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Year 5 > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

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1
Q

Define anaphylaxis

A

Airway, breathing and circulation problems with associated skin changes

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2
Q

Give 3 signs of anaphylaxis

A 
Anxiety 
Lightheadedness
LOC
Confusion
Headache
Hypotension 
Tachycardia
Skin flushing 
Hives
Itching 
Runny nose
Angioedema
Cough 
Hoarseness
Odynophagia 
SOB
Wheeze 
Vomiting
Diarrhoea
Cramping
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3
Q

How is anaphylaxis managed?

A 
A-E assessment 
Call for help 
Lie patient flat and raise legs 
Give adrenaline (0.5ml of 1:1000 IM)
Establish airway
Give high flow oxygen, IV fluid challenge, chlorphenamine (10mg IM/IV), hydrocortisone (200mg IM/IV)
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4
Q

How are acute asthma attacks classified by severity? Give a feature of each

A

Moderate - PEFR 50-75% best/predicted
Severe - PEFR 33-50%, cannot complete sentences
Life threatening - PEFR <33%, SpO2 <92%, silent chest, normal PCO2
Near fatal - raised PCO2, mechanical ventilation

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5
Q

Give 2 indications for NIV

A

COPD - pH <7.35, pCO2 >6.5, RR >23, persistent
Neuromuscular disease
Obesity

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6
Q

Give an absolute and relative contraindication to NIV

A

Absolute - severe facial deformity, facial burns, fixed upper airway obstruction
Relative - pH <7.15, GCS <8, confusion/agitation, cognitive impairment

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7
Q

Define trauma

A

Bodily harm resulting from exposure to an external force or substance (mechanical, thermal, electrical, chemical or radiant) or a submersion
This bodily harm can be unintentional or violence-related

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8
Q

How can trauma be classified by mechanism?

A 
Blunt 
Penetrating 
Acceleration/deceleration
Burn
Crush
Fall
Immersion/submersion
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9
Q

What approach should be used for a trauma patient?

A 
Catastrophic haemorrhage 
Airway 
C-spine
Breathing 
Circulation 
Disability 
Everything else
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10
Q

How can the risk of c-spine injury be assessed to determine whether a patient requires imaging?

A

C-spine XR needed if any of the following are present:
High risk factors - age >=65, dangerous mechanism, paraesthesia
Other factors - not ambulatory/sitting in ED, immediate neck pain, midline tenderness, unable to rotate neck

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11
Q

What options are available for c-spine immobilisation?

A

Collar

Blocks and tape

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12
Q

How are c-spine x-rays interpreted?

A

Lateral view - adequacy, alignment, bones, cartilage and corticated ring, prevertebral soft tissues (AABCCP)
AP - adequacy, alignment, bone, spaced spinous processes, soft tissue (AABSS)

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13
Q

How is the adequacy of a c-spine XR determined?

A

Check if C1-T1 can be seen (8 vertebrae)

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14
Q

What lines are used to check alignment on a c-spine XR?

A

Anterior vertebral line
Posterior vertebral line
Spinolaminar line
Posterior spinous line

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15
Q

What does a crack in the corticated ring mean?

A

Hangman fracture

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16
Q

How are prevertebral soft tissues assessed on c-spine XR?

A

Above C4 they can be 1/3rd of the width of a vertebral body

Below C4 they can be the whole width

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17
Q

What are the 3 views taken on c-spine XR?

A

Lateral
AP
Open mouth

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18
Q

Give 3 signs of a base of skull fracture

A

Battle’s sign
Raccoon eyes
CSF/blood leakage from ear/nose (haemotympanum, rhinorrhoea, otorrhoea)

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19
Q

Loss of function of what tracts are responsible for decorticate and decerebrate posturing?

A

DeCortiCate - Corticospinal

DeceRebRate - Rubrospinal

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20
Q

What are the indications for CT in head injury?

A

High risk - GCS <15 at 2 hours after injury, suspected open/depressed skull fracture, vomiting >=2 times, age >=65
Medium risk - amnesia >=30 mins before impact, dangerous mechanism

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21
Q

What causes a ‘blown pupil’?

