Emergency Medicine Flashcards
(115 cards)
1
Q
what is the cause of slow skin turgor
A
dehydration
2
Q
what is anaphylaxis
A
it is a severe reaction to any antigen due to major histamine release of mast cells
3
Q
when is it best to treat sepsis
A
golden hour - within an hour
4
Q
why does diabetes decrease immunity
A
more sugar means more favourable environment for infections to grow
5
Q
what is seen in torsades de pointes
A
polymorphic ventricular tachycardia
QRS axis is constantly shifting
6
Q
treatment for torsades des pointes
A
magnesium sulphate
7
Q
causes of torsades de pointes
A
MI
mitral valve prolapse
ischaemia
8
Q
management of unstable and stable torsades des pointes
A
unstable: DC cardio version
stable: Magnesium sulphate
9
Q
what is given to treat severe hyperkalaemia
A
calcium gluconate
- potassium is intracellular
- calcium is extracellular
calcium is given to push the potassium back inside the cells
10
Q
treatments for hyperkalaemia
A
- insulin with dextrose - pushes K into the cells
- salbutamol
- sodium bicarbonate - works on collecting duct to push the K into the urine
- potassium resin bond
or dialysis
11
Q
what is a lucid interval
A
after an injury for a period of time the person looks fine but isn’t
12
Q
what bleed in the brain presents immediately after injury
A
arterial
13
Q
what bleed in the brain presents slowly after an injury
A
venous bleed
14
Q
what type of bleed is an extradural bleed
A
arteriall
15
Q
what type of bleed is subdural
A
venous
16
Q
treatment anagram for MI
A
Morphine
Oxygen
Nitrate GTN
Aspirin
17
Q
patient comes in with flu-like symptoms, chest pain, ECG shows PR depression and ST elevation and raised troponin levels
what does the patient have and management?
A
pericarditis and given NSAIDS
18
Q
What is given in management of paracetamol overdose
A
Activated charcoal if OD was taken within an hour
Or
N-acetylcysteine
19
Q
Halitosis
A
Bad smelling breath
20
Q
Schatzi ring
A
Narrowing of lower oesophagus
21
Q
Optic neuritis
A
Painful loss of vision
Abnormal perception of colours
22
Q
Epigastric hernia
A
Protusionod the fat
Advise weight loss
23
Q
Reverse tick in ST depression with first degree heart block
Dizziness
Nausea
What is it
A
Digoxin overdose
24
Q
What is the antidote for digoxin overdose
A
Digibind
25
Patients who had an accident and have a GCS of <13 on admission or <15 after 2 hours should be given a CT scan when?
within one hour
26
anaphalaxsis attack treatment
adrenaline IM 0.5ml of 1:1000
27
numbness in hand and wrist
inability to straighten fingers
wrist drop due to direct pressure on upper medial arm
Saturday night palsy
28
vomiting
abdo pain
breathing fast and high blood glucose
diabetic keto acidosis
29
what is acute coronary syndrome
also called coronary artery disease
causes a cessation in the blood supply to the myocardium
ischaemic heart disease
30
symptoms of ACS
chest pain
SOB
sweating
palpitations
pain radiating to the jaw and arms
light headedness
31
what comes under ACS
unstable angina
NSTEMI
STEMI
32
stable angina presentation
pain on exertion
33
unstable angina presentation
pain all the time
34
NSTEMI presentation
troponin levels are increased but no changes on ECG
t wave inversion
35
STEMI presentation
ECG will show ST elevation
36
when is troponin best tested
when the pain is there
as this is when the troponin is released
37
what is MONA - in management for ACS
morphine
oxygen
nitrates
aspirin
38
when should PCI be done for STEMI
within 2 hours
39
If the patient cannot be given PCI in 2 hours then?
