Emergency Medicine - COPIED Flashcards
(110 cards)
1
Q
When would you use a collar and Cuff sling?
A
- gravity assist
- eg. impacted head of humerus (refer if impacted head)
2
Q
When to use Equinus cast
A
Ruptured achilles tendon
4
Q
Which bone is boxer’s fracture?
A
5th metacaral
5
Q
managment for sprains
A
Ice 20 mins every two hours. elevate << swelling.
Increase in pain 48 hours after injury. Takes 6-8 weeks to heal.
8
Q
Signs of scaphoid fracture?
A
- tenderness at anatomical snuff box.
- pain when pressing thumb proximally
IMP. Danger of avascular necrosis
9
Q
Scaphoid fracture management
A
Cast if suspected (scaphoid backslab)
Refer to review clinic in 10-12 days
10
Q
Types of wrist fracture
A
Smith’s - surgery
Colle’s (often due to FOOSH). Tx in A & E
11
Q
What is a haematoma block?
A
Analgesic technique used to allow painless manipulation of fractures while avoiding the need for full anesthesia.
This procedure is normally only appropriate for fractures of the radius and ulna.
12
Q
elbow fracture - what will you find on x-ray?
A
The sail sign.
Never a posterior fat pad unless there is a fracture.
13
Q
Tender points for knee - ottawa
other factors
> 55 yrs
can’t weight bear
can’t flex 90 o
A
14
Q
When?
A
Meniscus tear
15
Q
sling for elbow fracture?
A
Broad arm sling,
and backslab up to the shoulder.
16
Q
Clavicle management
A
Broad arm sling and let heal.
17
Q
Hamstring injury management
A
crutches and refer to fracture clinic
20
Q
Common cause of metatarsal fractures?
A
stress fractures; don’t need trauma history
21
Q
Weber fractures
A
22
Q
A
Battle’s sign, also mastoid ecchymosis, is an indication of fracture of middle cranial fossa of the skull, and may suggest underlying brain trauma.
23
Q
Otitis media bugs
A
haemophilus influenzae
streptococcus pneumoniae
moraxella catarrhalis
24
Q
A
Jones fracture is a break between the base and middle part of the fifth metatarsal of the foot.
tx. cast, 6 weeks rest.
25
Q
A
Stress fracture - metatarsals
Can occur from running or significant walking
can be hairline fracture with no displacement.
tx. review 7-10 days. analgesia and << activity. Possibly x-ray.
26
Q
Management of Otitis media
A
analgesia. 80% improve spontaneously.
>48hrs require antibiotics
amoxiciliin/ clarithromycin
27
Q
A
usually bilateral.
Refer to orthopaedics ; other injuries likely.
28
Q
What is the cause of most URTI?
A
common cold virus
29
Q
organism; bacterial tonsilitis
A
group A beta haemolytic streptococcus
‘Strep throat’
30
**peri-orbital cellulitis**
painful, unilateral red swollen eyelids
px often systemically unwell
31
**Orbital cellulitis; an emergency and requires intravenous (IV) antibiotics.**
In contrast to orbital cellulitis, patients with periorbital cellulitis do not have **bulging of the eye (proptosis**), **limited eye movement** (ophthalmoplegia), **pain on eye movement,** or **loss of vision.**
32
Why avoid amoxicilin with tonsillitis?
in case causative organism is Epstein-Barr virus (glandular fever); rash
33
**Acute-angle closure glaucoma**
**acutely painful red eye.**
Px usually \> 60, other symptoms; headache, nausea, blurred vision and **haloes around lights.**
34
**Giant cell arteritis**
**painless visual loss,** px usually \>60.
**Scalp tenderness, jaw claudication,** headache.
Blindness if not prompt treatment.
refer.
37
**dentritic ulcer** - not common
**presents as red eye with FB sensation.**
seen with fluoroscein , caused by **herpes-simplex virus**
38
sudden foot inversion can cause....
**avulsion fracture of the base of the 5th metatarsal.**
(tightening of peroneus brevis tendon)
tx. **support bandage** if can weight-bear
**backslab** is unable to weight-bear
39
hyphaema
Hyphaema
refer.
40
**Dacryoadenitis**
* Swelling of the outer portion of the upper lid, with possible redness and tenderness
* **Pain** in the area of swelling
* **Excess tearing or discharge**
* **Swelling of lymph nodes** in front of the ear
Common causes include mumps, Epstein-Barr virus, staphylococcus, and gonococcus.
