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Year 6 > Emergency medicine > Flashcards

Emergency medicine Flashcards

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1
Q

Those requiring CT head immediately <1 hour

A

GCS <13 on initial or <15 at 2 hrs
Fracture- basal/skull
Seizure
Focal neuro deficits
Vomit >1

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2
Q

Dose of adrenaline for ages

A

6m-6y 150mcg

6-12 300 mcg
>12 500mcg

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3
Q

Order management of suspected meningitis

A

LP before ABx
Unless
Signs of sepsis or rash
Bleeding risk
Raised ICP

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4
Q

Causes of confusion

A

PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration

Meds
Electrolytes

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5
Q

What to give in aspirin OD

A

Sodium Bicarbonate

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6
Q

Tx of hypothermia

A

Internal- fluid rewarming
External blanekts

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7
Q

Dx and tx of hypotension of someone on long term steroids with poor compliance

A

Addesonian crisis
IM HC

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8
Q

Dx of confusion, N+V, cherry red skin, 100% sats and tachycardia

A

CO poisoning
Sats high because measures those without CO

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9
Q

IX and Mx of CO poisoning

A

ABG- >20% carboxyhemoglobin
100% O2

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10
Q

Types of airway equipment

A

Guedel- OPA- insert up side down
NPA- do not use in basal skull fracture
Good if prominent gag reflex

Supraglottic airway/ laryngeal mask- short procedures

Endotracheal airway- protects against aspiration- inflatable cuff

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11
Q

Sx of alcohol withdrawal

A

Hours- insomnia, anxiety, agitation

12-24- hallucinations
72- delirium tremens

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12
Q

Mx of alcohol withdrawal

A

Chlordiazepoxide
Pabrinex

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13
Q

Sx of anastomotic leak

A

5-7 days post
Low grade fever
Ileus

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14
Q

Ix of anastomotic leak

A

CT with contrast

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15
Q

Beta blocker OD sx

A

Hypotension
Bradycardia
Mild hypoglycaemia
Mild hyperkalaemia

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16
Q

BDZ OD sx

A

Ataxia
Slurred speech
Resp depression

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17
Q

Organophosphates OD sx and tx

A

SLUD
Salivation /small pupils
Lacrimation
Urination
Diarrhoea

Treat with atropine

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18
Q

Compartment syndrome sx

A

Parasthesia, paralysis, severe pain, pulseless

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19
Q

When to refer asthma attack to ICU

A

Severe- failing to respond
Exhaustion
Resp arrest
Deteriorating PEF

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20
Q

Define STEMI

A

Chest pain at rest or minimal exertion, lasting >15 minutes
ECG changes (new ST-elevation or left bundle branch block)
Rise in troponin: myocardial necrosis

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21
Q

When to DC cardiovert in AF

A

Shock
Syncope
Acute pulmonary oedema (i.e. does not include chronic heart failure)
Myocardial ischaemia

