Emergency med Flashcards by Rakul Sri

how should you oxygenate a patient with poor respiratory effort?

mechanical ventilation with bag and valve mask

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which form of shock has warm peripheries

distributive e.g. sepsis

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

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skin manifestation of carbon monoxide poisoning

cherry red skin

rare

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when is an initial fluid bolus of 500ml appropriate

severe dehydration where systolic BP <90

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ECG changes in posterior MI

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

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key features of HHS [4]

severe hyperglycaemia
hypotension
hyperosmolality without significant ketosis or acidosis.

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treatment of aspirin overdose

IV sodium bicarbonate for urinary alkalinisation
haemodialysis if severe

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

activated charcoal

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treatment for paracetamol overdose <4 hours ago

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

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

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

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

Start N-acetylcysteine immediately

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treatment for paracetamol overdose ingestion >24 hours ago

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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treatment for staggered dose paracetamol overdose

Start N-acetylcysteine immediately

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

Kings College Criteria

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

Arterial pH Less than 7.3

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features of myxoedema coma [6]

hypothermic
hypotensive
bradycardia
slow mental function
lethargy
loss of consciousness

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initial adenosine dose in SVT

6mg IV

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initial step of management of tension pneumothorax

needle decompression followed by chest tube

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signs on ECG for PE [4]

sinus tachycardia
RAD
RVHS
S1Q3T3

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What does massive PE mean?

a PE with haemodynamic instability

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how is massive PE treated?

IV alteplase i.e. thrombolysis

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at what point are adrenaline and amiodarone given IV in ALS

which drug is a one off and which one is repeated

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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how is PEA or asystole managed? [2]

CPR
IV adrenaline in the first cycle and every other cycle

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dosage of adrenaline and amiodarone used in ALS

amiodarone 300mg IV
adrenaline 1mg IV

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contraindication to thrombolysis in management of MI [7]

* 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

timeframe for considering PCI from onset of symptoms and medical contact

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

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

thrombolysis

If patients present more than 12 hours of MI symptom onset | treatment approach

pharmacotherapy

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

re-vascularization within 12-24 hours

management of acute pulmonary oedema [5]

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,

management of haemodynamically stable torsade de pointes

2mg IV magnesium sulphate over 1-2 minutes haemodynamically unstable--> DC cardiovert

feature on ECG for torsade de pointes [2]

1. polymorphic VT on the background of prolonged QT 2. QRS "twists" around the isoelectric lines

definition of hypotension in shock

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

what is the sign someone is in Addisonian crisis when hypotensive

IV fluids don't improve the BP they need IV hydrocortisone definitively

management of Addisonian crisis

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

what is flumanezil used for? [2] | why can't it be used for mixed overdoses

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

5 signs of fluid overload

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

How often are adrenaline doses repeated in anaphylaxis

repeated every five minutes, several times if necessary

clinical signs on examination in aortic dissection [3]

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

biochemistry in Addisonian crisis

hyponatraemia (most classically), hyperkalaemia, hypoglycaemia and hypercalcaemia

Diagnostic investigations of Addison's disease

short Synacthen test

4 signs of hypopituitary coma

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

management of hypopituitary coma

hydrocortisone and T3 surgery if apoplexy is the cause

3 things to investigate in an unconscious person suspected of poisoning

glucose paracetomol salicylate

contraindications for activated charcoal [2]

alcohol metal salts like lithium

reversal agent for TCA overdose

sodium bicarbonate

reversal agent for beta blocker overdose

atropine

reversal agent for ethylene glycol (antifreeze) poisoning

fomepizole

reversal agent for cyanide poisoning

100 oxygen and sodium nitrate/thiosulphate

reversal agent for organophosphate toxicity

atropine

reversal agent for digoxin toxicity

digifab (digoxin-specific antibody)

reversal agent for iron toxicity

desferrioxamine

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

>= 10% TBSA

signs of severe hypothermia

temp <=35 deg (rectal) with no shivering

2 investigations for hypothermia

temperature (oral/axillary/PR) and ECG

management of hypothermia [6]

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

carboxyhemoglobin levels in CO poisoning | what is severe

10-30% >30% is severe

investigation in CO poisoning

ABG/VBG pulse oximetry will be falsely high

management of CO poisoning [2]

100% high flow oxygen NRB hyperbaric oxygen

which causes of shock cause low cardiac output [2]

hypovolaemia pump failure

which causes of shock cause low SVR [5]

sepsis anaphylaxis neurogenic endocrine failure e.g. Addison drugs

treatment of cardiogenic shock [2]

dobutamine dopamine

treatment of septic shock

noradrenaline

treatment of hypovolaemic shock

blood

adrenaline dose in anaphylaxis in adults

500mcg

treatment of bradycardia [3]

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

treatment of haemodynamically unstable PE

continuous infusion of UFH + thrombolysis

treatment of thyrotoxic storm

symptom control: IV propanolol (IV digoxin if CI) IV PTU IV hydrocortisone lugol (potassium iodide)

initial fluid type given in trauma

crystalloid

airway manoeuvre that can be used in cervical spine injury

jaw thrust

TRALI vs fluid overload

TRALI will not raise JVP and presents with hypotension and fever

causes of torsade de points

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

x-ray sign of epiglottis

thumb sign

Emergency med Flashcards

(73 cards)