43
It transmits the infraorbital artery and vein, and the infraorbital nerve, a branch of the maxillary nerve
Can be palpated during an examination.
44
Toes - x-ray or not?
If **associated wound** present, or injury is with the **great toe.**
46
Rhonchi
Continuous low pitched, rattling lung sounds that often resemble snoring.
**Obstruction or secretions in larger airways.**
Chronic obstructive pulmonary disease (COPD), bronchiectasis, pneumonia, chronic bronchitis, or cystic fibrosis.
Rhonchi usually clear after coughing.
47
Eye conditions not to miss
* acute-angle closure glaucoma
* peri-orbital cellulitis
* giant cell arteritis
* keratitis
* uveitis
48
drainage of aqueous humour
Formed in the anterior portion of the ciliary process in the **posterior chamber** of the eye.
Drains into the scleral venous sinus (**Schlemm's cana**l)
Blockage = glaucoma
51
What can cause sudden loss of vision?
retinal detachment
central retinal artery occlusion
vitreous detachment/ haemorrhage
+ **full neurological examination for cv event**
54
Conjunctivitis characteristics
* red, watery eye, often bilateral.
* VA is usually normal.
* bacterial or viral
Infectious, topical treatment,
NB\> check for FB, abrasion before diagnosing conjunctivitis
55
allergic conjunctivitis
bilateral, often related to hay-fever.
Chemosis (oedema of the conjunctiva) is a classic sign.
tx. antihistamines
57
an injury to the spine in which the **vertebral body is severely compressed**.
- severe trauma, such as a motor vehicle accident or a fall from a height.
58
**Compression fracture.**
collapse of a vertebra.
Trauma or a weakening of the vertebra (compare with burst fracture). This weakening is seen in patients with **_osteoporosis_**
**Wedge deformities**, with greater loss of height anteriorly than posteriorly
59
Vertical shearing
60
Anterior compression/ Open book
_Look at SI joint and pubic symphysis_
61
management of corneal abrasion
remove FB with damp cotton bud/ bevel of needle (with slit lamp)
antibiotic ointment
review 2-3 if not improving.
62
bilateral - **basilar skull fracture**
Bilateral hemorrhage occurs when damage at the time of a facial fracture **tears the meninges** and causes the **venous sinuses to bleed into the arachnoid villi and the cranial sinuses**
65
67
Le Fort Fractures
68
What passes through the optic canal?
optic nerve
ophthalmic artery
ophthalmic vein
69
Which part of the orbit do the cranial nerves IV, III, VI pass?
Superior orbital fissure
71
which extraoccular muscle attaches nasally?
Inferior Oblique
72
What nerve supplies the **_lateral rectus_** muscle?
**abducens (VI)**
long nerve makes it prone to injury.
73
foot bones 1
74
Foot bones 2
75
Foot bones 3
76
Foot bones 4
77
What is the anatomical signifiance of the c**entral artery** of the retina?
It runs **WITHIN** the optic nerve.
It's an end artery, a branch of the ophthalmic artery.
79
What's a common symptom of a fractured orbit?
**Diplopia**
due to obstruction of rectus muscles, or suspensory ligament is not fixed.
81
Two main types of conjunctiva based anatomically
* palpebral conjunctiva lines the lids
* bulbar conjunctiva is over the eyeball
82
What's the function of the choroid?
Dark pigmentation to prevent internal light reflection, supplies blood to the retina
83
What can cause miosis?
NB\> latency of pupillary responses increases with age
Light
opiates/ opioids
anti-hypertension medication
84
What can cause mydriasis?
anticholinergic drugs
MDMA
cocaine
amphetamines
some hallucinogens
85
What is the signifance of a lack of consensual pupillary response?
* problem with motor connection
* could be; oculomotor nerve or Edinger-Westphal nucleus
86
What is Argyll Robertson (AR) pupil and what's the most important cause (and very specific)?
bilateral small pupils that r**educe in size on a near object** (i.e., they accommodate), but do not constrict when **exposed to bright light**
Syphilis
+ diabetic neuropathy
87
What drug can be used for emergency treatment of acute-angle closure glaucoma
**pilocarpine**
NB. causes miosis
92
Cauda Equina - signs and symptoms
* altered sensation perineal area, bowel/ urine/ sexual dysfunction
* PR - loss of tone and sensation
94
PPPP
stop bleeding
**P**ressure
**P**osture
**P**atient - time
**P**ray
95
Signs/ symptoms of fractured zygomatic arch
swelling/ bruising - periorbital
pain, numbness, diplopia, reduced eye movements
altered pupillary reflexes, facial flattening/ symmetry
- **look at jaw from behind and put fingers on zygomatic arches**. Compare for differences.
