Emergency

Question 1

Usual adult doses >12years for anaphylaxis drugs?

Answer 1

0.5ml 1/1000 adrenaline IM
10mg Chlorphenamine IM or IV
200mg Hydrocortisone IM or IV

Question 2

Investigations in anaphylaxis to confirm?

Answer 2

Tryptase ↑

Question 3

What is septic shock?

Answer 3

Hypotension induced by sepsis which continues despite adequate fluid resuscitation.

Question 4

Pathophysiology of septic shock?

Answer 4

Vascular permeability ↑ NO↑ = dilatation and ↑ lactate due to hypoxia

Question 5

Causes of cardiogenic shock?

Answer 5

MI, Valvular rupture, septal problems

Question 6

Features of cardiogenic shock?

Answer 6

Tachy, basal crackles, gallop rhythm, ↑ JVP, Oedema.

Question 7

Fluids in cardiogenic shock?

Answer 7

Caution, start with 250ml and reassess

Question 8

Definition of cardiogenic shock?

Answer 8

Heart is unable to meet demands of body in terms of perfusion. (mechanical impairment)

Question 9

Hypovolaemic shock define?

Answer 9

Anything provoking a major reduction in blood volume- this can be absolute or relative.

Question 10

Types of respiratory failure and values?

Answer 10

1 = ↓Pao2 <8 on air. 2=↓Pao2 with ↑CO2 >6.5

Question 11

Causes of type 1 respiratory failure?

Answer 11

Pneumonia, Lung collapse, Pneumothorax, Asthma, Fibrosis, contusion.

Question 12

Type 2 respiratory failure causes?

Answer 12

Reduced respiratory drive, Obstruction, Severe asthma, Peripheral muscular disease -myasthenia and Guillain Barré. (exhaustion- all type ones too). Skeletal abnormalities (kyphosis)

Question 13

Management of type 1 respiratory failure?

Answer 13

Give O2, via face mask, may need assisted ventilation if Pao2 <8 despite 60% O2

Question 14

Management of type 2 respiratory failure?

Answer 14

Titrated oxygen therapy, starting at 24%, check ABG’s may need NIPPV if no improvement after an hour.

Question 15

When is amiodarone given during cardiac arrest?

Answer 15

After 3 shocks

Question 16

When should adrnealine be given in a cardiac arrest?

Answer 16

Immediately if PEA/Asystole then every 2 cycles

Shockable rhythm shock first then resume CPR and give adrenaline every 2 cycles.

Question 17

4 H’s and 4 T’s?

Answer 17

Hypothermia, Hyperkalaemia, Hypovolaemia, Hypoxaemia

Tension, Tamponade, Thrombus, Toxins

Question 18

How would you define a paracetamol overdose?

Answer 18

> 4g in 24hrs

Question 19

Acute overdose of paracetamol defined as?

Answer 19

> 4g or >75mg/kg in 1 hour

Question 20

What is a staggered paracetamol overdose?

Answer 20

> 4g over >1hr

Question 21

Signs and symptoms of paracetamol overdose?

Answer 21

RUQ pain, Vomiting, AKI, Jaundice or simply initially asymptomatic.

Question 22

When to treat a paracetamol overdose?

Answer 22

Level above treatment line at 4hrs post ingestion, If staggered overdose. Or any overdose ↑150mg/kg.

Question 23

How is NAC given?

Answer 23

150 mg/kg over 1 hour, 50 mg/kg over 4 hours, then 100mg/kg over remaining 16hours all in glucose.

Question 24

Blood gas disturbances in salicyclate overdose?

Answer 24

Initially resp alkalosis which become a metabolic acidosis.

Question 25

Management of salicylate poisoning?

Answer 25

Charcoal, can try correct acidosis with bicarb and urinary alkalination If very severe consider haemodialysis especially if if shocked

Question 26

Salicylate poisoning symptoms?

Answer 26

Tinnitus, sweating, N&V

Question 27

Treatment of TCA overdose? at what QRS ?

Answer 27

Charcoal if <1hr of ingestion. If QRS >100ms consider IV bicarb, hypoxaemia and electrolytes should be corrected

Question 28

TCA overdose symptoms?

Answer 28

tachycardia, drowsiness, a dry mouth, nausea and vomiting, urinary retention, confusion, agitation

Question 29

Investigation of choice in TCA overdose?

Answer 29

ECG for QRS and Blood gases for acidosis

Question 30

Iron overdose treatment?

Answer 30

Lavage within 1 hr of ingestion otherwise desferrioxamine 15mg/kg/hr

Question 31

Recovery of spinal shock heralded by which reflexes?

Answer 31

Babinski and perineal.

Question 32

AKI stage one defined as?

Answer 32

Creatinine rise of 26 micromol or more within 48 hours Rise in creatinine 50-99% 1.5-2 x baseline (if known) in 7 days Urine <0.5ml/kg/hr 6hrs

Question 33

AKI stage two defined as?

Answer 33

Rise in creatinine 100-199% 2-2.99 x baseline (if known) in 7 days Urine <0.5ml/kg/hr 12hrs

Question 34

AKI stage three defined as?

Answer 34

Rise in creatinine 200% 3 x baseline (if known) in 7 days Urine <0.3ml/kg/24hrs or anuria

Question 35

Pre-renal causes of AKI?

Answer 35

Usually hypotension and dehydration/volume depletion, renal artery stenosis also heart failure and cirrhosis

Question 36

Intrinsic causes of AKI?

Answer 36

Glomerulonephritis, Interstitial nephritis and tubular necrosis (often rhabdomyolysis)

Question 37

Post renal AKI causes?

Answer 37

Infection, ureteric stones, bladder problems, BPH

Question 38

Imaging in AKI?

Answer 38

An ultrasound scan of the kidneys, ureters and bladder is required in severe cases of AKI, especially if there is no response to initial management, in order to evaluate for any obstructive causes.

Question 39

Potential drugs to stop in AKI?

Answer 39

ACEi and ARBs NSAIDs Aminoglycoside antibiotics Potassium-sparing diuretics (due to increased risk of hyperkalaemia)

Question 40

5 W's of post op fever?

Answer 40

``` Wind-Chest infection (2 days) Water- UTI (3-5 days) Walking- VTE (5-7 days) Wound- Infection (~ day 7-10) Wonder Drugs- Iv cannula sites or blood transfusion reaction ```

Question 41

Over 40 and first unprovoked DVT no signs of cancer on bloods or CXR what investigation to consider?

Answer 41

CT abdo pelvis

Question 42

How is salbutamol used in hyperkalaemia?

Answer 42

5mg nebs back to back over 30mins 10-20mg in total

Question 43

Dose of glucose and insulin for hyperkalaemia?

Answer 43

50ml of 50% glucose infused over 5-10 mins with 10units of actrapid

Question 44

Calcium gluconate dose for hyperkalaemia?

Answer 44

30ml of 10% calcium gluconate, can repeat after 5-10mins if ECG does not change

Question 45

ECG features in hyperkalaemia?

Answer 45

Widened QRS, tented T waves, small P waves

Question 46

When is hyperkalaemia deemed significant?

Answer 46

Greater than 6mmol

Question 47

Causes of hyperkalaemia? three ways?

Answer 47

Increased k+ intake (rare) Decreased excretion- drugs potassium sparing Entry in cells reduced such as beta blockers digoxin and low insulin levels