Emergency medicine Flashcards

Question

ACS syx ivx:

Answer 1

- crushing central chest pain - sudden onset - radiates to back/ jaw/ arm - impending doom - dyspnoea - N+V, sweating and palpitations IVX: troponin raises at 12hr and peak 24hrs. CK increased, CXR heart failure, ECG signs STEMI = st elevation and LBBB NSTEMI = st depressiion and t wave inversion IMMEDIATE MANAGEMENT for confirmed STEMI or NSTEMI (MMONACH) ECG + blood markers + Secure IV access Morphine 2.5-10mg (treat nausea) Metoclopramide 10mg IV O2 high glow if sats <94% Nitrates - GTN spray 2 sprays + BB - Bisoprolol Aspirin 300mg PO Clopidogrel 300mg Heparin (if within 12hrs of Sx onset and undergoing rimary PCI) OR Fondaparinux (NSTEMI – LMWH continue for 2-5d, CI with PCI) Bloods: FBC, U+E, glucose, lipid profile (LDL, HDL, triglycerides) CXR After care for all patients with recent NSTEMI or STEMI (ABC’S): ACEi – indefinite BB – 12 months anti-Coagulants X 2 (Aspirin and Anti-plat = ticagrelor or clopidogrel) 12 months Statin

Answer 2

type a = ascending 70% type b desceding 30% syx: tearing chest pain sudden onset dyspnoea, dizziness, sweating, syncope ivx: CT ANGIOGRAM Ecg: rule out MI CXr: widened medistinum - double knuckle aorta!! tracheal deviation to right ``` Treatment: oxygen 15L nrbm 2X iv access iv opiate and antiemetic manage hypotension = LABETOLOL infusion + arterial line to slow heart rate and blood lost CALL CARDIOLOGY A = SURGICAL B =MEDICAL ```

Answer 3

sharp central retrosternal chest pain worse on deep inspiration, swalloping and movement low grade fever + dysphagia IVX: ECG, ST elevation - concave upwards and present in all chest leads unlike MI, troponin, echo Treatment: analgesia, NSAID + PPI, pericardiocentesis

Answer 4

simple = after 12 hours - anxious, restless, N+V, palpitations etc delerium tremens = 24-72 hours MEDICAL EMERGENCCY - hypertension, fever, hallucinations, fits, arryhtmias, hyperreflexia if severe can lead to wernike-korsakoff syndrome (triad) - ophthalmoplegia - gait ataxia - confuison tx: supportive, bdzs, chlordiazepoxide stops seizures, IV/IM thiamine- PABRINEX

Answer 5

proximal block: at av node, may be asymptomatic - QRS: NARROW distal block: chest pain, sob, confusion, syncope, sudder death QRS: broad examination: JVP cannon A waves when atria and ventricles contract same time. ``` treatment: monitor heart via defibrillates lay flat legs raised oxygen 15L NRMB iv access --> 0.5mg atropine IV every 2-3 mins --> Adrenaline IV ```

Answer 6

THIRST, POLYURIA, WEIGHT LOSS, DRY MOUTH, NAUSEA, VOMITING, ABDO PAIN altered mental state low insulin so increased glucose but unable to enter cells = starvation and dehydration Diagnosis = GLUCOSE >11, PH <7.3, BICARB >15 + KETONES > 3 ivx: bloods, urinalysis, ecg, cxr, ABG: METABOLIC ACIDOSIS tx: 1. 500ml 0.9% NaCL over Fluid resus 2. IV insulin with sodium chloride 0.9% conc of 1 unit/mL; infuse at a fixed rate of 0.1 units/kg/hour e.g 60Kg = 6 units 3. Add KCl if needed 4. Add Glucose 10% when levels fallen enough

Answer 7

ivx: bloods, glucose, CT HEAD 8 HOURS if - GCS <13, open fracture, basal skull signs, >1 vomiting episode, seizure, focal neuro signs. ct must be interpreted within 1hour ``` basal skull - panda eyes- orbital bruising subconjunctival haemorrhage bleeding from ears CSF- ears or nose Battle sign: bruising over mastoid process ``` ``` TX: c spine immobilisation iv opioid if skull fracture: IV CEFUROXIME tetanus immunisation treat seizures with bzs and phenytoin ```