97
White-Eyed Blowout
Greenstick fracture of the orbital floor or medial orbital wall resulting in **ischemic entrapment of an extraocular muscle.**
* Typically **children**
* **Minimal external signs of trauma** mask the severity of the orbital injury.
Commonly due to sports injuries.
99
Signs/ symptoms **fractured mandible**
pain/ restricted movement
missing teeth, numbness, teeth not meeting properly
**Sublingual haematoma**; often indicative of fractures.
100
General advice for facial fractures
no nose blowing
no sneezing
knocked out teeth; keep in saline or milk. 1-4 hour window to reimplant.
Bites; Augmentin antibiotic
101
What is the most common cause of hypotension?
+ what drugs commonly cause hypotension
hypovolaemia
\>\>\> diuretics
alpha/ beta blockers
102
Common causes of hypotension (6)
* sepsis
* acidosis
* medications
* nitrates (GTN)
* CCBs
* many anaesthetic agents
103
orthostatic hypotension values
20 mmHg drop of systolic pressure
20 beats per minute increase in HR
(remember two min delay between position changes)
108
What is a Salter-Harris Fracture?
A fracture that involves the **epiphyseal plate.**
109
What are the EM physiological side effects of NO insulin causing hypoglycaemia? (3)
\>\>\> sugar in blood, none in cells.
Breakdown of fats and proteins; ketones and **acidosis**
leads to **_dehydration, Potassium loss and acidosis._**
Dehydration because water follows excretion of sugar (osmotic diuresis)
110
what could be triggers for hypoglycaemia attacks?
infections; UTI, pneumonia
physiological stressors including cold, status epilepticus.
111
What is a big danger of px with long-standing diabetes and neuropathy?
MI or abdominal conditions such as infection or pancreatitis may be painless. Maybe osteomyelitis in the feet..
112
Tests for diabetes
Blood glucose
urine or blood test for ketones
pH (venous fine)
113
Symptoms of hypoglycaemia
confusion**, sweating, fatigue** and feeling **dizzy**.
maybe pale, weak, blurred vision, tachycardia, unconsciousness
114
EM tx of hypoglycaemia
50ml of glucose 50% if IV access available.
otherwise 1 mg glucagon
(as PAs 10% glucose IV okay)
non-emergency; dextrose, then more complex carbohydrates.
115
What is Kussmaul breathing?
**Deep and labored breathing pattern** often associated with **severe metabolic acidosis**, particularly diabetic ketoacidosis (DKA) but also kidney failure.
116
What is diagnosis of DKA based on?
Diabetic ketoacidosis is a serious complication of Type I DM.
Diagnosis based on
**diabetes** (blood glucose \>11 mmol/L)
**ketones** (urine or blood)
**acidosis** (pH \<7.30 venous blood)
117
Diagnositic symptoms of DKA?
polydipsia
weight loss
dehydration
+ Kussmaul breathing
118
Tx for DKA
(Sickness and vomiting, abdominal pain, muscular weakness)
**500ml** then another 500ml then another 500ml (**saline**). MUST ensure patient is **rehydrated** before giving insulin. 0.1units per kilo per hour.
As sugar moves into cells (insulin taking effect) potassium follows therefore px becomes **hypokalaemic**. Normal potassium 3.5 to 5.
Watch urine output to check hydration.
Red flag; peds until 22-23 yr old. Can die from cerebral oedema; therefore don’t give insulin until properly hydrated.
119
Why rehydrate gradually with DKA?
to avoid rapid intracellular osmotic/ sodium shifts that may cause fatal CNS oedema.
Remember: with DKA and polydipsia, rapid fluid shift from intracellular compartments.
120
What factors cause cause a hypoglycaemic attack?
Too high a dose of medication (insulin or hypo causing tablets)
Delayed meals
Exercise
Alcohol
121
What could **blood clotting abnormalities** and **platelet consumption** indicate with a septic px?
**development of disseminated intravascular coagulation (DIC**); clotting factors and platelets are consumed by clot formation in the peripheral circulation.
