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Year 6 > Emergency med > Flashcards

Emergency med Flashcards

1
Q

how should you oxygenate a patient with poor respiratory effort?

A

mechanical ventilation with bag and valve mask

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2
Q

which form of shock has warm peripheries

A

distributive e.g. sepsis

due to systemic vascular resistance decrease rather than fall in cardiac output

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3
Q

skin manifestation of carbon monoxide poisoning

A

cherry red skin

rare

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4
Q

when is an initial fluid bolus of 500ml appropriate

A

severe dehydration where systolic BP <90

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5
Q

ECG changes in posterior MI

A

ST depression, broad R waves, and upright T waves in leads V1-3

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6
Q

key features of HHS [4]

A

severe hyperglycaemia
hypotension
hyperosmolality without significant ketosis or acidosis.

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7
Q

treatment of aspirin overdose

A

IV sodium bicarbonate for urinary alkalinisation
haemodialysis if severe

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8
Q

treatment for paracetamol overdose ingestion less than 1 hour ago + dose >150mg/kg

A

activated charcoal

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9
Q

treatment for paracetamol overdose <4 hours ago

A

Wait until 4 hours to take a level and treat with N-acetylcysteine based on level

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10
Q

treatment for paracetamol overdose ingestion within 4-8 hours + dose >150mg/kg:

A

Start N-acetylcysteine immediately if there is going to be a delay of ≥8 hours in obtaining the paracetamol level

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11
Q

treatment for paracetamol overdose ingestion within 8-24 hours + dose >150mg/kg

A

Start N-acetylcysteine immediately

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12
Q

treatment for paracetamol overdose ingestion >24 hours ago

A

Start N-acetylcysteine immediately if the patient has jaundice, right upper quadrant tenderness, elevated ALT, INR >1.3 or the paracetamol concentration is detectable

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13
Q

treatment for staggered dose paracetamol overdose

A

Start N-acetylcysteine immediately

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14
Q

Criteria used to predict mortality from paracetamol overdose and to identify those patients who would potentially benefit from liver transplantation

A

Kings College Criteria

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15
Q

what arterial PH is an indication for liver transplant in paracetamol overdose

A

Arterial pH Less than 7.3

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16
Q

features of myxoedema coma [6]

A

hypothermic
hypotensive
bradycardia
slow mental function
lethargy
loss of consciousness

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17
Q

initial adenosine dose in SVT

A

6mg IV

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18
Q

initial step of management of tension pneumothorax

A

needle decompression followed by chest tube

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19
Q

signs on ECG for PE [4]

A

sinus tachycardia
RAD
RVHS
S1Q3T3

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20
Q

What does massive PE mean?

A

a PE with haemodynamic instability

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21
Q

how is massive PE treated?

A

IV alteplase i.e. thrombolysis

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22
Q

at what point are adrenaline and amiodarone given IV in ALS

which drug is a one off and which one is repeated

A

both are after 3rd shock for a shockable rhythm

amiadarone is a one off
adrenaline is given every other cycle from the 3rd

note: amiodarone only used for shockable rhythms

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23
Q

how is PEA or asystole managed? [2]

A

CPR
IV adrenaline in the first cycle and every other cycle

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24
Q

dosage of adrenaline and amiodarone used in ALS

A

amiodarone 300mg IV
adrenaline 1mg IV

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25
Q

contraindication to thrombolysis in management of MI [7]

A
  • Aortic Dissection
  • GI bleed
  • Allergic reaction
  • Iatrogenic: recent surgery, anticoagulation
  • Neurological disease: recent stroke (within 3 months), malignancy
  • Severe HTN (>200/120)
  • Trauma, including recent CPR
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26
Q

timeframe for considering PCI from onset of symptoms and medical contact

A

12 hours from onset of symptoms and within 2 hours of presentation

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27
Q

Patients who present within 12 hours of symptom onset but after 2 hours of medical contact for MI receive…

A

thrombolysis

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28
Q

If patients present more than 12 hours of MI symptom onset

treatment approach

A

pharmacotherapy

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29
Q

Patients found to be at a high risk of death with NSTEMI require…

A

re-vascularization within 12-24 hours

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30
Q

management of acute pulmonary oedema [5]

A

Positioning the patient upright
Administering oxygen
Establishing IV access
Administering IV Furosemide
Considering non-invasive ventilation such as Continuous Positive Airway Pressure (CPAP) if initial medical therapy fails,

31
Q

management of haemodynamically stable torsade de pointes

A

2mg IV magnesium sulphate over 1-2 minutes

haemodynamically unstable–> DC cardiovert

32
Q

feature on ECG for torsade de pointes [2]

A
  1. polymorphic VT on the background of prolonged QT
  2. QRS “twists” around the isoelectric lines
33
Q

definition of hypotension in shock

A

systolic blood pressure < 90 mmHg or a drop in systolic blood pressure of ≥ 40 mmHg for ≥ 15 minutes