Answer 8

``` ELDERLY T2DM syx- develop over days to weeks dehydration - thirst, polyiria, weight loss, dry mouth weakness and cramps altered mental state ``` Ivx: urinalysis UP glucose, UP ketones, UP Na. Glucose: >30mmol/L. Treatment: gradual saline rehydration over 24-48 hrs (risk of cerebral oedema if too fast) replace K when urine starts to flow. start LMWH

Answer 9

prodrome: change in mood etc before Seizure: partial - aura Generalised- LOC, tonic clonic Post octal: headache, confusion, tiredness, todds palsy Status epilpeticus : contiuous generalised seizures lasting >5mins. treatment: - recovery position - 4mg lorazepam IV or buccal midazolam / rectal diazolam oxygen 15l 2X iv access RAPID S. INDUCTION if unresponsive

Answer 10

``` >24 hours non resolving urgent CT head within 1 hour treatment: ischamic 300mg aspirin Thrombolysis with alteplase if <4.5 hrs after onset - Clopidogrel for long term use ``` Haemorrhagic: prothrombin and vit K to normalise clotting

Answer 11

``` WORST ever headache sudden onsent blow to back of head history of preceeding exertional activity neck pain photophobia N+V Drowsiness, confusion, syncope, fits ``` ivx: CT head within 12 hrs LP in normal ct head - xanthacrhomic yellow due to break down of hb ``` treatment: A-E NIMODIPINE --> ca channel blocker reduces cerebral artery spasm maintain airway Surgical clip analgesia antiemeteic if GCS <8 contact neuro ```

Answer 12

collapse with brief LOC self resolving 2 mins prompt recovery preceeding sweating, N+V, light headedness sudden reflex bradyardia + vasodialiation ivx: ECG, tx: reassure and lie supise and raise legs

Answer 13

syx --> euphoria, dialtated pupils, palpitations, tach and hypertension SYMPATHETIC OVERDRIVE ``` treatment: refer to toxobase consider activated charcoal if <1hr after ingestion cool down correct electrolye imbalance fluids and bicard consider symptomatic bzds ```

Answer 14

``` resp depression hypotension pinpoint pupils convulsions and coma PARASYMPATHETIC OVERDRIVE ``` treatment: maintain airway, bag valve mask IV NALOXINE = TITRATE UP DOSE

Answer 15

<24 hrs N+v but asymptomatic 24-72 hrs N+V and Ruq pain 72hrs plus = jaundice, hepatic encephalopathy, hypoglycaemia and seizures ivx = clotting and INR + LFTs and ABG tx: 0-1hr activated charcoal 0-4 hours must wait to measure paracetemol level 4-8hrs measure paracetemol level and treat with N-ACETYLCYCSTEINE = PARVOLEX IF 15HR + or staggered dose over 1hr then treat with NAC and dont bother with pcm as uninterpretable. consider 5'2

Answer 16

syx dry skin and mouth dilated unreactive pupils + urinary retention jerky limb movements/ ataxia drowsiness and coma arrhythmias (anticholinergic - cant see, cant pee, cant shit cant spit) abg:metabolic acidsos and ecg, bloods toxicology treatment: maintain airway, give po activated charcoal if taken with hour. IV BZD if fitting IV NA BICARBONATE to treat acidosis and arrythmias

Answer 17

Syx: headache, neck stiffness, photophobia non blanching purpuric rash late sign Brundski: involuntary lifting of leg when lying supine and head is raised Kernigs: unable to extend knee when thigh is flexed to 90degrees ivx: LP unless raised icp bloods - wcc. raised crp. low glucose on lumbar = bacterial Treatment: fluids, maintain airway, send bloods off asap viral: acyclovir bacterial: IV dexamethasone and IV cefotaxime and amoxicillin or in community IM benzypenicillin

Answer 18

Signs of raised ICP syx papilloedema, altered LOC, increased hr, decreased BP. Headace worse when lying down/ coughing/ bending seizuresin 50% and focal neuopathy behavioural changes ivx: CT head and MRI biopsy and avoid LP risk of coning. treament: surgery, chemo. radio and for cerebral oedema dexamethasome 4mg over 8hrs.

