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DPD 2020 > Emergency medicine > Flashcards

Emergency medicine Flashcards

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1
Q

24 year old male • Acutely short of breath • HR 120 • BP 129/87 • RR 35 • SpO2 98% on 15LO2 • GCS 15

what are your diffferential?

A

Pneumothorax

  • Anaphylaxis
  • Asthma
  • Pneumonia
  • Cardiac failure
  • ARDS
  • Pleural effusion
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2
Q

24 year old male • Acutely short of breath • HR 120 • BP 129/87 • RR 35 • SpO2 98% on 15LO2 • GCS 15

Initial assessment •

Known asthmatic • Acute SOB today • No chest pain • SPO2 92% on arrival- 98% with O2 • Chest- bilateral wheeze • No other PMH • Able to say a few words

WHat is it?

A

Asthma

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3
Q

How do you differentiate between acute severe asthma and life threatening Asthma

A

Acute Severe Asthma •

(PEF) 33-50% of best

Can’t complete sentences

Respiration ≥25/min

ƒPulse ≥110 beats/min

Life-threatening Asthma

  • PEF <33% of best
  • SpO2 <92%

Silent chest, cyanosis, or feeble respiratory effort

Arrhythmia/hypotension

Exhaustion, altered consciousness

Essentially:

Decompensation

Unable to maintain adequate PO2 and PCO2

Drowsy due to rising PCO2, hypotension or exhaustion

Need intubation

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4
Q

how does an Asthmatic present?

A

Wheeze

breathless

tachycardic

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5
Q

How do you treat an acute asthma attack?

A

Nebulised salbutamol • IV salbutamol • Nebulised adrenaline • Nebulised magnesium • Oral steroids • IV steroids

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6
Q

What is the pathophysiology of asthma

A

Reversible airway disease

Hyper reactivity

Airflow limitation

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7
Q

A patient with an acute attack get#s worse

RR drops to 10/minute • SpO2 91% on 15L • HR 90 • Drowsy

What do you do?

A

Call for specialist

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8
Q

is the carbo dioxide high low or normal in asthmatics

A

low

hyperventilating

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9
Q

34 year old female • Suddenly felt unwell • Widespread urticarial rash • HR 130 • BP 75/40 • Collapsed • Wheezy

What are differentials

A
  1. Ectopic pregnancy
  2. Acute severe asthma
  3. Sepsis

4. Anaphylaxis

  1. Pneumonia
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10
Q

What are causes for collapse

A

drugs

  1. alcohol
  2. likely intracranial pathology
  3. low BP
  4. bleeding
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11
Q

What does this person have

A

ANAPHYLAXIS

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12
Q

What is the pathophysiology of anaphylaxis

A
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13
Q

34 year old female • Suddenly felt unwell • Widespread urticarial rash • HR 130 • BP 75/40 • Collapsed • Wheezy

No known allergies • Ate a chicken korma • Lips and mouth felt tingly • 1 episode of diarrhoea • Then was complaining of feeling itchy • Collapsed • Ambulance report she developed wheeze en route to hospital

what does she have?

A

anaphylaxis

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14
Q

How do you treat anaphylaxis

A

Adrenaline • 500mcg • 0.5ml 1;1000 IM

  • Lie her flat and put legs in the air – Why? get blood to the brain
  • Piriton • Hydrocortisone • Fluids
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15
Q

how does adrenaline work

A

α1 – vasoconstriction and relaxation of GI tract

  • α2 – platelet aggregation and reduction in noradrenaline release from nerve terminals
  • β1 – inotropic and chronotropic cardiac effects and relaxation of GI tract
  • β2 – bronchodilatation, increase in noradrenaline release from nerve terminals, increase in intracellular cyclic adenosine monophosphate (cAMP) production in mast cells and basophils, reduction in the release of cellular mediators
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16
Q

Central chest pain to left arm • Pale and sweaty • Smokes 30/day • Hypertension • Diabetes • As his ECG is performed he collapses and becomes unconscious

A

MI anteriorlateral

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17
Q

What are your priorities in someone with an MI?

What do you initiallly

A
  1. Call for help
  2. Open his airway and start rescue breaths
  3. Get IV access
  4. Get a 12 lead ECG

Check for signs of life? • Open airway • Check pulse • no pulse , not breathing = cardiorespiratory arrest

do CPR

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18
Q

What are reversible causes of cardiac arrrest

A

hypoxia

hypovolaemia

hypothermia

hypokalaemia

Tension pneumothorax

Tamponade

Toxins

Thromboembolic

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19
Q

What does this ECHO show

Study These Flashcards
A

cardiac tamponade

20
Q

what are shockable rhythms

Study These Flashcards
A

pulseless VT and VF

21
Q

Which are non shockable rhythms

Study These Flashcards
A

Pulseless activity

asystole

22
Q

What do you do if someone has a cardiac tamponade

Study These Flashcards
A

Emergency pericardial centesis

23
Q

What is a life threatnening feature of Asthma?