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22
Q

Features of cardiac tamponade

A

Beck triad- reduced heart sound, raised JVP, reduced BP
Pulsus paradoxus

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23
Q

Ethylene glycol posoning

A

Raised anion gap
Intoxication
N+V

Acute tubular necrosis >24 hours

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24
Q

Tx of HHS

A

Fluid- 1L 1-2 hours then 2-4 etc
Insulin- if ketones >1

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25
Mx of SE
Bloods for glucose, FBC/UE/CRP,Calcium/Phosphate/Magnesium, drug levels if the patient is on anti-epileptic medications Anaesthetic review to ensure the airway is managed IV lorazepam 4mg A second dose of lorazepam should be given if no response In the absence of IV access, PR diazepam or buccal midazolam can be administered.
26
Tx of SVT
Vasovagal Adenosine 6,12,18 Verapamil in asthmatic
27
Causes of long QT
TIMMES Toxins- macrolides, anti psychotics, TCA Inherited Ischaemia Myocarditis Mitral valve prolapse Electrolytes - hypokalaemia and hypocalcaemia SAH
28
Mx of Upper GI bleed
IV fluid resus Blood transfusion if Hb <7 NBM and O2 PPI If variceal- Abx and terlipressin
29
Mx of AKI
Find and treat cause Bloods, urine Stop nephrotoxic drugs- ACEi, NSAIDs, diuretics, gentamicin IV fluids Treat complications Dialysis if needed
30
Causes of syncope
Cardiogenic - palpitations Postural hypotension- drugs, low volume- more than 20/10 drop after 3 mins of standing Neurogenic- vasovagal- stress
31
Cause of seizure
Electrolytes Tumour Infection Drug Neuro- epilepsy, stroke Pre eclampsia
32
Ix of seizure
ABG (For acute prolonged seizures looking for hypoxia and hypercapnia) Blood tests: FBC, U&Es (including serum calcium, magnesium and phosphate) LFTs, glucose Urine test: urine toxicology screen Imaging: CT Head
33
Digoxin poisoning sx
Palpitations (due to arrhythmias) Bradycardia typically without hypotension Yellow-green colour disturbance Visual haloes Confusion Hyperkalaemia
34
Mx of digoxin OD
Measure digoxin level Fluids Correct electrolytes Continuous cardiac monitor Digabind- symptomatic
35
Causes of hypoglycaemia
Insulin, GLP1, sulphonylurea, BB ALF, sepsis, adrenal insufficiency
36
Ix of hypoglycaemia
Check medications Serum insulin, C peptide- not if acute setting
37
Mx of hypo
Conscious- short acting carbs Unconsious- IV 10% dextrose 200ml or 1g IM glucagon
38
Mx of thyrotoxic storm
Propanolol Propylthiouracil IC HC
39
Mx of epistaxis
Direct compression 10-15 mins Then nasal cautery Then nasal packing
40
Mx of bradycardia with adverse features
Atropine If do not respond- pacing
41
Causes of sudden painless vision loss
Central retinal vein/artery occlusion Retinal detachment Vitreous haemorrhage Ischaemic optic- GCA painful tho
42
When to CT head <8 hrs
Amnesia or LOC Age >65 Bleeding disorders Cant remember >30 misnaming before Dangerous MOA
43
If patient with DKA with tx has reduced GCS what should you do
Slow down IV fluids Then IV mannitol
44
How cerebral oedema presents in DKA
New onset headache Reduced GCS Bradycardia
45
If septic shock doesn't respond to fluids what is next Tx
Noradrenaline Infusion
46
If someone with HF has low GFR what should you do to frusemide
Increase From 40 to 80- since it MOA works through being absorbed in glomeruli
47
When to dialysis a patient with AKI
Persistently high potassium that is refractory to medical treatment Severe acidosis (pH<7.2) Refractory pulmonary oedema Symptomatic uraemia (pericarditis, encephalopathy) Drug overdose (e.g. aspirin) FUKAD
48
Where decompression of Pneumothorax occurs
MCL Just above 3rd rib
49
If RR below 10 and hypoxic what should you do
Ventilate- manual- connect bag valve to 15L
50
Other Sx of compartment syndrome
Pain on passive movement Increase analgesic requirement Pain out of proportion
51
When to consider blood transfusion
Hb <70 With ACS <80
52
Important Ix for DKA
VBG/ ABG
53
Scoring systems for UGI bleed
Glasgow Blatchford- pre endo- decide on timing of procedure - <0 outpatient Rockall- mortality
54
Best prognostic marker of paracetamol OD
Prothrombin time
55
What to do if staggered paracetamol OD
Give NAC since difficult to interpret graph
56
Aortic dissection presentation
Sudden tearing chest pain Paralysis due to cut off in blood supply Aortic regurg
57
Spinal cord compression by mets on MRI mx
Dexamethasone with PPI cover
58
Cut off for PCI
<12 hours Cant get to PCI centre in 2 hours
59
New anaphylaxis follow up
Specialist allergy clinic
60
Patient with low GCS has oropharyngeal airway what should you do
If <8 intubate with cuff endotracheal tube
61
Tx of LA OD
Lipid emulsion
62
When to remove spleen
Haemodynamically unstable and complete devascularisation
63
Types of syncope
Orthostatic- going from lying to standing- on BP meds Cardiogenic- whilst sitting or lying, palpitations Vasovagal- cough, stress Regain consciousness quickly, orientated, can have brief jerks
64
Differentiating types of shock
Septic- warm peripheries Cardiogenic- cool, weak pulse, crackles Hypovolaemia- cool, weak pulse, no pul oedema Obstructive- signs obstructing heart- murmur Neuro- damage to back- warm peripheries- decrease in symp
65
Tx of paracetamol OD
Give NAC if If >150mg/kg 8hr ago >24hr if clearly symptomatic or deranged LFTs Give if Hx of anorexia
66
Tx of close contact on meningitis
Cipro to close contacts of last 7 days
67
After new anaphylaxis mx
6 hours observation Home if stable Specialist allergy clinic Prescribe 2 adrenaline with training
68
Alcoholic ketoacidosis sx and tx
Ketones Vomitting, pain Normal BM High anion gap Saline and thiamine
69
Scoring for those at risk for developing a pressure sore
Waterlow score
70
Change in sight with thyroid disease
Urgent referral
71
Anaphylaxis protocol
Adrenaline M - 5 mins apart Administer chlorphenamine and hydrocortisone (latest Resus Council guidance puts significantly less emphasis on this in the immediate management) IV fluid challenge if hypotensive
72
Tx of acute reseeding sx
IV phosphate
73
Upper GI bleed when should you give PPI
After endoscopy confirms no variceal bleed
74
Double vision when both eyes are open, and it is painful to open his mouth.
Depressed fracture of zygoma
75
Flushing, N+V, palpitations with drinking alcohol and what medication
Metronidazole
76
Major haemorrhage protocol
Baseline bloods before transfusion- FBC< GS, clotting Trauma <3h- Tranexamic acid bolus followed by infusion Use O neg until known 6U RBC for 4U FFP
77
If fluid resuscitation with several L of NaCl what may happen
Hypercholremic acidosis Normal anion gap
78
Abdo pain, constipation, weakness, neuropsychiatric blue lines on lips
Lead poisoning
79
Shock classification
Class I shock would be completely compensated for. <15 Class II shock would cause tachycardia. 15-30 Class III shock causes tachycardia and hypotension as well as confusion. 30-40 Class IV shock causes loss of consciousness as well as severe hypotension >40
80
Stabbed patient with raised CVP tx
Tamponade- treat with thoracotomy

Year 6 (28 decks)

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