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Emergency Medicine Flashcards

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1
Q

How do you measure for the size of a C-spine Collar?

A

From chin to where the trapezius enters the neck

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2
Q

Where are the major areas that bleeding can occur?

A

“on the floor or four more”

  • external bleeding
  • abdomen
  • pelvis
  • thorax
  • long bones
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3
Q

Name two causes of non-trauma related pupil dilation and when should you suspect these?

A

Anisocoria
or
cataracts

*suspect when GCS 15

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4
Q

What is the ratio of blood products given?

A

RBCS: 4: FFP: 2: Platelets:1

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5
Q

List three reasons why a patient may have impaired clotting ability in trauma?

A
  1. Reduction in clotting factors due to intial clot/ loss of blood
  2. dilution from fluids
  3. Hypothermia
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6
Q

In major trauma why is fluids not advised, but instead just blood?

A
  1. causes haemodilution
  2. Sudden increase in blood pressure can dislodge the first (and best) clot
  3. Hypothermia - liquids are cool
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7
Q

Which drug should be given to all patients requiring transfusion in trauma and what rate is it given at?

A

Tranexamic acid 1g over 10 minutes

*must be standard within 3 hours of bleeding

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8
Q

List some features that would suggest someone has received burns to their airway following a fire:

A

Hoarseness of voice / change to voice

Soot in sputum/ around nose

Burns to face/ neck

Cough

Acute inflammatory changes to oropharynx

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9
Q

What are the two major complications of burns to the lungs, and how do you test for one of them?

A

Direct lung injury due to hot air

Carbon monoxide poisoning

*Need an ABG to detect carboxyhemoglobin

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10
Q

With regards to burns, what percentage of the body does the chest and abdomen take up?

how much is one leg?

and how much is the perineum?

A

Chest and abdomen = 18%

One leg = 18%
(Front and back)

Arm: 9%
(front and back)

Perineum = 1%

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11
Q

Out with the rules of 9, how else can you estimate the amount of burns someone has?

A

Patient palmar surface.
= 1%

so how many palm surfaces of their own palm have they burnt?

Lund and Browder chart
- used for children as more accurate

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12
Q

What is the fluid requirements for burns?

A

Anything over 2nd degree burns with >15% burns or 10% with smoke inhalation.

Parkland’s formula:
- Weight (kg) x % of burn x 4

*the first half should be given over the first 8 hours from burn. (not from presentation)
the remainder should be given over the next 16 hours.

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13
Q

What is the most accurate way of working out burn surface area and when is it used?

A

Lund and Browder

- used in paediatrics

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14
Q

List some causes of coma:

A

Coma with focal or Lateralizing

  • CVA
  • Trauma
  • Space occupying lesion

Coma without focal or lateralizing but meningism

  • meningitis
  • Subarachnoid

Coma without any features:

  • Toxins (including insulin)
  • Endocrine (thyroid, Addison’s)
  • Metabolic (Hyponatruamia, hypoglycaemia)
  • Organ failure
  • Seizure
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15
Q

Highlight the indications for an urgent CT head:

List some for CT head within 8 hours

A 
GCS <13 
GCS <15 for over 2 hours 
Open or depressed skull fracture or evidence of skull fracture 
Seizure 
Focal neurology 
>1 episode of vomiting

CT within 8 hours:

  • > 65 years or older
  • clotting disorders
  • high impact mechanism
  • > 30 mins retrograde amnesia
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16
Q

Falls are very common in the elderly 1/3 >65 will fall. List some key examinations that should be conducted when someone falls:

A
  • timed up and go test
  • 180 spine test

Standing/ sitting BP

Gait Examination

Proprioception and Romberg’s test
- cerebellar examination

Ocular Examination and visual acuity

PR examination
- blood loss - hypovolemia

*examine for pressure sores following a long period on the ground

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17
Q

List the main investigations needed for every patient that presents with collaspe and list some other that are needed:

A

ECG
BM
Lying/ standing blood pressure

Additional: 
Bloods:
- FBC 
- U&amp;Es 
- CK (long lie) 
- CRP - infection? 
- Troponin if M.I

Orifies:
- urine dip (infection)

X-rays:

  • x-ray of any area damaged
  • Head CT?
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18
Q

What are the key features of delirium?

A

Recent onset fluctuating awareness

Impairment of memory and attention

Disorganised thinking

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19
Q

What are some of the common causes of delirium along with a pneumonic?

A

SMASHED

S - Sepsis 
M - Meningitis / Mental illness 
A - Alcohol withdrawal 
S - Seizures / stimulans 
H - Hyper's (thyroidism, calcium) / Hypo's 
E - Electrolytes / Encephalopathy 
D - Drugs
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20
Q

What important aspects from the history do you want to establish in someone presenting with delerium?

