Emergency Medicine Flashcards
(211 cards)
1
Q
what is the primary survey
A
ABCDE
2
Q
what are signs of airway obstruction
A
look for chest movement and assess airflow from nose and mouth
snoring, stridor, added noises, gurgling, paradoxical movement
3
Q
what does snoring show
A
inspiratory obstruction
4
Q
what does stridor show
A
inspiratory obstruction
5
Q
what does wheeze show
A
lower respiratory tract obstruction
6
Q
what does gurgling suggest
A
obstruction due to secretions/ blood
7
Q
what does hoarseness show
A
oedema of chord- shows impending obstruction in burns pts
8
Q
what does paradoxical movement suggest
A
complete airway obstruction: chest wall drawn in and abdomen expands when attempting to breath
accessory muscle use, intercostal recession and tracheal tug can be present in all forms of airway obstruction
9
Q
what are the options for airway management
A
IF YOU HAVE CONCERN ABOUT THE AIRWAT SEEK SENIOR HELP IMMEDIATLEY
head tilt chin lift
in trauma jaw thrust (if worried about C spine)
suction (secretions), magills forceps (debris)
adjunct: NPA, OPA
endo tracheal tube
surgical airway
10
Q
what are the primary breathing interventions
A
Bag valve mask
non rebreather mask
non invasive ventilation
mechanical ventilation
other: nebs, abx. needle decompression, chest drain, naloxone (depends on cause)
11
Q
where is a chest drain inserted
A
4/5th intercostal space just anterior to the mid axillary line
12
Q
what should you assume a patient to be when in shock
A
bleeding- look floor, abdo, pelvis, chest, long bones
13
Q
what are the possible interventions within C
A
2 orange/ grey cannulas for IV fluids/ RBC if bleeding pelvic binder, splints tranexamic acid permissive hypotension (to try and not disrupt fromed clots to prevent bleeding) inotropes for septic shock (alongside abx)
14
Q
what fluid for shocked patients
A
crystalloid IV fluids: 0/9 NaCl or Hartmanns
boluses of 250-500ml of warmed 0.9% nacl should be given with A-e following each bag
15
Q
what is included in D
A
AVPU
GSC
pupils (reactivity and equality- may show lateralisation)
glucose
16
Q
what is cushings response
A
decreased Hr and incresed BP decreased RR response to decreased cerebral perfusion due to raised ICP
17
Q
what are the components and minimum score of the GCS
A
minimum 3 (unresponsive) eye response (max 4, min 1: 4 spontaneous, 3 sound/speech, 2 firm pressure, 1 no response) verbal response (max 5 min 1: 5 orientated, 4 confused conversation, 3 inappropriate words, 2 incomprehensible sounds, 1 no response) motor response (for best response, use best limbs, above level of injury, max 6 min 1: 6 obeying commands, 5 localising a pressure stimulus (purposeful movements towards stimuli), 4 normal flexion to pressure stimulus, 3 abnormal flexion to pressure stimulus, 2 extension to pressure stimulus, 1 flaccid, no response)
18
Q
what treatment for seizures
A
lorazepam
19
Q
treatment for low glucose
A
10% dextrose bolus 200ml
20
Q
what is E
A
exposure: trauma, pressure areas, cellulitis
measure temp and maintain
21
Q
what are the red flags for headaches
A
first and worst, thunderclap (SAH)
unilateral with eye pain (cluster HA, acute glaucoma)
unilateral HA with ipsilateral symptoms (migraine, tumour, vascular)
cough initiated, worse in morning/ bending over (increased ICP, venous thrombosis)
persisting HA with scalp tenderness (GCA)
fever or neck stiffness (meningitis)
change in the pattern of ‘usual’ HAs
decreased consciousness
22
Q
what should you worry about in HA in pregnancy
A
pre-eclampsia
23
Q
what causes of HA might have signs of meningism
A
meningitis, SAH
24
Q
what causes of HA may have no signs on examination
A
tension,migraine, cluster, post traumatic, drugs, CO poisoning, anoxia, SAH
25
what causes of HA may have decreased consciousness
```