A

Herniation of uncus through tentorium

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22
Q

What are the 4 types of rewarming in trauma?

A

Passive (blankets)
Active external (bair hugger)
Active internal (warm fluids, cavity lavage)
Extracorporeal

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23
Q

How should a secondary survey be structured in trauma?

A

Head to toe examination
Complete neurological examination
AMPLE history - allergies, medications, PMH, last eaten/drank, events related to injury

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24
Q

How should wounds be assessed?

A

A-E assessment

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25
What information should be obtained in the history for a wound?
Mechanism of injury Time of injury PMH Occupation and hand dominance
26
Give 2 things to consider on assessing a wound
``` Damage to regional structures Need for XR Need for anaesthetic for proper examination Control of bleeding Need for washout/debridement ```
27
Name 3 types of wounds
``` Incisional Laceration Abrasion Puncture Penetration Contusion Haematoma ```
28
What options are available for wound closure?
``` None Glue Steristrips Sutures Staples Skin graft ```
29
What type of wounds are fit for primary closure?
Clean Minimal contamination Recent Well opposed
30
What type of wounds are fit for secondary closure?
``` Puncture Abrasion Late presentation Bites Abscesses ```
31
What type of wounds should never be closed?
Bites
32
What should be considered for bite wounds?
``` Do not close Always XR Antibiotics Tetanus status BBV Follow-up ```
33
What is the maximum dose of lignocaine? What can be used to increase this?
3mg/kg | + adrenaline = 7mg/kg
34
Name 3 types of suture and their use
Simple interrupted - shallow, no tension Continuous - scalp, long Locking continuous - moderate tension, haemostasis Subcuticular - cosmetic Vertical mattress - eversion, reduce dead space, decrease tension Horizontal mattress - fragile skin, high tension Percutaneous/deep - reduce dead space, decrease tension
35
What information should be given to the patient with a wound you have managed before they leave?
``` Dressing information Keep it dry and clean Warn about infection and signs to look out for Timeline for suture removal (7-10 days) Healing/scarring ```
36
What is the difference between a burn and a scald?
Burn - dry thermal damage to the skin and underlying tissues (e.g. flame, electrical) Scald - wet thermal damage to the skin and underlying tissues (e.g. boiling water)
37
How is the degree of a burn classified?
Superficial - erythema, mild pain, 7-14 days to heal Superficial partial - wet pink blisters, moderate pain, 2-4 weeks to heal Deep partial - drier red may have blisters, sluggish/absent CRT, pain may not be present, 3-8 weeks to heal with severe scarring, needs grafting Full thickness - dry white, absent CRT and pain, needs grafting
38
How is the area of a burn calculated?
Lund and Browder method | Rule of 9s
39
How is fluid replacement for a burn calculated?
Parkland formula Volume of Ringer's lactate = 4ml x BSA x weight (kg) Give half of this in the first 8 hours and the rest over the next 16 hours
40
How should the fingers be assessed for tendon injury?
FDP - keep PIP of the finger being tested extended and ask the patient to flex DIP FDS - keep all fingers extended except one being tested, ask patient to flex PIP
41
What signs are indicative of flexor tenosynovitis?
Kanavel's signs - tenderness over flexor tendon, symmetrical swelling of the finger (sausage), finger held in flexion, extreme pain on passive extension
42
How should a toxicology presentation be assessed?
``` A-E assessment Call for help Local guidelines/algorithms Interventions and re-assessment Documentation Check TOXBASE ```
43
Define a toxidrome