A

When it started

Previous level of intellect

Drug/ Alcohol history

Functional status

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21
Q

Which patients who present with acute urinary retention should be admitted to urology?

A

Residual volume >1.5L

Abnormal U&Es

Frank haematuria or clots

Frial/ elderly who can’t manage their catheter

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22
Q

What is the act called when someone lacks capacity? If there is an emergency and treatment is needed to save the person’s life but they lack capacity then what should be done? contrast this to a non-life or death emergency:

A

Adults with incapacity act 2000

Life or death or prevention of significant deterioration:
- emergency treatment can be given without capacity under common law

In non - life or death a certificate of incapacity must be issued.

  • they then rely on proxy to treat.
  • if no proxy then the doctor in charge may make the decision
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23
Q

Using the adults with incapacity act 2000, If there is disagreement between the attending doctor and the proxy of the patient, what must be done?

A

A second medical opinion from another doctor should be sought. If they agree then treatment can go ahead.
If they disagree then the attending doctor needs submit a request to courts - in that meantime only life saving treatment can be given

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24
Q

Under which act are you under to report any suspicion of harm or impeding harm to an adult who is unable to safe guard themselves? and what must you do?

A

Adult Support and Protection Act 2007

  • Contact senior
  • Notify social work
  • Complete AP1 form
  • Datix incident
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25
What are the adverse features that are seen in the peri-arrest situation which should prompt further management?
Hypotension <90mmHg Syncope M.I signs on ECG Heart Failure
26
If a patient is in a tachy arryithmia and unstable what should the management be?
Synchronised Cardioversion*3 attempts if still unstable Amiodarone + re-shock - 300mg - 900mg over 24 hours
27
What bloods and investigations do you want into a seizure?
``` FBC U&Es Glucose Calcium LFTs ABG Antiepileptic drug/ AED levels** ``` EEG - this can give diagnostic info and assess if they are still seizing Head imaging: - head CT or - Head MRI *Store for analysis later
28
What are the main factors determining how a pneumothorax is treated i.e. whether a chest drain is used or not?
Age >50 Underlying lung conditions Signs of breathlessness Size (>2cm will generally be treated) **note bilateral or hemodynamically compromised pneumothorax will also be treated with chest drains
29
What are the options for long term management of pneumothorax?
Surgical pleural desis Chemical pleural desis for those unable to undergo surgery - Talc
30
list some causes of central cyanosis:
``` Severe respiratory illness Upper airway obstruction Congenital cyanotic heart disease Eisenmenger's syndrome High Altitude Methaemoglobinaemia ``` *methaemoglobinaemia will present with central cyanosis but normal PaO2 pressures (as oxygen dissolved in blood is normal)
31
what is the most common cardiac arrest to occur in anaphylaxis?
PEA
32
List the immediate management of anaphylaxis and list the monitoring of it:
Call for help Lie patient flat Raise legs Adrenaline 1:1000 IM *repeat after 5mins *dose is 500MICROgrams Secure Airway High flow oxygen IV access - fluid challenge Chloraphenamine Hydrocortisone Monitor: - BP - Oxygen sats - ECG
33
High light the key areas of management of DKA:
1. IV fluids and Insuliin 2. Monitoring and correct of: KCl, ABG and Glucose 3. Careful monitoring of fluid output 4. Screen for cause - septic screen 5. Monitor ECG *long acting insulin may be continued but short acting should be stopped.
34
What is needed in the diagnostic criteria for HHS? what is the management and some important points to remember:
``` Severe hyperglycemia Hyperosmolar state +/- Acidosis +/- Ketones ``` Management: - IV fluids - Insulin - LMWH - Monitoring of electrolytes * care fluid resuscitation should take place. - usually frail and underlying heart disease * slow reduction in glucose to prevent cerebral oedema
35
Outline the resuscitation of a person with cardiac arrest due to hypothermia
* no defibrillation or inotropic drugs if < 30degrees - remove wet cloths - Rewarm as quickly as possible (Warmed IV fluids, blankets, Bair hugger) - Resuscitation drugs given at x2 normal limit (8-10mins) * long time on CPR. * *you can't be cold and dead, only warm and dead
36
If someone is in moderate - to severe pain (4/10) when should they have revaluation of pain done?
Every 120 minutes
37
What is ketamine and what are some condraindications to its use?
Non - competitive NMDA receptor blocker Contraindicated in: - head trauma - Stroke - Eclampsia/ pre-eclampsia - severe HTN
38
Where are the potential sites for IO insertion?
Proximal humerus Proximal tibia Distal tibia
39
What is the functioning of the Adult Support and Protection Act 2007? And what test can be done to determine if someone is a vulnerable adult?