stroke
encephalitis/meningitis
cerebral abscess
SAH
venous sinus occlusion
tumour
subdural haematoma
```
26
what causes of HA can cause papilloedema
```
tumour
venous sinus occlusion
malignant
IIH
CNS infections present for >2 weeks
```
27
what can cause wheezing
asthma, COPD, HF, anaphylaxis
28
what can cause stridor
foreign body/ tumour
acute epiglottitis
anaphylaxis
trauma
29
what can cause crepitations
HF
pneumonia
bronchiectasis
fibrosis
30
what causes of breathlessness can have a clear chest on examination
```
PE
hyperventillation
metabolic acidosis (DKA)
anaemia
drugs
shock
pneumocystis jivorecii
CNS causes
```
31
what will be found on percussion in a pleural effusion
stony dullness
32
what are the life threatening causes of chest pain
```
MI
ACS
Aortic dissection
tension pneumothorax
oesophageal rupture
```
33
what is a coma
state on unrousable unresponsiveness
34
what is the immediate management for a patient in a coma
ABCDE
protect cervical spine if trauma
examine and collateral Hx to find cause
35
what treatment for wernickes encephalopathy
pabrinex (thiamine) IV
36
what antibiotic for meningitis
if in community give Benpen/ cefotaxine/ ceftriaxone
in hospital ceftriaxone/ cefotaxime
37
what tx for enceophalitis
aciclovir
38
what is the decorticate position
arms flexed into chest, thumb in clenched fist
39
where is the damage if decorticate position present
above level of red nucleus in the midbrain
40
what is the decerebrate position
extended arms- pronated forarms by sides, adducted and internally rotated shoulders,
41
where is the damage in decerebate posture
below level of red nucleus in the brain
42
what is shock
circulatory failure causing hypoperfusion
| systolic bp <90/ MAP <65 with evidence of tissue hypoperfusion (mottled skin, low urine output, lactate >2)
43
how do you calculate MAP
CO x SVR
| CO= SV x HR
44
what can cause cardiogenic shock
ACS, arrythmias, AD, acute valve failure, secondary causes: PE, tension pneumothorax, cardiac tamponade)
45
what can cause loss of Systemic vascular resistance
```
sepsis
anaphylaxis
neurogenic (spinal cord injury, epidural, spinal anaesthetic)
endocrine (addisons, hypothyroidism)
drugs
```
46
what does a raised JVP in shock show
cardiogenic shock likely
47
what does a difference in BP between arms mean
aortic dissection
48
how do you treat hypovolaemic shock
```
treat underlying cause
fluid bolus (10-15ml/kg crystalloid via large peripheral line, if improved repeat)
```
49
tx for haemorrhagic shock
stop bleeding if possible
give up to 2l crystalloid then crossmatch bloods if still in shock
five FFP with red cells
consider tranexamic acid
50
what is septic shock
sepsis + lactate >2 despite fluid resus or requirement of vasopressors to maintain MAP >65
51
what is the management of sepsis
B- blood cultures
U- urine output monitoring
F- 500ml boluses of crystalloids (saline) over 15 mins. get senior help after 2 boluses
A- broad spectrum Abx within 1 hr
L- blood gas for lactate
O- oxygen
get senior help after 1 hr if still not improving
52
management for anaphylactic shock
```
secure airway, give 100% 02
remove cause
raise feet to help circulation
IM 0.5mg adrenaline repeat every 5 mins
IV chlorphenamine and hydrocortisone
fluids (saline)
if wheeze treat as for asthma)
measure tryptase 1-6 hours after suspected anaphylaxis
```
53
what are the life threatening causes of cardiac chest pain
MI, AD, PE
54
what are the urgent causes of cardiac chest pain
unstable angina, coronary vasospasm, pericarditis, myocarditis
55
what is the life threatening GI cause of chest pain
oesophageal rupture
56
what is an urgent GI cause of chest pain
pancreatitis
57
what scoring systems show cardiac risj
TIMI: stemi risk score
GRACE: patients with ACS determine their mortality in hospital
58
