Emergency medicine Flashcards
(38 cards)
What are the symptoms and treatment of foreign body above the glottis?
Hoarseness of voice
Drooling
Gagging/ coughing
Inspiratory stridor
Tt: flexible nasal endoscopy
What are the symptoms and treatment of foreign body below the glottis?
Unilateral expiratory wheeze
Tt: bronchoscopy (flexible for detecting, rigid for extracting)
What are the symptoms of a basal skull fracture, and which bone is most likely affected?
Battle’s sign (mastoid ecchymosis)
CSF rhinorrhea (torn dura, risk of meningitis)
Seventh nerve palsy
Periorbital ecchymosis (racoon eyes)
Haemotympanum
Vertigo
This type of fracture most commonly affects the petrous portion of the temporal bone, the external auditory canal, and the eardrum.
What is the difference of the pain experienced during an MI and an aortic dissection?
MI: pain occurs slowly and gains intensity with time, usually a few hours; dull and crushing pain.
AD: sharp, tearing or ripping pain, abrupt and at its maximum from the time of onset.
What is the most appropriate action in a suspected TCA overdose, and why?
ECG monitoring.
Important ECG finding suggestive of TCA poisoning is QRS widening (>100 ms); broad complex tachycardias may occur which are life threatening.
What is the suspected diagnosis and most appropriate initial investigation?
Severe epigastric pain, referred to the right shoulder;
Rigid abdomen;
History of rheumatoid arthritis
Dx: perforated peptic ulcer
Investigation: erect chest X-ray. Air under the diaphragm gives the diagnosis of a perforation
What are the signs of heroin withdrawal?
Agitation, nervousness, abdominal cramp, sweating, shivering, arthralgia
What is the most appropriate treatment for active bleeding in a patient with liver disease and a high INR?
Fresh frozen plasma, which contains clotting factors not produced in liver disease
What are the findings of subdural haemorrhage?
Thunderclap headache;
Requires urgent CT of the brain;
Crescent-shaped hyperdensity
What are the findings of extradural haemorrhage?
Usually follow trauma;
Biconvex or lens-shaped haemorrhage
How to treat if a high amount of paracetamol has been consumed > 36 hours ago?
- Obtain paracetamol levels, INR, venous gas, renal profile, liver profile and FBC
- If jaundiced, start NAC immediately, don’t wait for blood results
How to treat if a high amount if paracetamol has been consumed > 15 hours ago or if a staggered ingestion was taken > 24 hours ago?
Start NAC within 1 hour
How to treat if a high amount of paracetamol was ingested and the timing is uncertain?
Start NAC within 1 hour
How to treat if a high dose of paracetamol was ingested < 1 hour ago and the dose was > 150 mg/kg?
Give activated charcoal orally with IV antiemetic
Take blood sample 4 hours post-ingestion
If paracetamol levels are above treatment line, star NAC
How to treat if a high dose of paracetamol was ingested < 4 hours ago?
Delay blood tests until 4 hours post-ingestion
If paracetamol levels are above treatment line, star NAC
How to treat if a high dose of paracetamol was ingested > 4 hours ago and the results would be available within 8 hours of ingestion?
Obtain paracetamol levels, INR, venous gas, renal profile, liver profile and FBC
If paracetamol levels are above treatment line, star NAC
How to treat if a high dose of paracetamol was ingested > 4 hours ago and the results would not be available within 8 hours of ingestion?
Prescribe NAC
Also do paracetamol levels and continue NAC if above treatment line
What are the “sepsis 6”?
Take 3, give 3
Take 3
- blood cultures
- FBC, urea and electrolytes, coltting, lactate
- start monitoring urine output
Give 3
- high flow oxygen
- intravenous fluid challenge
- intravenous ATB
What is the maximum daily paracetamol dose?
4g in adults
ie: 2x 500mg tablets four times a day
What is the percentage of body surface burned that requires fluid replacement in children?
10%
What are the symptoms and most commonly affected bone in an orbital blowout fracture?
Periorbital ecchymosis, enophthalmos and diplopia on upward gaze
Most common: maxilla (orbital floor)
followed by ethmoid (medial wall)
What is the consequence for rapid correction of hypernatraemia?
Cerebral oedema
“high to low your brain will blow”
What is the consequence for rapid correction of hyponatremia?
Central pontine myelinolysis
“low to high your pons will die”
Why should diabetic patients, who take insulin, take carbohydrates before going to bed if drinking alcohol?
Because during alcohol intoxication, the liver is too busy to break down glycogen, so glucagon is ineffective