Answer 19

consider over 50 + recent onset headache associated with jaw claudication pain over temporal artery low grade fever and weight loss, night sweats visual disturbance= blindness/diplopia ivx: bloods - UP ESR, fbc for normocytlic normochronic anaemia, UP WCC. temporal artery biopsy = definitive diagnosis treatment: STEROIDS hydrocortisone 200mg IV or pred 40mg PO refer emergency to opthal.

Answer 20

Presents sismilarly to SAH THINK YOUNG WOMEN ON COMBINED ORAL CONTRACEPTIVE PILL Syx: signs of raised ICP, papilloedema, altered LOC, hr increased, bp decreased. seizures Ivx: LMWH start warfarin to reach INR 2-3 If unresolved after a few days STREPTOKINASE bzds for seixures.

Answer 21

Throbbing unilateral headache nausea, photophobia, malaise, anorexia, vomiting tx: analgesia 1g paracetemol Antiemetic: metoclopramide Sumatriptan- 50mg as the migraine starts

Answer 22

Barking coug aged 6m-6years - viral hoarse voice and barking cough worse at night mild fever, decreased air entry dont examine throat - need to differentiate from epiglottis treatment: resolves in 3 days if severe: A-E and 02, intubation DExamethasone

Answer 23

UC: colon + rectum only, dialated thin bowel wall crypt abscesses, red granulomatous appearance CD: thick bowel wall, skip lesions, cobbelstone appearance tx: predinisolone + Mesalazine Gastro: most cases self resolving. if not - ORT and antiemetic and fluid bolus + bulk forming

Answer 24

aged 3-6yrs following URTI syx: earache preceeded by deafness, fever and discharge. ivx: otoscopy- buldging TM with absent light reflex treatment: po analgesia, abx amoxicillin ent follow up if perforation advise not to swim