what scoring system for PE
well: suspected PE
| PERC : PE rule out criteria
59
what are the abdominal causes of SOB
ascites, obesity, pregnancy
60
what are the common causes of resp acidosis
severe asthma, pneumonia, hypoventilation
61
what are the causes of respiratory alkalosis
hyperventilation, panic attack, salicylate poisoning
62
metabolic acidosis causes
DKA, lactic acidosis, alcohol
63
what are the causes of metabolic alkalosis
severe vomiting, loss of potassium
64
what symptoms should you include in an abdo pain history
(normal) + urinary, gynae and GUM
65
what is important to include in a head injury history
```
mechanism
LOC
vomiting
visual disturbances
associated injuries
seizure
amnesia
bleeding risk
```
66
what is in a head injury exam
```
ABCDE
GCS
pupils
ears
external signs of head injury
neurological examination
cervical spine
```
67
what in trauma can cause a 3rd nerve palsy
CN3 nerve palsy- raised ICP
68
what are the signs of a base of skull #
haemotympanum, CSF leak, panda raccon eyes, battles signs
69
what is cushings triad
```
an increase in ICP results in a decrease in cerebral blood flow- to over come the BP arterial pressure will increase
cushings triad:
-hypertension
-bradycardia
-irregular breathing
```
70
when should you do a cervical spine CT in HI patients
GCS less than 13
| patient intubated
71
describe an extradural haemtoma
bleedinf between skull and outer layer of dura due to rupture of middle meningeal artery, happens in young peoepl: brief LOC, lucid interval then reduced GCS
72
describe a subdural haematoma
blood between dura and arachnoid matter, insidious onset in the elderly, reverse warfarin and evacuate the clot
73
what can cause inverted T waves
ischaemia, PE, BBB, raised ICP
74
treatment for STEMI
300mg aspirin ASAP, morphine, O2 if needed, GTN
if within 12 hours and can be given in 2 hours: PCI, give prasugrel and heparin
If within 12 hours but PCT not possible in 2 hours: fibrinolysis (streptokinase/ alteplase) and fondaparinux/ clopidogrel if already on AC
medical management (>12 hours): tricagrelol and consider clopidrel with aspirin
75
NSTEMI management
300mg aspirin
fondaparinux (anti thombin)
so grace score to calculate risk
if low risk (predicted 6 month <3/=%) tricagrelor and aspirin, consider clopidogrel
if high risk urgent angiography if unstable, within 72 hours if stable, tricagrelor and aspirin
76
what can haemotympanum be a sign of
base of skull #
77
when should you do a ct scan for head injury
```
lowered GCS
suspected skull #
signs if basal skull # (haemotympanum, panda eyes, CFS leak, battles sign)
post traumatic seizure
focal neurological deficit
>1 episode of vomiting
on anticoagulants
78
where do extra dural haematomas most commonly occur
under pterion due to middle meningeal artery rupture
79
what can be done to reduce ICP
hyperventillation, mannitol
80
what are signs of imminent coning
cushing reflex, dilated pupils
81
what can be given for wheeze
salbutamol, O2
82
O2 range for COPD patients
88-92
83
Tx for acute COPD presentation
salbutamol, prednisolone 40mg oral/ IV hydrocortisone if cant swallow, nebs iaptropium, IV magnesium/ salbutamol/aminophylline
abx and sepsis protocol if infective
NIV
84
what toxidrome does ectasy cause
sympathic- tachycardia, sweating, hypertension, dilated pupils
85
what is an opioid toxidrome
pin point pupils, reduces HR, RR and conscious level
86
what is an anticholingeric toxidrome (tricyclic antidepressants)
tachycardia, confusion, dysarthia, urinary retention, pyrexia and arrthymias
87
what is a sedative toxidrome (benzos)
reduced GCS and RR and HR and hypoxia
88
what is the cholinergic toxidrome
pinpoint pupils, sweating, VandD, urination, frothing at mouth
89
what substances need specific investigation
paracetamol 4 hours after ingestion