give them fibrinolysis - shouldn't give if there's a risk of bleeding then clopidogrel and low molecular weight heparin and then PCI after
40
NSTEMI management
Beta blockers (not to give to asthmatics)
A - aspirin
T - ticagreolor
M- morphine
A - anticoags
N- nitrates
41
ACS secondary prevention
aspirin 75mg daily
another Antiplatelet
atrovastatin
ACE inhibs
atenolol
aldosterone antagonist
42
ACS prevention
stop smoking
reduce alcohol
then rehab
43
Cardiac Tamponade - what is it
fluid of blood fills in the pericardial sac
pericardium cannot stretch
pressure increases and compresses the heart
44
causes of cardiac tamponade
trauma
pericarditis
TB
malignancy
45
becks triad
hypotension
raised JVP
quiet heart sounds
kussumauls signs - JVP rises on every inhale and produces a wheeze
pulses paradoxus - systolic BP just goes up and down and not constant
46
what is kussumauls sign
JVP rises on every inhale and produces a wheeze
47
what is pulses paradoxus
systolic BP just goes up and down and not constant
48
investigation for cardiac tamponade
ECHO
chest x ray
ECG - tachycardia and electrical alternanas
49
management for cardiac tamponade
urgent needle pericardiocentresis
cardiac surgery
50
what is SHOCK
acute failure of the CVS to perfuse the tissues enough
not enough oxygen
51
what is cardiac output
HR x Stroke volume
52
what is stroke volume
how much blood pumped out in each ejection
53
different types of shock
cardiogenic
hypovalemic
obstructive
distributive
54
hypovalaemic
Due to blood of fluid loss
low BP
low CO2
high HR
55
management for hypovalaemic shock
IV fluids
56
cariogenic shock
low CO2
low cardiac output
due to MI
low BP
high HR
57
management for cariogenic shock
58
obstructive shock
due to tension pneumothorax
cardiac tamponade
PE
low BP
high HR
59
what is distributive shock
septic
anaphylactic
neurogenic
60
septic shock
low SVR
caused by peripheral vasodilation
due to infection
low BP
high HR
61
anaphylactic shock
low SVR
severe allergic reaction
SOB
hives
angioedema
low BP
high HR
62
management of septic shock
iv antibiotics
63
management of anaphylactic shock
adrenaline 500mg 1:1000
64
neurogenic shock
due to CNS injury
can be due to trauma to head and spine
65
mgt of neurogenic shock
corticosteroids
66
sepsis vs septic shock
sepsis - consistent hypotension
it is the infection that can then go onto causing shock
67
what is sepsis
life threatening organ dysfunction caused by an infection
68
sepsis is more common in:
very young children
very old
immunosuppressed
recent surgery
IV drug use
69
clinical sigs of sepsis
temperature >38 degrees
high RR
blood pressure is <90
confusion
>9 HR
urine output is <0.5 Ml/Kg/hour
clammy skin
cyanosis
70
management of sepsis
take 3:
blood cultures, urine output and lactates
give 3:
high flow oxygen
IV fluids
antibiotics
71
golden hour of treatment for sepsis
1 hour
72
target for oxygen for patients with COPD
89-92%
73
what is neutropenic sepsis
sepsis
fever >38 degrees
neutrophil count will be less that <0.5x10^9
due to treatment related toxicity
74
features of neutrogenic sepsis
same as sepsis
additional: on chemo
had a recent UTI
pneumonia
75
management of neutrogenic sepsis
antibiotics immediately - don't wait for WBC count
give piperacillin and tazebactum
76
Steven John syndrome and toxic epidermal necrolysis
immune response causes epidermal necrosis
blistering and shedding of the skin
77
SJS important fact
affects less that 10% of the body
78
TEN (toxic epidermal necrolysis) important fact
affects more than 10% of the body
79
Steven John syndrome and toxic epidermal necrolysis common cause
medications
80
management for Steven John syndrome and toxic epidermal necrolysis
emergency!
supportive care - fluids
infection control
painkillers
81
causes of burns
thermal
electrical
chemical
friction
82
different types of thermal burns
contact
flame
scald - wet heat
83
different types of electrical burns
high and low voltage
worse if done for a long period of time
84
different types of chemical burns
acid and alkali
85
burns are the most common type of injury
true of false
true
86
what is the most common cause of burns in children
scald burns
87
common cause of burns in adults
flames
88
classification of burns - first degree
red and painful
superficial epidermal
89
second degree burn 1
partial thickness superficial dermal
blistered
red
painful
90
second degree 2
partial thickness
deep dermal
white and non blanching
reduced sensation
91
third degree
white/brown or black
no blisters
no pain - all tissue is dead
92
treatment fir burns
A-E approach - management of airways is important - smoke inhalation can cause narrowing of airways
iv fluids
wound care
93
management for burns FATT
fluids
analgesia
tests
tubes
94
burns can cause what shock?
hypovolaemic shock - as they can lose fluids
95
burns on the back and chest can cause?
it can cause obstructive shock -
96
what is a nilkolisky sign
when you apply pressure to a blister and it peels - looks like a burn
seen in SJS or TEN
97
paracetamol OD management
give charcoal within an hour
then N-acetyl cisitine
98
radial nerve injury at the humerous would cause?
wrist drop
99
radial nerve injury at forearm would cause?
finger drop
100
patient is unable to extend 4th and 5th digits of his hand
weakness in finger abduction and adduction
what nerve is damaged?
ulnar
101
radial nerve injury at axilla would cause
wrist drop and tricep weakness
102
median nerve injury would cause?
reduced finger flexion
reduced sensation - in median distribution of the hand
103
flumazenil is the antidote for?
benzodiazepine
104
naloze is the antidote for?
opioid
105
IV glucagon is an antidote for?
beta blocker overdose
106
terlipressin is given when?
in an oesophageal bleed to reduce portal hypertension
107
how much glucose is a good amount to give IV
10%
as 50% can irritate the veins
108
management for diabetic ketoacidosis
in the first hour - 1L of normal saline to reduce the acidosis
IF BP IS LOW:
give STAT of 500ml
IF BP IS NORMAL:
give 1L over 1 hour
109
methadone overdose symptoms
pinpoint pupils
decreased heart rate
decreased rest rate
drowsiness
110
what are the risks of referring syndrome
the electrolytes are very quickly taken up and used to make insulin which is released into the blood which then causes a massive drop in
potassium
magnesium and phosphate
this decrease can be fatal
and cause tachycardia
111
where is an inguinal canal placed
it is superior and medial to the pubic tubercle
112
where is a femoral canal placed
it is below and lateral to the pubic tubercle
113
how long do you take medication for PE
unprovoked - 6 months
provoked - 3 months
114
PE management
LMWH and apixaban for 5 days
and in an unstable patient give alteplase
115
what are the visual symptoms for COPD poisoning
cherry pink and flushed skin