122
Fluid challenge and central venous cannula/ measurement of CVP; **what's that about?**
If CVP **doesn't rise or rises transiently** and then falls, then px is '**underfilled**'.
123
What could **cefuroxime** and **clarithromycin** possibly treat?
CAP
+ may need vasopressor drugs to produce peripheral vasoconstriction if px adequately filled (CVP monitoring). Renal output would be poor.
124
symptoms of **septic** shock
* warm peripherae, bounding pulse with **low diastolic pressure**, low JVP
* pyrexia (or hypothermia)
* history and signs of underlying infection
125
Symptoms of **hypovolaemic shock** (this includes _burns_)
* **symptoms of fluid loss**, eg. melaena, haematemesis
* **cold peripherae**; **weak, thready pulse, low JVP**
* **skin pallor**, **dry mucous membranes**
126
symptoms of **cardiogenic** shock
* chest pain, palpitations, history of IHD, AF
* **Cold sweaty peripherae**; **weak pulse**, JVP raised, tachycardia
* pulmonary oedema
127
What's the difference between **hemiparesis** and **hemiplegia**?
**Hemiparesis** ; unilateral weakness
**Hemiplegia**; complete loss of power on one side
128
What is **Todd's paralysis**?
**A focal appendage transient weakness after a seizure.**
It usually subsides completely within 48 hours.
Todd's paresis may also affect speech, eye position (gaze), or vision.
NB\> important to differentiate from ischaemic stroke **because seizure is an exclusion criteria for thrombolysis.**
129
What % of px presenting to hospital with strokes, **fulfill criteria** for **thrombolytic tx**, and what is the drug?
**2%**
**Actilyse; recombinant tissue plasminogen activator alteplase**
130
What is the risk of thrombolytic tx of ischaemic stroke?
And the incidence?
significant risk of primary **intracerebral haemorrhage**
## Footnote
**1 in 30**
131
In the case of ischaemic stroke, what is the window for treatment?
**3 hours** from onset of symptoms.
| (this includes getting a CT scan!)
132
Thrombolysis; remember that...
lots of exclusion criteria!!!
Including:
* **seizures**
* **px on warfarin**
* **previous stroke within three month**
* **BP \>110 diastolic, \> 185 systolic**
* **hypoglycaemic/ hyperglycaemic**
133
Risk factors for CVD?
hypertension
hyperlipidaemia
diabetes mellitus
obesity
family history
smoking
134
What are **Charcot-Bouchard aneurysms**?
Aneurysms in the **small penetrating blood vessels of the brain**.
They are associated with **hypertension**.
The common artery involved is the lenticulostriate branch of the **middle cerebral artery.**
135
What are the following acronyms?
TACI
LACI
**TACI**: Total Anterior Circulation Infarction
**LACI**: Lacunar Infarction
136
How effective is prophylaxic treatment of AF with **warfarin** in preventing strokes?
yearly risk of **cerebral embolism** reduced from **3% to 1%.**
137
Aspirin, stroke, no CT scan results. **What's the story?**
No evidence that starting aspirin before CT findings are known adversely affects prognosis.
138
When is a CT scan URGENT following a stroke?
* if 3 hour window to start thrombolytics
* evidence of head injury
* severe headache at the time of onset of weakness
* GCS score deteriorating
* prior anticoagulation treatment
139
Are px with carotid artery stenosis at risk of embolic stroke?
+ exclusions?
**Yes**, especially if stenosis 70-99% (very high risk). Also: **is px well enough to receive tx?**
Carotid stenosis diagnosis; doppler
Exclusions?
**haemorrhagic strokes - TACI or POCI**
140
Stroke tx whilst awaiting CT scan results
Px **NBM**
Nasogastric tube, IV fluids
Oxygen mask, monitor cardiac rhythm (**digoxin** if needed)
Possibly catheter to monitor output
**Aspirin 75mg**
**Statins (low dose)** even if lipid levels normal
**TED** (thromboembolic disease) **stockings**
141
Why _don't_ you treat HT immediately following a stroke?
1. **cerebral autoregulation** of blood flow is disturbed and therefore risk of hypoperfusion.
2. **Watershed infarction**; there can be an extension of the stroke due to reduced blood supply around area of infarction.
NB. continue with regular BP meds if taken previously.
142
High BP two weeks after stroke. Which meds?
ACE inhibitors (**perindopril** - take at bedtime because can become dizzy)
thiazide diuretics