34
Q

what is the sign someone is in Addisonian crisis when hypotensive

A

IV fluids don’t improve the BP

they need IV hydrocortisone definitively

35
Q

management of Addisonian crisis

A

Fluid resuscitation for hypotension
Administration of IV hydrocortisone 100mg (Stat and then given regularly)
IV glucose if hypoglycaemic
Transition back to oral steroids after 3 days
Consideration of fludrocortisone if there is adrenal disease present

36
Q

what is flumanezil used for? [2]

why can’t it be used for mixed overdoses

A

Benzo overdose or reversal in benzo naive patients who have been dosed highly

can’t be used in mixed overdoses as there is a risk of seizure

37
Q

5 signs of fluid overload

A

Bilateral reduced air entry
Inspiratory crepitations
Raised JVP
S3 gallop
Peripheral oedema

38
Q

How often are adrenaline doses repeated in anaphylaxis

A

repeated every five minutes, several times if necessary

39
Q

clinical signs on examination in aortic dissection [3]

A

Radio-radial delay
Radio-femoral delay
Blood pressure differential between arms

40
Q

biochemistry in Addisonian crisis

A

hyponatraemia (most classically), hyperkalaemia, hypoglycaemia and hypercalcaemia

41
Q

Diagnostic investigations of Addison’s disease

A

short Synacthen test

42
Q

4 signs of hypopituitary coma

A

hypothermia
hypotension
septic signs without fever
short stature, loss of hair, gonadal atrophy

43
Q

management of hypopituitary coma

A

hydrocortisone and T3

surgery if apoplexy is the cause

44
Q

3 things to investigate in an unconscious person suspected of poisoning

A

glucose
paracetomol
salicylate

45
Q

contraindications for activated charcoal [2]

A

alcohol
metal salts like lithium

46
Q

reversal agent for TCA overdose

A

sodium bicarbonate

47
Q

reversal agent for beta blocker overdose

A

atropine

48
Q

reversal agent for ethylene glycol (antifreeze) poisoning

A

fomepizole

49
Q

reversal agent for cyanide poisoning

A

100 oxygen and sodium nitrate/thiosulphate

50
Q

reversal agent for organophosphate toxicity

A

atropine

51
Q

reversal agent for digoxin toxicity

A

digifab (digoxin-specific antibody)

52
Q

reversal agent for iron toxicity

A

desferrioxamine

53
Q

when should an adult burn case be referred to a specialist burns unit

A

> = 10% TBSA

54
Q

signs of severe hypothermia

A

temp <=35 deg (rectal) with no shivering

55
Q

2 investigations for hypothermia

A

temperature (oral/axillary/PR) and ECG

56
Q

management of hypothermia [6]

A

warm, humidified O2
removal of wet clothing
rewarm slowly at 0.5 deg/hour
blankets
warm IV infusion
cardiac monitoring

57
Q

carboxyhemoglobin levels in CO poisoning

what is severe

A

10-30%

> 30% is severe

58
Q

investigation in CO poisoning

A

ABG/VBG

pulse oximetry will be falsely high

59
Q

management of CO poisoning [2]

A

100% high flow oxygen NRB
hyperbaric oxygen

60
Q

which causes of shock cause low cardiac output [2]

A

hypovolaemia
pump failure

61
Q

which causes of shock cause low SVR [5]

A

sepsis
anaphylaxis
neurogenic
endocrine failure e.g. Addison
drugs

62
Q

treatment of cardiogenic shock [2]

A

dobutamine
dopamine

63
Q

treatment of septic shock

A

noradrenaline

64
Q

treatment of hypovolaemic shock

A

blood

65
Q

adrenaline dose in anaphylaxis in adults

A

500mcg

66
Q

treatment of bradycardia [3]

A

atropine, up to a maximum of 3mg
transcutaneous pacing
isoprenaline/adrenaline infusion titrated to response

67
Q

treatment of haemodynamically unstable PE

A

continuous infusion of UFH + thrombolysis

68
Q

treatment of thyrotoxic storm

A

symptom control: IV propanolol (IV digoxin if CI)

IV PTU
IV hydrocortisone
lugol (potassium iodide)

69
Q

initial fluid type given in trauma

A

crystalloid

70
Q

airway manoeuvre that can be used in cervical spine injury

A

jaw thrust

71
Q

TRALI vs fluid overload

A

TRALI will not raise JVP and presents with hypotension and fever

72
Q

causes of torsade de points

A

T (=Terfenadine)
H (=Haloperidol)
E (=Erythromycin)
M (=Methadone)
A (=Amiodarone)
S (=Sotalol)
C (=Chloroquine)
O (=Ondansetron)
T (=Tricyclic Antidepressants)
S (=Serotonin Reuptake Inhibitors).

73
Q

x-ray sign of epiglottis

A

thumb sign

Year 6 (19 decks)

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