salicylates after aspirin
(if in doubt if these consumed do them anyway)
90
how do you calculate anion gap
(Na+K)-(Cl+HCO3) normal 8-16
91
what are the causes of a raised acid gap acidosis
```
methanol
uraemia
dka
peradyhide
iron OD
lacftic acid
salicylate
```
92
what is a sign of cardiotoxicity in toxicology
prolonged QT interval
93
what does activated charcoal
decontaminates the gut, prevents absorption by binding to toxins, can only be given within an hour of ingestion
94
what is the treatment for glutathione
N-acestylcysteine (maintains glutathione levels prevention hepatocellular damage)
then after 21 hours of administration get LFTS and coagulation screen to look for hepatocellular damage
95
what is the antidote for ticyclic antidepressants
sodium bicarb
96
what is the antidote for beta blockers
glucagon
97
how can a substance without an antidote be treated
by increasing renal elimination e.g. salicyltates (theophyline given)
98
what is the treatment for patients presenting with STEMI >12 hours after symptom onset
THROMBLOLYSIS, fondaparinux
99
what might be seen on ECG in a NSTEMI
st depression, flat or inverted T waves
| or normal
100
what should you gice morphine with
metaclopramide
101
what is fondaparinux
a factor Xa inhibitor, anticoagulant
102
what is pulsus alternatans seen in
pulmonary oedema
103
treatment for severe pulmonary oedema
```
oxygen if needed
diamorphine
furosemide
GTN spray
if high BP nitrate infusion
```
104
tx for cardiogenic shock
oxygen
diamorphine
correct arrythmias
optimise filling pressure (pulse, JVP)- under filling plasma expander, over filling inotropes (dobutamine)
105
Tx for cardiac tamponade
pericardiocentesis
106
give examples of SVT with abberrant conduction
AF/ a flutter with BBB
107
what should you do if you cant pinpoint rhythm in broad complex tachycardia
treat as VT
108
Treatment for broad complex tachycardia
correct hypokalaemia and hypomagaesia
if unstable: DCV with sedation, IV amiodarone over <20mins, consider repeat shocks, if refractory procainamide or sotalol
if stable: amiodarone over 20-60 mins
find cause, ICD
109
what is the treatment for VF
DCCV
110
TX for SVT with abberant conduction
adensoine
111
tx for sinus tachycardia
beta blockers
112
tx for SVT
oxygen, correct electrolytes
if unstable DCC, IV amiodarone over <20 mins
if stable and rhythm irregular probs AF: beta blocker, verapamil, digoxin or amiodarone, anticoagulants, DC cardioversion.
if unstable rhythm regular: vagal maneovres, adenosine (if this achieves sinus rhythm likely paroxsymal re-entrant SVT, if not likley a flutter treat with BB)
113
management for bradycardia
ecg, check electrolytes and digoxin levels, assess cause
if adverse signs (chock, syncope, HF, Myo ischaemia) atropine
if risk no adverse signs but risk of asystole/ no response to atropine: repeat atropine, TC pacing, adrenaline
114
what is a severe asthma attack
unable to complete sentences in one breath
RR >/= 25
pulse rate >/=110
PEF 33-50% of predicted or best
115
what is a life threatening attack
```
PEF <33%
silent chest, cyanosis
arrythmia/ hypotension
exhaustion, confusion, coma
low PaO2, high PaCO2
```
116
treatment for acute asthma attack
O2
5gm salbutamol nebulised
if severe/ life threatening add ipatropium
hydrocortisone IV/ prednisolone oral
reassess every 15mins
if not good response consider Iv magnesium
if still no improvement ICU
117
treatment for acute COPD exacerbation
if dont need admitted: increase SABA dose, 30mg pred for 5 days, consider abx
CXR to rule out infection and pneumothorax
ABG
nebulised bronchodilators (salbutamol and ipatropium)
O2 therapy: oxygen via a Venturi 24% mask at 2-3 l/min or Venturi 28% mask at a flow rate of 4 l/min or nasal cannula at a flow rate of 1-2 l/min (if a 24% mask is not available).