Classic constellation of signs and symptoms caused by a dangerous level of toxins in the body, often the consequence of an overdose, which can be used to help identify the culprit drug
44
Give 3 signs/symptoms of an anticholinergic overdose
``` Confusion Agitation Hallucination Hyperthermia Dry mouth Urinary retention Reduced bowel sounds Mydriasis Flushed skin Tachycardia Hypertension Tachypnoea Shaking Myoclonus ```
45
How is an anticholinergic overdose managed?
Supportive measures Benzodiazepines for agitation Sodium bicarbonate for QRS prolongation
46
Name an anticholinergic drug which could potentially be the cause of an overdose
Antihistamines Tricyclic antidepressants Antipsychotics
47
Name a sympathomimetic drug which could potentially be the cause of an overdose
Cocaine Amphetamine Methamphetamine
48
Give 3 signs/symptoms of sympathomimetic overdose
``` Mydriasis Hyperthermia Lacrimation Urination Diaphoresis Hypertension Tachycardia Tachypnoea Increased bowel sounds Agitation Diarrhoea Hallucinations Paranoia ```
49
How is sympathomimetic overdose managed?
Benzodiazepines Aspirin and GTN for chest pain Cooling +/- dantrolene
50
Name a opioid drug which could potentially be the cause of an overdose
Heroin Morphine Methadone
51
Give 3 signs/symptoms of opioid overdose
``` Coma CNS depression Pinpoint pupils Respiratory depression Needle marks Hypothermia Bradycardia Hypotension ```
52
How is opioid overdose managed?
Naloxone
53
Name a benzodiazepine drug which could potentially be the cause of an overdose
Diazepam | Street valium
54
Give 3 signs/symptoms of benzodiazepine overdose
``` Coma CNS depression Respiratory depression Hypotension Bradycardia Rhabdomyolysis Hypothermia ```
55
How is a benzodiazepine overdose managed?
Supportive measures | Flumazenil (try to avoid)
56
What information is important to ascertain in paracetamol overdose?
Timescale - within 1 hour, 1-8 hours, 9-24 hours, >24 hours | Type - staggered, therapeutic, all at once
57
Give 3 signs/symptoms of paracetamol overdose
``` Nausea and vomiting Lethargy RUQ pain Hepatomegaly RUQ tenderness Abnormal LFTs Confusion Jaundice Encephalopathy Hypoglycaemia Lactic acidosis Coagulopathy AKI ```
58
What dose limits can guide likelihood of toxicity?
<75mg/kg over 24 hours - unlikely 75-150mg/kg over 24 hours - uncommon but possible >150mg/kg over 24 hours - risk of serious toxicity
59
How is paracetamol overdose managed?
N-acetylcysteine (most effective within 8 hours of ingestion) SNAP protocol Need to plot dose
60
What are the indications for N-acetylcysteine in paracetamol overdose?
Above nonogram line Dose >150mg/kg Biochemical evidence of liver injury Clinical evidence of liver failure
61
What serious adverse effect can N-acetylcysteine have?
Anaphylaxis
62
Give 3 signs/symptoms of salicylate overdose
``` Nausea Vomiting Tinnitus Deafness Lethargy Dizziness Sweating Pyrexia Respiratory alkalosis Seizures Coma ```
63
How is salicylate overdose managed?
Urinary alkalinisation with IV sodium bicarbonate | Haemodialysis
64
Give 3 signs/symptoms of beta-blocker overdose
``` Bradycardia Hypotension AV block Syncope HF Bronchospasm Hypoglycaemia Hyperkalaemia Coma Seizure ```
65
How is beta-blocker overdose managed?
``` Bradycardia - atropine Resistant - glucagon, high dose insulin Propranolol - IV sodium bicarbonate if wide QRS Sotalol - monitor for Torsades Consider pacing ```
66
What one thing do you want to know about a beta-blocker or calcium channel blocker overdose?
Immediate or modified release
67
Give 3 signs/symptoms of calcium channel blocker overdose
``` Bradycardia First degree heart block Hypotension Refractory shock MI Mesenteric ischaemia Hyperglycaemia Hyperkalaemia Acidosis Vomiting Seizures Pulmonary oedema Renal failure ```
68
How is calcium channel blocker overdose managed?
IV fluids Atropine 10% calcium gluconate High dose insulin
69
Give 3 signs/symptoms of tricyclic antidepressant overdose