Answer 25

``` = Bacterial indicator age 3-14 tonsillar swelling/ exudate anterior cervical lymphadenopathy temp > 38 absence of cough monospot test if ebv and throat swab a culture ``` syx mild fever, prodromal coryzal and blocked nose. ``` Treatment: bacterial analgesia abx BENZYLPENICILLIN or clarithromycin avoid amoxicillin if suspected EBV ```

Answer 26

cauda equina - back pain and lower limb weakness - altered peri anal or perineal sensation schpincter disturbance ``` MSSC - back pain and tenderness leg weakness and pain/sensory disturbance tx: 16g dexamethasone and PPI urgent neuro referral ``` ``` ruptured AAA - central umbilical pain --> back expansile and pulsatile hypo--> collapse --> shock bruising acutey unwell tx; surgical repair ```

Answer 27

usually inversion ottowa - pain in malleolar zone + bone tendernesss at.. a) posterior edge of lateral malleolus b) bone tenderness at posterior edge of medial malleolus c) inability to weight bear immediately after injury and in ED tx: rice analgesia- ibuprofen recovery 4 weeks

Answer 28

colles: FOOSH dinner fork smiths: falling on flexed wrist xray + check neurovascular status!! treatment: backslab pop cast + sling manipulated under anaesthetic if grossly displaced fracture. Biers block Iv regional LA

Answer 29

Pain and tenderness around hip joint radiates towards knee unable to weight bear affected leg shorter and internally rotated intracapsular: can affect blood supply ot femoral head but extracapsular doesnt ivx: lateral hip x ray check if NOF- intra/extracapsular + trochanteric? disrupted trabeculae and abnormal pelvic contours (shentons line) Garden classicificaion = degrees of femoral displacement Bloods: prepare for surgery cross match tx: iv morphine, fluid resus, a-e, femoral nerve block and refer to ortho

Answer 30

Irregularly irregular pulse Syx: chest pain, palpitations, dizziness, syncope, collapse, dyspnoea. Ivx: ecg absent p waves, narrow QRS, sawtooth in flutter with 2:1 block ``` Tx: tachycardia pathway oxygen 15l NRBM iv fluids if haemodynamically UNstable --> DC electrocardiovert if dosnt work IV FLECANIDE or IV AMIODARONE ``` if stable or flutter = rate control B blocker in heart failure- rhythm control: digoxin, only given in sedentry patients. if syx >48hrs then anticoagulate LMWH

Answer 31

Qrs = NARROW <0.12s causes: AF, wolf parkinson white, (things above the ventricles) Syx: palpitations, fatigue, sob tachycardia +100bmp. ecg: wpw delta wave , st changes. do trop!! ``` Treatment: TACHYCARDIA PATHWAY o2 + fluids If haem unstable 1. Amiodarone 300mg IV 2 DC shock ``` If Stable 1. Vagal manouvres 2. ADENOSINE 6mg --> 12mg

Answer 32

over 60 and hx of IHD broad complex tachyarrhytmias syx? palpitations, SOB, dizziness, syncope, collapse >150bpm - cannon A waves in jvp ECG: REGULAR, >012s broad qrs, absent p and t waves, ``` Treatment: pulseless VT- CPR HAEMODYNAMICALLY UNSTABLE 1. Syncronised DC 2.IV AMIODARONE 300mg ``` STABLE 1. IV AMIODARONE 300MG electrical dc under sedation ?

Answer 33

NO BREATHING OR PULSE ivx: ECG: rate up to 500bpm NO P Q R ST waves ``` treatment: A-E call crash team CPR 30:2 ADRENALINE OR REVERSE CAUSES HHHH TTTT ```

Answer 34

syx: resp wheese, chest tightness, swelling of lips and tongue, itchy rash, hypotension, nausea and vomiting ``` treatment: DEFINITIVE AIRWAY IF NEEDED ARCH - ADRENALINE 0.5ML 1:1000 IM every 5 mins - RANITIDINE IV - Chloraphenamine IV 10MG - Hydrocortisone 100-200mg ``` -5mg SALBUTAMOL NEB +0.5 IPRATROPIUM BROMIDE NEB 1-2L SALINE 0.9% IV

Answer 35

map <65, systolic <90 Tachy + 100 (those on b blockers cant do this) syx: pallor, cool peripheries, decreased urine output, syncope treatment: A-E raise legs IV ACCESS + consider giving blood 20ml.kg 0.9% NACL

Answer 36

SIRS + TEMP UNDER 36/ ABOVE 38 - hr >90, RR >20, WCC HIGH IVX: FBC, U+E, GLUCOSE, CLOTTING, URINE OUTPUT ``` TX = BUFALO!!! Blood cultures Urine output Fluid challenge Antibiotics broad spec Lactate 02 ``` if non responsive to fluids give vasopressor e.g. noradrenaline

Answer 37

creatinine rise >26 in 48hrs creatinine rise >1.5X baseline 7 days urine output <0.5ml/kg for 6 hrs treatment: stop nephrotoxic drugs + treat infection fluids 500ml over 25 mins give bicarb for acidosis oedema: sit up and furosemide

Answer 38

unable to urinate painful distended bladder may have delirium exam: suprapubic tenderness and dull to percuss. screen for cauda equina. ivx: urine dipstick and MSU treatment: urgent decompression catheter urethral 14g men treat cause e.g bph tamsulosin

Answer 39

``` young adolescent boy MEDICAL EMERGENCY sudden onset severe scrotal pain may radiate to groin/ lower abdo painful walking unilateral red swollen testes ``` treatment: emergency surgery within 6-12 hrs bilateral orchidoplexy!! do both so doesnt happen other side

Emergency medicine Flashcards

(64 cards)