The target oxygen saturation should be 88– 92%
steroids (Iv hydrocortisone/ Oral prednisolone)
if no response aminophylline
NIV
ABx if signs of infection
Physio to aid sputum expectoration
118
what can cause a pneumothorax
```
spontaneous (ruptured bulla, young thin men)
chronic lung disease
infection
traumatic
carcinoma
CTD
```
119
what are the signs of a pneumothorax
reduced expansion, hyperresonance, diminished air sounds, tracheal deviation in tension
120
treatment for a pneumothorax
SOB and/or rim of air >2cm on CXR (dont do CXR if tension): aspiration: large bore needle into 2nd ICS mid clavicular line
chest drain 4-6th ICS mid axillary line
if secondary (underlying lung disease, smoker, trauma or on mechanical ventilation) go straight to chest drain
primary pneumothorax <2cm rim not breathless consider discharge and review in 2-4 weeks
secondary pneumothorax rim 1-2cm aspirate then repeat cxr, if now <1cm observe if >1cm chest drain
2nd with rim <1cm admit and observe w/ high flow oxygen
121
commonest cause of pneumonia
strep pneumoniae
122
signs of consolidation
diminished expansion, dull percussion, increased tactile vocal fremitus and resonance, bronchial breathing
123
what makes up the curb65 score
```
confusion
Urea >7
RR >30
BP <90/60
age >/=65
```
0-1 home tx
2 hospital
3 severe ICU
124
tx for pneumonia
02 if needed
treat septic shock if present
Abx:
-CAP 0-2 amoxicillin/doxy 3-5 co-amoxiclav + clarithromycin (erythromycin if preg, levoflox if allergic)
HAP- non severe co-amox/doxy PO, severe IV piperacillin and tazobactam
125
what causes PE ECG changes
RV strain
126
PE ecg changes
```
sinus tachycardia
RBBB
RC strain (t wave inversions V1-4)
RAD
SIQIIITIII (deep S waves, Q wave, inverted T wave)
```
127
Ix for PE
```
wells score
ECG
CXR
ABG
CT pulmonary angiography
```
128
tx for PE
```
O2 if hypoxic
morphine and antiemetic
DOAC/ LMWH
Iv fluid bolus
if stable- vasopressors: dobutamine/noradrenaline
in unstable- thrombolysis: alteplase
long term anticoagulation
```
129
what do vasopressors do
support cardiovascular system:
-alpha adrenergic, venoconstriction increases SVR
used in vasodilatory/ distributive shock states
e.g. noradrenaline, metaraminol, ephedrine
130
what do inotropes do
beta adrenergic
increase CP by increasing contractility
used in cardiogenic/ low flow shock
e.g. adrenaline, dobumatine
131
which fluids for the critically ill
crystalloids first line: hartmans and plasma-lye better than saline
132
what are plasma expanders
synthetic colloid fluids- HES, gelatins
133
what treatment for refractive cardiogenic shock
intra-aortic balloon pump- improves cardiac output
134
what are resuscitated patients at risk of
re-arrest and secondary hypoxic brain injury
135
what can rapid infusion of saline in resus cause
metabolic acidosis
136
what electrolytes does glucose 5% have
none
137
what is glucose 5% good for
mainteance
138
what is closer to plasma hartmanns or saline
hartmanns
139
name a plasma expander (colloid)
gelofusine
140
does ICF or ECF increase when you give a crystalloid (hartmans/saline)
ECF (interstitial and plasma)
141
does ICF or ECF increase when you give glucose 5%
both increase (why not good for resus)
142
what is the point of colloids
oncotic pressures draws more water into the plasma- but dont really work better than crystalloids in resus
143
Frail 82 year old lady who broke her ankle and was found lying on the floor a day later. She is drowsy with dry mucous membranes. Urea and creatinine are raised. Glucose 5% or crystalloid
glucose 5%
144
name a mild opioid
codeine
145
name a mild opioid
codeine
146
treatment for nociceptive pain
mild- paracetamol +/-NSAID
mod- paracetamol +/- NSAID + codeine
severe- paracetamol +/- NSAID + morphine
147
treatment for neuropathic pain
amitriptyline
| gabapentin/carbamazepine
148
what is in a standard opioid PCA
