Emergency medicine Flashcards by Hiba Alhasso

When a patient arrives in A+E, what are the different pathways for triage

Stream 1
Stream 2
Resuscitation

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what kind of patients end up in stream 1

walking wounded

minor ailments

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what kind of patients end up in stream 2

those that need a bit more attention e.g. NOF #, pneumonia…

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What kind of patients end in resus

critically ill
trauma patients
airway obstruction

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What is a primary survey

initial ABCDE

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what is the secondary survey

examination of patient from top to toe after the initial ABCDE

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how can you assess someones airway

by talking to them

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what are signs of a patent airway

patient can talk to you

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what are signs of an obstructed airway

snoring
hoarse voice 
stridor 
gurgling 
seesaw chest - paradoxical movement

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causes of airway obstruction

tongue
burns
trauma
foreign bodies

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management of airway obstruction

head tilt chin lift / jaw thrust
adjuncts - OPA/NPA
iGel
ETT

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how should you assess breathing

RR
SaO2
Auscultate chest and check for movements
Check for tracheal deviation

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How should you assess circulation

check for pulse and rate
check CRT
BP

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how should you assess disability

neurological: GCS, AVPU
pupils
DEFG - DON’T EVER FORGET GLUCOSE

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how should you assess exposure

assess for external sources of haemorrhage, cellulitis, trauma, open #, temperature, pressure areas

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What are some common presentations to A+E

chest pain 
SOB
abdominal pain 
head injury 
poisoning

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what are some differentials of chest pain

ACS: unstable angins, NSTEMI, STEMI
PE 
pneumonia
trauma
MSK 
oesophageal 
AAA rupture 
aortic dissection 
arrhythmia 
acute heart failure

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what are some differentials of SOB

PE 
tension pneumothorax 
pneumonia 
anaphylaxis 
asthma 
COPD exacerbation 
pulmonary oedema 
DKA

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what are some differentials of abdominal pain

GI: appendicitis, diverticulitis, cholecystitis, gastroenteritis, IBD
Gynae: ectopic pregnancy, ruptured ovarian cyst
Uro: renal colic, UTI
Vascular: ischaemic colitis, AAA rupture
Other: DKA

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In females with abdominal pain, what is the most important investigation to do

pregnancy test

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what questions should be asked about head injury

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witnessed
LOC
visual disturbance 
confusion 
vomiting 
seizure 
c-spine 
amnesia 
bleeding risk

what are some basic investigations for a patient

will vary depending on symptoms

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FBC
U+E, LFT, CRP
lactate 
blood cultures 
ABG
urinalysis/pregnancy test
d dimers 
ECG
USS, CT head/abdo, CXR

if a patient has a GCS of <8 what does this imply

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loss of airway control

what is Cushings response

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late response to raised ICP

bradycardia
hypertension
irregular breathing

what is involved in a head injury examination

``` GCS and components AVPU Pupils ears signs of BOS# neurological exam c-spine ```

what are signs of BOS#

haemotympanum CSF from nose/ear battle sign raccoon eyes (bilateral)

if a patient fits the criteria, how fast should they obtain a CT head

within 1 hour

what are important questions to ask in someone who has presented with paracetamol overdose

``` intentional vs accidental mood SH and personal history was it taken with anything else e.g. alcohol leave a note anyone else doing it how much and when witnesses previous attendances ```

how do you manage paracetamol overdose

ABCDE U+E, LFT plasma paracetamol levels at 4 hours, plot of graph N-acetyl-cysteine infusion over 23 hours liaison psychiatry involvement after infusion, INR and LFTs and paracetamol levels

what is a useful resource for toxins and poisons

TOX base

why is paracetamol overdose toxic

it forms a toxic metabolite called NAPQI which is really harmful to the liver depletion of glutathione means that this toxin accumulates and remains in circulation

what can happen to some patients who receive N-acetyl-cysteine

they may have an allergic like reaction | give piriton and steroids then continue

what mneumonic can be used to assess a persons mental health

'SAD PERSONS'

what is the management of MI

MONA+T PCI <120 min thrombolysis >120 min

what is 'redirecting' in A+E

educating patients about going to their GP or pharmacist for non-urgent things

what should you give to all patients who show signs of ACS

aspirin 300mg measure troponins GTN trial

in a COPD patient, what SaO2 levels should you aim for

88-92%

what is given for opioid overdose

IV naloxone

what are risks of rapidly reversing opioid toxicity

aggression immediate withdrawal feel really unwell

how should you administer naloxone

in slow increments until effect is seen

how should you monitor a patient after they have received naloxone

monitor for signs of withdrawal U+E RR often, patients want to leave ASAP

what is important to rule out in paediatrics

NAI | although kids are prone to bumps etc but it must be ruled out in all cases

what is the most effective method of wound closure in children

glue

what is a common cause of head trauma with a normal CT

concussion

symptoms of anticholinergic toxicity

``` dry skin dilated pupils tachycardia blurred vision gait ataxia speech dysarthria ```

antidote to anticholinergic toxicity

sodium bicarbonate

``` antidote for overdose on the following drugs: B blockers organophosphates iron salts sulfonylurea CO warfarin tricyclics salicylates Lignocaine ethylene glycol benzodiazepines ```

``` B blockers - glucagon organophosphates - atropine iron salts - desferrioxamine sulfonylurea - glucose, octreotide CO - O2 warfarin - vitamin K, clotting factors, FFP tricyclics - sodium bicarbonate salicylates - activated charcoal lignocaine - lipid emulsion ethylene glycol - fomepizole benzodiazepines - flumazenil ```

What dose of adrenaline do you give in the following scenarios and via what route: anaphylaxis cardiac arrest

anaphylaxis 500ug 1:1000 IM | cardiac arrest 1mg 1:10000 IV

What are the earliest signs of anaphylaxis

hypotension and tachycardia (flushed peripheries) angioedema is generally a late sign

in the management of an MI, you follow MONA+T which anti-emetic should you not prescribe with morphine and why? what is a better option

should not prescribe cyclizine as it causes tachycardia which is not ideal in an acute patient ondansetron is a better option

how do you activate the major haemorrhage protocol

call 2222 and state: "major haemorrhage in ward X" | get urgent bloods and resuscitate the patient with ABCDE

Emergency medicine Flashcards

(51 cards)