp failure / coma / death

IV glucose (glucagon ineffective)
Haemodialysis (if conc >500)

9

List the reversible causes of arrest (8)

Hypothermia
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia / metabolic

Thrombosis (cardiac/pulmonary)
Tension pneumothorax
Tamponade (cardiac)
Toxins

10

List the different types of shock (7)

Hypovolaemic
• Haemorrhagic
• Non-haemorrhagic

Distributive:
• Septic
• Anaphylactic
• Neurogenic

Cardiogenic:
• Direct (MI/Arrhythmia/Electrolytes/Valve)
• Indirect (obstructive)

11

Which types of shock cause 'cold shock' and 'warm'
What are the features of each

'Cold shock' – hypovol/cardiogenic
• Cold / pale / clammy
• Thready pulse / narrow PP

'Warm shock' – septic
• Hot / flushed / sweaty
• Bounding pulse / wide PP

12

What are the new Sepsis (2016) criteria (ARUHSS)

Appears Really Unwell, Heading to Septic Shock

• Altered mental state (new)
• RR >25 (or new need for O2)
• Urine not passed 18hrs (or <0.5ml/kg/hr 2hrs)
• HR >130
• SBP <90 (or 40+ under usual)
• Skin: ashen/mottled/cyanosed/non-blanching

13

What are the different classes of haemorrhagic shock and how is each managed

All: Titrated fluids / Transexamic acid

Class 1: HR >100 → fluid (crystalloids)
Class 2: HR >100 + Narrow PP → consider blood
Class 3: HR >120 → give blood + consider surgery
Class 4: >40% lost → surgery

14

List some specific aspects of management in cardiogenic shock

If pulm oedema → withhold fluids
Consider: Swan-Ganz / Central / A-line
Consider: 'renal' dose dopamine to protect

PCWP low → plasma expander
PCWP okay → ionotropes (dobutamine)

15

What is the 'triad of death'?

Post-massive transfusion bleeding disorder:
• Coagulopathy
• Hypothermia
• Metabolic acidosis

16

What circumstances in burns might you suspect an airway issue?

Fire in enclosed space

Stridor
Harsh cough
Carbonaceous sputum
Tachy/dyspnoea
Burnt nasal hair
Facial burns

17

Outline the immediate management in burns (5)
Outline the systemic management in burns (5)

Remove clothing (contains heat)
Cold water tap
Cling film (removes pain)
Fluid resus (if >15% SA adults / >10% children)
Assess severity (depth etc)

IV opiates
Hartmann's
Catheterise
Systemic Abx (if evidence infection)
Nutrition (early parenteral if enteral not poss)

18

What are some complications of burns (6)

Contractures
Sepsis (e.g. wound / inhalation-related chest)
Acute peptic ulceration (Curling's ulcer)
AKI (hypovol / Hb / myoglobin)
Psychological

19

What are the indications for specialist burns referral? (7)
Indications for outpatient management

Burns >30% total SA
Partial thickness >10% (5% children)
Full thickness >1%
Circumferential burns
Assoc inhalation injury
Chemical/electrical burns
Age extremes

Outpatient:
Adults partial thickness <10%
Children partial thickness <5%
Full thickness <1%