1mg morphine bolus with a 5 minute lockout
149
what oral morphine dose is equivalent to 60mg IV
120mg
150
what is the conversion from oral oxycodone to oral morphine
oxycodone is half the morphine dose
151
how do you calculate the breakthrough dose of opioids
one sixth of the daily total dose
152
can you use NSAIDs if there is chronic renal impairment
no
153
management for torsades de pointes
IV magnesium sulphate
154
how do you calculate rate on ECG
number of R waves in 30 boxes in rhythm strip x10 or 50 squares by 6
or 300 divided by no. of big boxes between QRS complexes
155
should you stop ACEi and ARBs before surgery
yes as risks hypotension and AKI
156
if non blanching rash present what should you do before admission
give benzylpenicillin
157
what is kernigs sign
pain + resistance on passive knee extension with hip fully flexed: sign of meningism
158
does all of the rash have to non blanching in meningism
no may only be one or two spots
159
what management for meningitis
take blood cultures first and do LP prior to antibiotics where no evidence of shock and able to do in within an hour
ceftriaxone
if features of meningism give dexamethasone
fluid resus + airway
prophylaxis- contact public health, cirpofloxacin for contacts
160
what does an LP show in the different types of meningitis
bacterial- turbid, polymorphs, low glucose, high protein
TB- fibrin web, low glucose
viral- clear, high glucose, low protein
161
when should you suspect encephalitis
odd behaviour, decreased consciousness, focal neurology or seizure preceded by infectious prodrome - treat before cause known
162
what causes encephalopathy
hypoglycaemia, hepatic encephalopathy, DKA, drugs, hypoxic brain injury, uraemia, SLE, wernickes,
163
what is a sign of HSV encephalitis
focal bilateral temporal lobe involvement
164
what is the treatment for viral encephalitis
aciclovir within 30 mins of patient presenting
165
what does a ring enhancing lesion on CT show
brain abscess
166
what is status epilepticus
seizures lasting >30 mins / repeated without intervening consciousness
167
what is the management for status epileticus
aim to try and stop seizure ASAP to prevent brain damage
secure airway
lorazepam IV 4mg , second dose after 10-20 mins if no improvement
(thiamine, glucose if indicated)
phenytoin infusion
ICU
168
when should you do CT in head injury patients
```
in one hour
GCS<13/ <15 at 2 hours post injury
focal deficit
suspected skull #
post traumatic seizure
vomiting > once
```
in 8 hours
any LOC/amnesia AND
>65/coagulopathy/ high impact injury/ retrograde amnesia >30 mins
if suspected C spine injury
GCS<13 , patient has been intubated,>65, coagulopathy, high energy injury, focal deficit, parasthesia of lower limbs
169
what is the management for raised ICP
```
correct hyoptension
elevate head to 30-40 degrees
hyperventilate to reduce C02
mannitol (osmotic diuretic)
dexamethasone for tumour oedema
restrict fluids
bore hole
```
170
what is needed to make a diagnosis of DKA
acidaemia
hyperglycaemia >11
ketonaemia/ ketonuria >3
171
what is the management for DKA
Admit to ICU if severe
fluid bolus
venous blood gas for pH
50 units of insulin in 50 ml saline at 0.1unit/kg/hour
check mg and ketones hourly
assess need for potassium when BM <14 start glucose alongside insulin
172
management for a hypo
if orientated 15-20mg carbs (orange juice) and recheck bm after 10 -15 mins
if uncooperative glucose gel
if unconscious IV glucose 75 mls 20% or 1mg im glucagon
long acting carbs when glucose >4
173
which patients do you see hypoglycaemic hyperosmolar states in
unwell type 2 DM
marked dehydration and glucose >30
no switch to ketone metabolism
174
management foe diabetic HHS
LMWH to all except if CI
rehydrate slowly
only use insulin if BM not falling
175
what diabetic drug carries a risk of lactic acidosis
