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Finals Revision > Emergency medicine > Flashcards

Emergency medicine Flashcards

1
Q

What is normal pH on a blood gas?

A

7.35 to 7.45

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2
Q

What is normal PaCO2 on a blood gas?

A

4.7 - 6 kPa

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3
Q

What is normal PaO2 on a blood gas?

A

11-13 kPa

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4
Q

What is a normal HCO3- on a blood gas?

A

22-26 mEq/L

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5
Q

What is a normal base excess on blood gas?

A

-2 to +2 mol/L

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6
Q

How to see if the patient is hypoxic on the blood gas

A

PaO2 should be >10 on room air

If they’re having oxygen therapy - their PaO2 should be 10kPa less than the % inspired concentration FiO2

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7
Q

What percentage oxygen is delivered by nasal cannulae, simple face masks, non-rebreather mask and venturi masks?

A 
Nasal cannulae -
1L - 24%
2L - 28%
3L - 32%
4L - 36%

simple face mask - 40-60%

Non-rebreather mask - 60-90%

venturi masks -
24%
28%
35%
40%
60%
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8
Q

What are the two types of respiratory failure?

A

Type 1 respiratory failure = hypoxaemia with normocapnia

Type 2 respiratory failure = hypoxaemia with hypercapnia

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9
Q

Causes of type 1 respiratory failure

A

Pulmonary oedema
Bronchoconstriction
Pulmonary embolism

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10
Q

Causes of type 2 respiratory failure

A 
COPD
pneumonia
rib fractures
obesity
Guillain Barre
MND
Opiates
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11
Q

What are the 4 acid base disturbances you see on blood gas?

A

Respiratory acidosis - acidotic pH <7.35, with high PaCO2 & normal HCO3-

Respiratory alkalosis - alkalemic pH >7.45, with PaCO2 low & normal HCO3-

Metabolic acidosis - acidotic pH <7.35, with normal PaCO2 & low HCO3-

Metabolic alkalosis - alkalemic pH >7.45, with PaCO2 normal & high HCO3-

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12
Q

How can you tell if an acid base abnormality has been compensated for on blood gas?

A

Respiratory acidosis with metabolic compensation - low/normal pH, with high PaCO2 and high HCO3-

Respiratory alkalosis with metabolic compensation - high/normal pH, with low PaCO2 and low HCO3-

Metabolic acidosis with respiratory compensation - low pH, with low HCO3- and low PaCO2

Metabolic alkalosis with respiratory compensation - high pH, with high HCO3- and high PaCO2

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13
Q

What does base excess show on a blood gas?

A

shows metabolic acidosis or alkalosis

  • High BE = there is a higher than normal amount of HCO3- in the blood (due to metabolic alkalosis or compensated respiratory acidosis)
  • Low BE = there is a lower than normal amount of HCO3- in the blood (metabolic acidosis or compensated respiratory alkalosis)
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14
Q

How can you tell if there’s mixed acidosis and alkalosis?

A

the CO2 and HCO3– will be moving in opposite directions (e.g. ↑ CO2 ↓ HCO3– in mixed respiratory and metabolic acidosis).

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15
Q

Causes of respiratory acidosis

A

Respiratory depression - opiates
Guillian-Barre
Asthma
COPD

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16
Q

Causes of respiratory alkalosis

A 
Anxiety - panic attack
pain causing an increase RR
Hypoxia causing increased alveolar ventilation to try compensate
PE
Pneumothorax
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17
Q

How do you calculate the anion gap?

A

Cations - anions

e.g. Na - (Cl + HCO3-)

18
Q

What is a normal anion gap?

A

8-12

19
Q

What is an abnormal anion gap?

A

> 20

Shows anion gap acidosis

20
Q

Causes of high anion gap metabolic acidosis

A

DKA
Lactic acidosis
Aspirin overdose
Renal failure

21
Q

causes of normal anion gap metabolic acidosis

A

GI loss of HCO3- = diarrhoea, ileostomy, proximal colostomy
Renal tubular disease
Addison’s disease (primary adrenal insufficiency)

22
Q

causes of metabolic alkalosis

A

GI loss of H+ ions - vomiting and diarrhoea
Renal loss of H+ ions - loop and thiazide diuretics, HF, nephrotic syndrome, cirrhosis, Conn’s syndrome (primary hyperaldosteronism)

23
Q

Causes of mixed respiratory and metabolic acidosis

A

Cardiac arrest

Multi-organ failure

24
Q

causes of mixed respiratory and metabolic alkalosis

A

Liver cirrhosis in addition to diuretic use
Hyperemesis gravidarum
Excessive ventilation in COPD

