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RCPCH TAS/ AKP > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

(56 cards)

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1
Q

What strength of adrenaline in anaphylaxis?
+ Doses

A

1:1000
- <6y: 150 micrograms
- 6-12y: 300 micrograms
- >12y: 500 micrograms

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2
Q

Presentation of anaphylaxis

A

Mins after exposure
- Urticaria, angioedema
- Upper airway obstruction
- Abdominal cramping / diarrhoea
- Shock

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3
Q

What are the phases of bone healing?

A
  1. Inflammatory phase (hours-days): Inflammation, formation of haematoma –> primary calculus
  2. Reparative phase (days-weeks): Thick callus forms around bone.
  3. Remodelling phase (months-years): Osteoblastic / osteoclastic activity
    May need to repeat xray - see callus formation
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4
Q

Types of shock

A
  • Hypovolaemic - haemorrhage
  • Distributive - Sepsis, anaphylaxis
  • Cardiogenic - Arrhythmia
  • Dissociative - Profound anaemia
  • Obstructive - PE, tamponade, pneumothorax
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5
Q

What is pre-load?

A

Tension in ventricular wall at end of diastole (“Stretch”)

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6
Q

What is afterload?

A

Tension in left ventricular wall required to push blood into aorta (“Squeeze”)

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7
Q

What is myocardial contractility?

A

The ability of the heart to react to pre-load and after-load

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8
Q

Noradrenaline/ adrenaline mechanism of action

A
  • Alpha-1 receptors
  • Increased vasc. resistance (increased HR / SV / CO)
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9
Q

Dopamine mechanism of action

A
  • Alpha-1, Dopamine-1 receptors
  • Increased vascular resistance
  • Selective vasodilation: renal, cerebral, coronary, mesentry
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10
Q

Dobutamine mechanism of action

A
  • Beta-1/2 receptors
  • Increased HR and CO
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11
Q

Vasopressin mechanism of action

A
  • V1/2 receptors
  • Increased vasc. resistance due to reduced UO and vasoconstriction
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12
Q

What are the reversible causes of cardiac arrest?

A

4 H’s: Hypotension, Hypoxia, Hypothermia, Hypo/hyperkalaemia
4 T’s: Tamponade, toxins, tension pneumothorax, Thrombus

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13
Q

How is cardiac output calculated?

A

CO = HR x SV

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14
Q

How is BP calculated?

A

BP = SV x Vascular resistance

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15
Q

Description of superficial (simple erythema) burns

A

Erythema. No blistering. +/- peeling
Epidermis only
1 week healing.

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16
Q

Description of Superficial partial thickness burn

A

Wet erythema and blistering. Painful. Usually no scarring. 2w to heal.
Epidermis and upper 1/3 dermis.

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17
Q

Description of Deep partial thickness burn

A

Yellow / white. Blistering. Less painful that superficial. Risk scarring. Takes 8 weeks to heal.
Deeper layers of dermis

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18
Q

Description of full thickness burn

A

White/ brown. Painless. Scarring / contractures.
All layers of skin.

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19
Q

How to calculate fluid resus in burns

A

4 x body weight x % area of burn
In 24 hours

50% in 1st 8 hours, maintenance fluid given on top of this.

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20
Q

Burns criteria for referral to a specialist centre

A
  • > 5% total SA
    Burns to face, hands, feet, genitalia, perineum
  • Full thickness
  • Electrical / chemical burns
  • Inhalation
  • Circumferential burns
  • Suspicious
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21
Q

What is Cushing’s Reflex?

A

Result of raised ICP
- Irregular respirations
- Bradycardia
- Hypertension

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22
Q

Presentation raised ICP

A
  • Cushing’s response
  • Reduced GCS
  • Headache - morning / coughing / sneezing
  • Focal neurology
  • Retinal haemorrhage
  • Sunset sign - downward looking pupils
  • Papilloedema
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23
Q

Treatment raised ICP

Study These Flashcards
A
  • Elevation of bed 30 degrees (improved venous return)
  • Supportive
  • Fluid restriction
  • Mannitol 20%/ 3% saline
  • Surgical decompression
  • Strict regulation ventilation / temp
24
Q