metformin
176
what is a myxoedema coma
most hypothyroid state before death
| treatment- ICU, T3 (liothyronine), Iv hydrocortisone
177
what is a thryoid storm
```
severe hyperthyroid
Tx
propranolol (may need digoxin)
carbimazole
steroids to prevent peripheral conversion of T4 to T3
treat suspected infection
```
178
how might people in addisonian crisis present
in shock - vasoconstriction, in creased HR,
179
treatment for addisonian crisis
IV hydrocortisone
fluid bolus
monitor for hypoglycaemia
180
treatment for hypopituitary coma
IV hydrocortisone (signs= hypothermia, hypotension +/- septic signs without fever)
181
signs and management of phaeochromocytoma emergencies
pallor
pulsing HA, hypertension, feels about to die, pyrexial
Tx ICU for combined alpha and beta bockade, (alpha started first as unapposed beta block can worsen hypertension)
alpha block- phentolamine
182
when can activated charcoal be given
<1hr of dose
183
when do you want to test paracetamol blood levels
4hrs after dose
| if over this time and suspect large dose give acetylcysteine anyway
184
antidote for paracetamol
acetylcysteine
185
antidote for opioids
naloxone
186
what blood should always be done in poisoning
salicylate, paracetamol and glucose
187
what medications do you give in ALS and when
```
shockable rhythms:
• Give adrenaline every
3–5 min
• Give amiodarone after
3 shocks
non shockable:
adrenaline asap
```
188
what are the 4h's and t's of the reversible causes of cardiac arrest
hypoxia, hypovolaemia, hyperkalaemia/hypoglycaemia/hypocalcaemia, hypothermia
thrombosis, tension pneumothorax, tamponade, toxins
189
doses of adenosine in SVT
6,12,18
| get chest pain and doom
190
doses of amiodarone
VT non resus: 200mg oral or 5ml/kg over 20-120 mins
| resus- 300mg in 20ml glucose 5% then 150mg if required
191
atropine dose
500mcg IV
192
what is in a shock pack and how is it given
4 units RBC
4 units FFP
1 pool platelets
given 1:1 if trauma, 2:1 if other, with 1 gram TXA if trauma
193
what vasopressor for sepsis
noradrenaline
194
what abx for sepsis
IV amox (vanc) met and gent
195
tx for TCA OD
sodium bicarb
196
tx for Beta blocker OD
glucagon
197
what is cushings reflex
bradycardia, hypertension, resp depression
198
what is the decerebate postion
arms abnormal extended
199
what is the decoritate position
arms abnormally flexed
200
what is the motor score including decorticate and decerebrate of GCS
```
6- obeys commands
5- localises to pain
4- withdraws to pain
3- abnormal flexion (decorticate)
2- abnormal extension (decerebrate)
1- none
```
201
when is major haemorrhage protocol activated
bleed + BP <90, HR >110
202
what do you need to do in major haemorrhage
call 2222 state massive harmorhage
call bloodbank state massive haemorrhage
send urgent : FBC, coagulation screen, fibrinogen, crossmatch, U+E, calcium
blood bank will give 4 red 4 ffp
consider tranexamic acid and 1:1 ratio if trauma, if not 2:1
if controlled re call to stand down
203
what tests dont miss out in ABCDE
ECG
CXR if short of breath and low sats (check not pregnant)
cannulas
204
what tests dont miss out in ABCDE
ECG
CXR if short of breath and low sats (check not pregnant)
cannulas
205
what are the doses of adrenaline
cardiac arrest 10mls 1:10000 IV
anaphylaxis 500micrograms 1:1000 IM
206
management of hyperkalaemia
if ECG changes and >6 or no ECG changes and >6.5
1. 10mls 10% calcium chloride/ gluconate over 10 mins (dont need if <6.5 and no ecg changes)
2. fixed rate insulin in 25g glucose infusion
3. salbutamol
207
how to calculate breakthrough morphine
1/6th 24 hour dose
208
10 of tramadol/ codeine/ dihydrocodeine= ? morphine
1
209
10 oral morphine= ? sc morphine
5 (half dose)
210
10 morphine = ? oxycodone
5
211
what are the anticipatory care meds
morphine sulphate
midazolam
hyoscine butylbromide (secretions)
levomapropamize (nauseas)