A can’t complete a sentence

resp rate >25

PEF <33%

Pulse >110

24
Q

Which is the correct dose of adrenaline in anaphylaxis

A 0.5ml of 1:10

B: 0.5ml to 1:100

C. 0.5 of 1:1000

D. 0.5 of 10000

Study These Flashcards
A

C. 0.5 of 1:1000

25
38 year old male • Motorcycle vs car • Bullseye windscreen • LOC initially then GCS 15/15 • HR 100 BP 145/78 • GCS 9/15 What does he have? how do you approach it
extradural haematoma Structured approach to the injured patient • Catastrophic Haemorrhage? * Airway with c spine control * Breathing * Circulation * Disability * Exposure * ‘C-ABC’ A- Noisy • B - Good air entry, no obvious injury – Normal breath sounds, Percussion resonant * C- HR 100 BP 145/78 * D- E 2 V 2 M 5 = 9/15 – Dilated left pupil * E- large scalp wound, blood from ear
26
What does he have?
1. Subarachnoid haemorrhage 2. Subdural haemorrhage 3. Extradural haematoma 4. Tumour
27
Why do you get a dilated pupil in head trauma
herniation of the brain through the foramen magnum - at first one pupil and then the other
28
How do you know how bad an extradural haematoma is?
midline shift
29
How do you manage an extradural haematoma?
* Optimise oxygenation – A, B, C * Keep CO2 normal – A,B * Maintain cerebral perfusion – (CPP= MAP-ICP) * Make sure nothing more life threatening takes priority – Primary survey * Neurosurgical input & theatre
30
WHat could you when looking for an airway in ABCD IF there is a problem what would you do?
Are they breathing? • Is it normal or noisy? – Noisy = obstructed – Obstructed = do something! • **Do they need a ‘definitive airway’** * **LMA** * **intubation**
31
How do you assess breathing in a trauma patient?
– Look: chest rising – Palpate: surgical emphysema, lacerations – Percuss: look for pleural effusion – Auscultate
32
What does this guy have
pneumothorax
33
What does this guy have
broken ribs haemothorax surgical emphysema
34
How do you treat a tension pneumothorax
large bore canula in th e 2nd intercostal space
35
How do asses circulation
**Assessment** – Pulse, BP, capillary refill time – General appearance
36
if someone is really hypotensive and you suspect bleeding Where would you look?
Source of haemorrhage – ‘ on the floor & 4 more’ – Chest/Abdo/Pelvis/Long bones
37
How do you deal with haemorrage
38
What is this?
open book fracture close the hip with a pelvic binder
39
if someone is hypotensive due to haemorrhage or blood loss, how do you get their BP up
transfusion of packed red cell and plasma Turn off the tap * Fluids * Warfarin • Coagulopathy to correct • TXA Damage control surgery
40
how quickly do you need to give TXA
wihtin an hour
41
HOw do you look at dissability out of ABCD
GCS - Glasgow Coma Score – level of consciousness • Pupils * Blood sugar * Limb movements
42
A 17-year-old male is stabbed in the left side of his chest just medial to the nipple. • His blood pressure is 90/60 and his pulse is 130. • On inspiration his JVP increases and his peripheral pulses and blood pressure decrease.
\*Diagnosis?\* 1. Tension pneumothorax **2. Cardiac tamponade** 3. Pneumonia 4. Thoracic heamorrhage
43
If someone has a caridac tampopnade due to trauma how would you treat it
thoracotomy need to close off the site of bleeding Pericardiocentesis - would just refill
44
what are injuries you want to look out for in people that were in a fire?
Direct Burns * Inhalation Injury * Smoke Inhalation * Carbon Monoxide Poisoning * Cyanide Poisoning * Trauma
45
how does a full thickness burn look like
turn white
46
According to ATLS principles what should you treat first? A. cardiac tamponade B. splenic rupture C. traumatic haemothorax D. fractured pelvis E.bladder rupture
C. traumatic haemothorax
47
if a patient had a history of a lucid period which traumatic brain injury would you be most concerned about subarachnoid subdural extradural diffuse axonal injury
extradural

DPD 2020 (48 decks)

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