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Flashcards in Emergency Medicine Deck (17):

What are the Grades of Hypovolaemic shock?

1 . Up to 15% blood loss. Compensated so signs are normal

2. 15-30% blood loss. Tachycardia, tachypnea and delayed cap refill. Narrow pulse pressure due to increased diastolic

3. 30-40% blood loss. Systolic below 100mmHg, marked tachycardia and tachypnea

4. >40% blood loss. Extreme tachycardia and tachypnea. Systolic below 70mmHg. Absent cap refill


What are the main systems review questions?

CNS - Headache? Dizziness? Changes to vision/hearing?
CVS - Pain? Palpitations? SOB?
Resp - Cough? Wheeze? Haemoptysis?
GI - Bowels (constipation or diarrhoea?), Nausea? Vomiting? Rectal bleeding?
UT - Pain? Blood? Frequency/urgency?
MSK - Muscle/Joint pain? Stiffness? Swelling?

Also weight loss and easy of bruising/bleeding?


When should you get a CT head within 1 hour?

GCS 1 episode of vomiting


When should you get a CT within 8 hours?

>65 years old
Dangerous mechanism of injury (pedestrian/cyclist in RTC, occupant ejected from vehicle or fall from a height of >1m/5 stairs)
More than 30mins of retrograde amnesia of events immediately before injury


What are the components of the GCS?

Eyes: 1 - Not open, 2 - Open to pain, 3 - open to voice, 4 - open spontaneously

Speech: 1 - No response, 2 - Grumbling/groans, 3 - Odd words, 4 - Confused speech, 5 - Oriented to time, place and person

Movement: 1 - No response, 2 - Abn extension (de-cerebrate), 3 - Abn flexion (cerebrate), 4 - Withdraw to pain, 5 - Localise to pain, 6 - Obeys commands


What are the PE rule out criteria?

B - Blood in sputum
R - Room air sats 50yo
T - Thrombosis (previous of suspected)
H - HR >100bpm (at any time)
S - Surgery in last 4 weeks


What are the types of shock?

- Pump failure
- Obstruction

- Haemorrhae, dehydration, burns, trauma

- Septic, anaphylactic, neurogenic


What is the primary abnormality associated with each type of shock?

Cardiogenic - Reduced cardiac output

Hypovolaemic - Reduced PCWP

Distributive - Reduced SVR


What blood test is useful in anaphylactic shock?

Serum tryptase
- B-tryptase is release from mast cell granules


What is SIRS? What are its criteria?

Systemic Inflammatory Response Syndrome

- Temp >38 or 90bpm
- RR >20
- Acutely altered mental state
- Glucose >7.7mmol/L (if not diabetic)
- Raised or lowered WBC count


What is sepsis?

Infection with two of the SIRS criteria (see below)

- Temp >38 or 90bpm
- RR >20
- Acutely altered mental state
- Glucose >7.7mmol/L (if not diabetic)
- Raised or lowered WBC count


What is severe sepsis?

Sepsis with evidence of end organ dysfunction (lactic acidosis, oliguria or altered mental state)


What is bacteraemia?

Presence of bacteria in the blood stream


What is septicaemia?

Bacteraemia + SIRS


What are the types of myocarditis?

Eosinophillic myocarditis
-Hypersensitivity myocarditis

Granulomatous myocarditis
-Granulomatous infections

Giant cell myocarditis
-Associated with thyoma, lymphoma, SLE, thyroiditis and dermatomyositis


Explain neurogenic shock

Sudden loss of signals from sympathetic nervous system that maintain tone
=> massive venous dilatation => blood pools => BP drops


What are the red flags for syncope?

ECG abnormalities
HF or previous MI
TLoC during exercise
Family history of Sudden Cardiac Death age