The act is designed to protect and benefit adults at risk of being harmed who are unable to safeguard themselves, their properties or rights. - this harm may be from others or themselves - means as a doctor you must report any suspected or impending harm, using a AP1 form 3 point test: - Is the person unable to safeguard themselve or property? - Are they at an increased risk of harm as a result? - Physical/ Mental/ Disability which makes them more at risk?
40
List some risk factors for domestic violence:
``` Female Young Age Pregnant Substance abuse Mental illness Stalking ```
41
When finding out about domestic violence, open ended questions are first used then more direct. What is the mnemonic for knowing the questions to ask?
HARK - Humiliation: Emotional abuse - Afraid: Physical attack / threatening - Rape - Kick: Physical attack
42
If domestic violence is determined, what actions as a junior doctor should you take immediately?
Meticulously document Report to consultant Safeguard - especially if children at home Offer contact regarding police Offer - to alert GP
43
What advice can be given to patients sufferring form domestic violence?
Help identify a safe place Contact support agencies - Scottish Woman's aid - Respect - Men's advice line Discuss packing a bag
44
Highlight some drugs which can cause mydriasis:
Benzodiazepines Alcohol Anticholinergics - TCAs Cocaine Amphetamines MDMA
45
List some differentials for toxidromes that cause hyperthermia:
Serotonin syndrome Anticholinergic syndrome Neuroleptic malignant syndrome Malignant hyperthermia
46
What is the infusion rate of naxlone and how should they be monitored?
Infuse 60% of the total dose over 1 hour. Observations over 6 hours, with checks every 15mins. - BP - HR - Respiratory rate - oxygen sats - GCS
47
What are the indications for NAC in paracetamol overdose?
Levels above the nomogram >4 hours after ingestion >150mg/kg Staggered doses Biochemical or clinical evidence of liver damage
48
Highlight the different clinical features of paracetamol overdose:
Stage 1 (0-24 hours) - N&V - lethargy - Asymptomatic * normal LFTs Stage 2: (1-3 days) - RUQ pain - Hepatomegaly * abnormal LFTs Stage 3: (3-4 days) - Jaundice - encephalopathy - hypoglycemia - Coagulation defects - death * Elevated LFTs +++ Stage 4: (4 days - 6 weeks) - recovery
49
What is the management of calcium channel blocker overdoses?
IV fluids Gastric lavage Atropine Calcium gluconate High dose Insulin - Euglycaemia therapy (HIET)
50
Name a tool which can be used in the ED to assess suicidal risk?
SADPERSON
51
When can the C- collar be taken off in a patient without Imaging?
Painfree GCS 15 No neurological signs No midline tenderness *check movements once off. If problem rotation will usually be most compromised.
52
What are the Jackson model of burns?
Coagulation zone: - most damage - irreversible - tissue death due to coagulation Stasis zone: - Decreased tissue perfusion - potentially salvable Hyperaemia zone: - Tissue perfusion is increased
53
Highlight the degree of burns and some of the features associated with them:
1st degree / Superficial: - epidermal layer - painful - blanches on pressure - blister formation 2nd degree / Partial thickness: - superficial partial thickness - deep partial thickness * both involve epidermis and dermis * both painful 3rd degree / Full thickness - extends into subcutaneous tissue - Painless lesion - white to grey to black - non blanching 4th degree: - involves underlying muscle and bone
54
Outline the details between 2nd degree/ partial thickness burns:
Superficial partial thickness: - epidermis and portions of dermis - painful weeping lesion - blanches with pressure - painful Deep partial thickness: - painful on pressure - wet/ dry or pale - sluggish blanching
55
At what level will a burn lesion no longer be painful?
3rd degree
56
What are some complications of burns to be aware of?
Infections - especially pseudomonas infection Rhabdomyolysis Compartment syndrome - which can occur across the chest Fluid loss/ electrolyte loss
57
In burns, how much if the front and back of the head in percentages? and how much is the front and back of an arm?
Face is 4.5% with the whole head making 9% Each arm side is 4.5% with entire arm being 9%
58
Which circumstances would you refer to a burns unit?
>10% TBSA in an adult >3% TBSA in a child Over major joints Circumferential burns Chemical or electrical burns Pregnancy On the face or genitals
59
What investigations do you want in a burns patient?
ABCDE *check for other injuries such as C-spine Bloods: - FBC - U&Es - Coagulation - Carboxyhaemoglobin - ABG - Glucose Orifices: - Catheterise if possible - fluid assessment is essential
60
What is your immediate management of a burns patient?
ABCDE A - secure airway. May require airway support *early intubation may be required B - check for circumferential burns *bronchospasm may occur which salbutamol is needed C - IV fluids - Catheter D - Tetanus prophylaxis - IV morphine E - Cool the wound with saline - Cling film or sterile stressing * assess degree of burn * contact burns unit or plastics

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