``` Drowsiness Tachycardia Hypotension Dry mouth Blurred vision Constipation Urinary retention Seizure Prolonged GT Broad complex arrhythmia Coma Anticholinergic syndrome ```
70
How is tricyclic antidepressant overdose managed?
IV bicarbonate | Intubate ASAP
71
What are the antidotes for digoxin, iron, methotrexate and sulphonylureas?
Digibind Desferrioxamine Folic acid Octreotide/glucose
72
What are the antidotes for antipsychotics, lithium, warfarin and heparin?
Procyclidine IV fluids/haemodialysis Vitamin K/prothrombin complex Protamine sulphate
73
What are the 2 main toxicology emergencies?
Serotonin syndrome | Neuroleptic malignant syndrome
74
Name 2 drugs which can cause serotonin syndrome
``` SSRIs TCAs MAOIs Cocaine MDMA ```
75
Give 3 signs/symptoms of serotonin syndrome
``` Altered mental status Autonomic hyperactivity Neuromuscular abnormality Spontaneous clonus Tremor Hyperreflexia Ocular clonus and agitation, sweating or hypertonia with fever ```
76
How is serotonin syndrome managed?
``` Consult TOXBASE Stop all serotonergic agents ECG Bloods including CK Agitation - diazepam/midazolam Hyperthermia - fans/ice packs Severe - cyproheptadine/chlorpromazine ```
77
What are the 2 main causes of neuroleptic malignant syndrome?
Recently started antipsychotics | Stopping Parkinson's drugs abruptly
78
Give 3 signs/symptoms of neuroleptic malignant syndrome
``` Pyrexia Diaphoresis Tachycardia Hypertension Muscle rigidity Agitated delirium with confusion Reduced reflexes Lead pipe rigidity Normal pupils Reduced GCS ```
79
How is neuroleptic malignant syndrome managed?
Stop antipsychotics IV fluids Dantrolene Bromocriptine
80
Give 3 signs/symptoms of carbon monoxide poisoning
``` Pounding headache Nausea and vomiting Vertigo Ataxia Confusion Tachycardia False elevation of O2 saturation Pink skin and mucosa Rhabdomyolysis Lactic acidosis DIC ```
81
How can O2 saturation be checked in carbon monoxide poisoning when falsely elevated?
VBG/ABG - carboxyhaemoglobin levels
82
How is carbon monoxide poisoning managed?
High flow/hyperbaric O2 | Manage complications
83
Define frailty
``` Health state related to ageing Increased vulnerability to stressors Loss of biological reserves Failure of homeostatic mechanisms Accumulation of damage to cells in multiple organs ```
84
Why is frailty important to consider in EM?
Frail patients have disproportionate changes in their health following seemingly small stressors, with a prolonged recovery period, and potential inability to return to previous functional levels
85
Why is it important to identify frailty in EM?
Frailty should trigger a comprehensive geriatric assessment (CGA) - MDT approach
86
How should a falls history be approached?
Before During After Collateral history
87
What investigations should be done in a patient with a fall?
``` ECG XR (chest, limb, pelvis)/CT Urinalysis Bloods - FBC, U&Es, CRP, LFTs, CK, troponin, D-dimer, INR, G&S FAST scan ```
88
What should be considered in the management of a fall in ED?
Treat consequences Social circumstances preventing safe discharge PT/OT assessment
89
What drugs cause meiosis?
``` Opiates Clonidine Antipsychotics Ondansetron Mirtazepine ```
90
What drugs cause mydriasis?
``` Benzodiazepines Alcohol Anticholinergics Seretonergics Cocaine Amphetamines MDMA ```
91
What is the toxidrome for anticholinergics?
``` Blind as a bat (mydriasis) Hot as a desert (hyperthermia) Mad as a hatter (delirium) Red as a beet (flushed skin) Dry as a bone (dry mucous membranes) ```
92
What is the treatment for anticholinergic toxicity?
Cooling Benzodiazepines (agitation) Sodium bicarbonate (QRS prolongation)
93
What is the toxidrome for cholinergics?
``` Pin point pupils Frothing at the mouth Sweating Crying Running nose Vomiting Urination Diarrhoea ```
94
What is the treatment for cholinergic toxicity?
Intubate (respiratory depression) Atropine (severe) Pralidoxime (neuromuscular dysfunction)

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