25
Q

Mx of acute bronchitis

A

Antipyretic
SABA
ABx if bacterial cause suspected - unlikely as mostly caused by viruses

26
Q

Mx for all patients with ACS

A

Aspirin 300mg
Oxygen if sats <94%
Morphine if severe pain
Nitrates (careful if hypotensive)

27
Q

Mx for STEMI

A

Aspirin 300mg
Oxygen if sats <94%
Morphine if severe pain
Nitrates (careful if hypotensive)

PCI if possible within 120 minutes - give praugrel, unfractionated heparin

If PCI not possible within 2 hours = fibrinolysis (streptokinase, alteplase and tenecteplase) and give ticagrelor afterwards

28
Q

Mx for NSTEMI

A

Aspirin 300mg
Fondaparineux if no immediate PCI is planned

Estimate 6 month mortality (GRACE)
If low risk = ticagrelor
High risk = PCI, give ticagrelor & unfractionated heparin

29
Q

Criteria for diagnosing AKI

A

Rise in creatinine of 26 + in 48 hours
>50% rise in creatinine over 7 days
Fall in urine output to less than 0.5ml/kg/hour for more than 6 hours
>25% fall in eGFR in children/young adults in 7 days

30
Q

Mx of AKI

A

IV fluids if dehydrated
Stop NSAIDs, ahminoglycosides, ACei, ARBs, diuretics
Consider if the person has sepsis and treat it

31
Q

Symptoms of anaphylaxis

A

Swelling of throat/tongue - hoarse voice and stridor

Respiratory wheeze
Dyspnoea

Hypotension
Tachycardia

Must be having ABC problems to have anaphylaxis

Other symptoms - generalised pruritus, widespread erythematous/urticarial rash

32
Q

Mx of anaphylaxis

A

IM adrenaline
- 0.5ml 1 in 1000 for adults (>12yo)

give IM adrenaline every 5 minutes if necessary

IV fluids for shock
IV adrenaline infusion if still ABC problems despite 2 doses of IM adrenaline

After stabilisation:

  • Chlorphenamine
  • Serum trypase levels

Give an adrenalin auto-injector on discharge

33
Q

mx for ruptured AAA

A

symptoms - severe central abdo pain radiating to the back with pulsatile expansile mass +/- shock

immediate vascular review
CT if haemodynamically stable to confirm diagnosis, if not straight to theatre

34
Q

mx for acute heart failure

A

IV loop diuretic - furosemide
oxygen
Vasodilators - nitrates (unless hypotensive)

If respiratory failure = CPAP

If hypotension - inotropic agent (dobutamine), vasopressor (norepinephrine), mechanical circulatory assistance (intra-aortic balloon counter pulsation/ventricular assist device)

Continue their beta blockers

35
Q

Mx for acute exacerbation of COPD

A

Increase frequency of bronchodilator / give neb SABA

Prednisolone 30mg (for 5 days)

ABx - amoxicillin or clarithromycin or doxycycline

36
Q

mx of compartment syndrome

A

fasciotomy
raise limb
remove bandages/casts

37
Q

mx of DVT

A

apixaban/rivaroxaban at treatment dose

unless renal impairment / antiphospholipid syndrome = LMWH

Stop after 3 months if provoked DVT or after 6 months if unprovoked

38
Q

Mx of DKA

A

Fluid replacement with 0.9% NaCl

Insulin IV fixed rate 0.1 unit/kg/hour
Once glucose is <15 mol/L, start 5% IV dextrose

Correct hypokalaemia that results from insulin infusion - replace at a rate of <20 mol/hour

39
Q

Mx of ectopic pregnancy

A

+ve pregnancy test + transvaginal USS

Expectant, medical or surgical management depending on size of ectopic, ruptured, symptoms, presence of fetal heartbeat, level of HCG

40
Q

Mx of status epilepticus

A

ABC
IV lorazepam, PR diazepam or buccal midazolam
Repeat after 10-20 minutes

Ongoing = IV phenytoin or phenobarbital infusion

Ongoing = GA and intubation

41
Q

Characteristics of extra dural haemorrhages

A

Between skull bone and dura mater

Rupture of middle meningeal artery on the temporal surface of the skill

Hx of trauma and skull fracture

Lucid interval followed by unconsciousness

CT = convex shaped mass

42
Q

Mx of extra dural haemorrhage

A

ABCDE approach
Check BMs
Check for coagulopathy and reverse any anticoagulation
prophylactic abx for open skull fractures
anticonvulsants to reduce seizure risk
Mannitol/barbiturates to reduce ICP
Burr hole craniotomy - to remove haematoma
Hemicraniotomy if lots of blood/cerebral oedema

Finals Revision (18 decks)

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