Indications for CT Head

Study These Flashcards
A
  • Suspicion NAI
  • Post-traumatic seizure
  • GCS <14 on arrival, <15 2 after injury
  • Open, depressed, basal skull fracture
  • Focal neuro deficit
  • Bruise / swelling >5cm in <1 y/o
    >1 of: LOC >5 mins, drowsiness, amnesia >5mins, >2 x vomits, dangerous mechanism
25
Presentation spinal cord injury
Loss of motor / sensation function Unopposed parasympathetic response --> bradycardia / hypotension
26
Pathophysiology drowning
1. Submersion / immersion in liquid 2. Asphyxia +/- aspiration 3. Hypoxia + ischaemia 4. Multisystem failure
27
What is diving reflex?
Facial contact with cold water --> bradycardia and vasoconstriction to preserve blood supply to vital organs
28
Describe primary prevention
Removal of circumstances causing injury eg lock on medicine cupboard
29
Describe secondary prevention
Reduce severity of injury eg bike helmet
30
Describe tertiary prevention
Optimal treatment eg good first aid
31
Paracetamol overdose: Mechanism and presentation
Mechanism: NAPQI produced by saturation of life CYP450, unable to conjugate to glutathione Presentation: Abdo pain, vomiting, liver failure
32
Paracetamol OD management
N-acetylcysteine - Over Tx line - Staggered >1 hour - >150mg/kg
33
Presentation and management of ingestion button batteries
Clear history Abdominal pain +/- perforation Tx: AXR / CXR, endoscopic removal
34
Carbon monoxide poisoning: Mechanism and presentation
Mechanism: Binds to Hb --> lower o2 transport Presentation: Headache, nausea, drowsy, confusion, coma Worse prognosis in Preg, cardio conditions, (resp conditions)
35
CO poisoning managment
High flow o2
36
Salicylate OD: Mechanism and presentation
Mechanism: Stimulates resp. centre, uncouples oxidative phosphorylation Presentation: Vomiting, tinnitus, resp. alkalosis (acidosis = late), hyperventilation, sweating, diplopia, dizziness
37
Salicylate OD management
<1 hour - activated charcoal Urine alkalinisation Haemodialysis
38
Symptoms of theophylline OD
Hyperventilation / resp. alkalosis Vomiting Agitation Dilated pupils Hyperglycaemia Tachycardia.
39
TCA OD: Mechanism and presentation Eg amitriptylline
Mechanism: Interferes with cardiac conduction (blocks Na+ channels) Presentation: Tachycardia, arrhythmia, drowsy, seizure
40
TCA OD management
Sodium bicarb Supportive
41
Presentation organophosphate poisoning
Miosis - antimuscarinic eye effects
42
Ethylene glycol poisoning: Mechanism and presentation Eg antifreeze
Mechanism: Toxic metabolites interfere with cellular energy production Presentation: Intoxication, tachycardia, severe met. acidosis, renal failure, HTN
43
Ethylene glycol/ methanol poisoning management
Fomepizole Alcohol Competitive inhibitors of alcohol dehydrogenase
44
Iron OD: Mechanism and presentation
Mechanisms: Corrosive --> disruption of oxidative phosphorylation --> free radicals Presentation: Vomiting, diarrhoea, GIB, seizures, coma, gut strictures
45
Iron OD Tx
IV Desferrioxamine (binds to free iron and enhances renal elimination) Activated charcoal if <1 hour
46
Amphetamine OD presentation and management
Dilated pupils Hypertension, tachycardia Skin pallor Hyperexcitability, agitation Hypokalaemia. Hyperpyrexia Rhabdomyolysis Acute renal / liver failure Tx: beta blockers, BDZ
47
Treatment of beta-blocker OD
Atropine Glucagon
48
How is Anion gap calculated
[(Na+ + K+) - (HCO3- + Cl-)]
49
Causes of raised anion gap (>16 mmol)
MUDPILES Methanol Uraemia DKA Propylene Glycol Iron and Isoniazid Lactic acidosis Ethylene glycol Salicylates
50
What is Klumpke's palsy and how does it present?
Damage to T1 SNS chain --> ulnar and median nerves. Excessive abduction of arm. Can move arm but not hand Loss of sensation thumb, index and middle finger
51
How to calculate cerebral perfusion pressure
Cerebral perfusion pressure = MAP - ICP
52
Presentation of lead poisoning
- Pica eg lead containing products, drinking water from old lead pipes Nausea Abdo pain Constipation Blue discolourationg of gums Neuropathy, GDD, impaired cognition
53
Classification of hypovolaemic shock
I-II: <25% III: 25-40% IV: >40%
54
Which nerve is most likely to be damaged in distal radius fracture?
Median nerve
55
Describe features of Rheumatic fever
GAS infection Mainly 4-15 years. Common middle and east Asia, Eastern Europe and SA. Fleeting migratory polyarthritis affecting large joints.
56
What is "pulled elbow" / "Nursemaid's elbow"?
Radial head subluxation. Presentation = holding arm to side with extended elbow and pronated forearm. Comfortable unless asked to move. <6y (weak annular ligament). Caused by sudden pull on extended, pronated forearm.

RCPCH TAS/ AKP (20 decks)

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