Emergency Flashcards

(79 cards)

1
Q

% oxygen given by different masks / nasal specs

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

Examples of crystalloids

A

Normal saline
Hartman’s solution
Ringers lactate

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3
Q

What is a colloid

A

Solution containing large molecules.

Helps keep fluid in the intravascular

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4
Q

Examples of colloids

A

Dextran

Salt poor albumin

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5
Q

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

A

20%

1.5 - 2 L

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6
Q

Causes of cardiogenic shock

A
Acute MI
HF
Tension pneumothorax 
Cardiac tamponade
PE
Aortic dissection
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7
Q

Symptoms of anaphylaxis

A
Urticaria 
Angioedema
Hypotension
Tachycardia
Bronchospasm + wheeze
Skin flushing
Abdo cramping
Diarrhoea and vomiting
Dizziness, syncope, shock
Sweating
Cyanosis
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8
Q

Management of anaphylaxis

A
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
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9
Q

Signs of SIRS

A
2 or more of:
Tachycardia >90
Tchypnoea >20
Pyrexia >38
Hypothermia < 36
WBC >12 or <4
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10
Q

What is sepsis

A

SIRS + confirmed infection

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11
Q

What is severe sepsis

A

SIRS + source of infection + organ dysfunction

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12
Q

What is septic shock

A

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

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13
Q

What is the sepsis 6

A

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

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14
Q

Symptoms of opiate overdose

A
Euphoria
N+V
Constipation
Anorexia
Hypotension
Respiratory depression 
Tremor
Pin poin pupils
Erectile dysfunction
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15
Q

Management of opiate overdose

A

ABC

Naloxone IV or IM

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16
Q

Symptoms of opiate withdrawal

A
Dilated pupils
Lacrimation
Sweating
Diarrhoea
Insomnia
Tachycardia
Abdo cramps
N+V
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17
Q

Syx of cocaine intoxication

A
Formication = coke bugs
Tachycardia
Mydriasis 
Hypertension
N+V
Euphoria
Increased libido
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18
Q

Syx of alcohol withdrawal

A
12 hrs after last drink
Anxiety
Insomnia
Sweating
Tachycardia 
Tremor
Seizures
Delirium tremens
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19
Q

Duration of action of lignocaine

A

20min

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20
Q

Syx of lignocaine toxicity

A
Perioral tingling
Metallic taste
Dizziness 
Light headedness
Tinnitus 
Difficulty focusing
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21
Q

Duration of bupivicaine

A

6-8 hours

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22
Q

8 reversible causes of cardiac arrest

A
Hypoxia
Hypovolaemia
Hyper/hypokalaemia/hypocalcaemia
Hypothermia
Tension pneumothorax
Tamponade 
Toxins
Thromboembolism
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23
Q

Signs of tension pneumothorax

A
Hypotension
Respiratory difficulty 
Raised JVP
Decreased breath sounds
Trachea deviated away
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24
Q

Treatment of tension pneumo

A

16 or 14 G cannulae, 2nd ICS, MCL

Replace with chest drain

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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