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Year 6 - MBBS COPY > Firms: Emerg > Flashcards

Firms: Emerg Flashcards

(112 cards)

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1
Q

A-E Approach: A

A

Patent? Responsive? Added sounds?

If not responsive: look, listen, feel approach

If not breathing: check pulse, call help, start CPR

Think about airway manoeuvres/adjuncts, suction, protect c-spine

If struggling to maintain bleep the anaesthetist and only move on once happy

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2
Q

A-E Approach: B

A

Obs: RR and O2 sats

O/E: inspect chest, tracheal deviation, expansion, percuss, ausc

Ix: ABG, CXR, Covid Swab | Mx: O2

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3
Q

A-E Approach: C

A

Obs: HR and BP

O/E: inspect peripheries, CRT, JVP, HS I+II, large bore cannula in each ACF, take bloods, G+S/XM, cultures, give fluid challenge, UO

Ix: ECG, Troponin, BNP | Mx: Abx

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4
Q

A-E Approach: D

A

Work around the C: pupils, AVPU/GCS, temp, glucose, drug chart

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5
Q

A-E Approach: E

A

Examine entirety for rashes, trauma, bleeding

Plus perform crude abdo, consider urine dip and PR, NV limb exams

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6
Q

What scoring system do nurses use for every pt?

A

Manchester Triage System where 1 is immediate resus and 5 is non-urgent

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7
Q

How do you act as a scribe?

A

Sign in sheet, pt stickers and date pages, pt wristband, age and gender, time of arrival, preload trauma booklet w obs, AMPLE

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8
Q

What does AMPLE stand for?

A

Allergies
Medications
PMHx
Last Meal
Events

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9
Q

What are the reversible causes of cardiac arrest?

A

Hypoxia
Hypovolaemia
Hypo/HyperK
Hypothermia

Toxins
Tamponade
Tension Pneumothorax
Thromboembolism

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10
Q

How do the 4H’s and 4T’s translate to the primary survey?

A

H’s: O2 sats, obvious bleeding and HR/BP, VBG, temp

T’s: known hx, examine, ECG, ultrasound, xray

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11
Q

Which organs are most prone to ischaemia?

A

Brain
Heart
Kidneys

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12
Q

What do pretty much all pts that come through resus get?

A

Fluids, O2, full CT

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13
Q

What are the two shockable and non-shockable rhythms?

A

Shockable: VF + pulseless VT -> one shock and 2mins CPR then reassess

Non-Shockable: asystole + pulseless electrical activity -> 2mins CPR then reassess

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14
Q

What must you stop when reassessing the rhythm?

A

Chest compressions

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15
Q

What joules is the shock charged to?

A

150J

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16
Q

What does ROSC stand for?

A

Return of spontaneous circulation

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17
Q

Chest Pain DDx

A

ACS - arm/neck/jaw, nausea, clammy, SOB, palps

PE + PT - SOB, haemoptysis, tender calves, recent surgery, long travel

Oesoph Rupture - epigastric & vomiting

Aortic Dissection - interscapular & neuro deficits

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18
Q

If they took GTN spray which helped?

A

Their own spray, when dx with IHD,

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19
Q

When is troponin measured?

A

Upon arrival and three hrs later

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20
Q

What is a good marker of re infarction?

A

CK-MB

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21
Q

When someone says they’re on HRT what should you inquire?

A

Reason, cyclical/continuous, SEs

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22
Q

How to counsel a miscarriage dx?

A

Very common 1/5 known pregnancies

It usually means the preg isn’t viable and not one you’d want to continue anyway

It doesn’t affect your fertility and chances of getting pregnant again

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23
Q

What can happen if you inject local into an artery?

A

Arrhythmias + Necrosis

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24
Q

Asthma Severity BTS

A

Acute Mod: inc sx + PEF 50-75%

Acute Severe: inability to complete sentences + PEF 33-50%, RR >=25, HR >=110

Life-Threat: clinical signs + PEF <33%, SpO2 <92%, T1RF

Near-Fatal: T2RF +/- requiring mechanical ventilation

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25
What are the clinical signs of life-threatening asthma?
Altered conscious level, exhaustion, arrhythmia, hypotension, cyanosis, silent chest, poor resp effort
26
Drugs causing pupil dilation
Cocaine, TCA, Atropine
27
Drugs causing pupil constriction
Opiates, Nicotine, Pilocarpine
28
What is the definitive airway?
Tracheal intubation by the anaesthetists
29
How many mL/hr is an infusion rate of one drop per second?
180mL/hr
30
How do you categorise tachycardia’s?
Narrow Reg: sinus, SVT, Atrial Flutter, AVRT, AVNRT Narrow Irr: AF Broad Reg: VT + SVT w BBB Broad Irr: Torsades + AF w BBB
31
Tx for SVT
Vagal Manoeuvres: carotid massage + valsalva IV Adenosine DC Cardioversion NB: skip to DC cardioversion if haem unstable or others contraindicated
32
What do you need to consider when performing a carotid massage?
Always auscultate for bruits first and don’t perform it on both sides simultaneously
33
What should you have on standby when giving IV adenosine?
Resus equipment in case of VF or bronchospasm
34
Tx of Torsade de Pointes
IV Mg Sulfate
35
Tx for VT
Pulseless - defibrillation Unstable - DC cardioversion Stable - IV amiodarone
36
Which part of the rhythm do you synchronise cardioversion with?
The R wave
37
How do you categorise bradycardia’s?
Sinus + Heart Block
38
The different types of heart block
AV, RBBB, LBBB, bifascicular, trifascicular
39
Def of bifascicular block
Combination of RBBB w either LAFB or LPFB
40
Which is more common LAFB or LPFB?
LAFB
41
Def of trifascicular block
Presence of conducting disease in all three fascicles: right bundle branch, left anterior fascicle, left posterior fascicle
42
Why do pts fall?
CVS: arrhythmia, syncope, postural hypotension Neuropsychiatric: vision, vestibular, cerebellar lesion, peripheral neuropathy, cognitive MSK: instability, deconditioning, gait Toxins: meds, polypharm, substance abuse Environmental Hazards
43
How do you assess someone after a fall?
Hx + Collateral: location and activity, associated sx, drug hx, mobility aids, ADLs O/E: CVS (HR BP HS ECG), Neuro - LL, MSK - Hip, Timed Up and Go Test (>12s), TURN180 (>4 steps)
44
What should you always ask about in a fall hx? (2)
Injury to the head and any neck/back pain How long they were on the floor for to assess risk of rhabdomyolysis
45
Selection of adults for CT head scan
GCS <13 @ initial assessment GCS <15 @ 2hrs after injury Or: suspected skull fracture, any sign of basal skull fracture, post traumatic seizure, focal neuro deficit, >1 ep of vomiting since injury
46
Selection of children for CT head scan
GCS <14 @ initial assessment GCS <15 @ 2hrs after injury Or: suspected skull injury, tense fontanelle, any sign of basal skull fracture, focal neuro deficit, NAI
47
Selection of infant for CT head scan
GCS <15 @ initial assessment Or: presence of bruise, swelling or laceration >5cm on the head
48
Signs of a basilar skull fracture
Raccoon eyes w tarsal plate sparing, haemotympanum, CSF otorrhea (Halo sign), postauricular ecchymosis (Battle sign)
49
What else should you enquire about if the pt complains of PV bleeding?
FLAWS + Anaemic Sx
50
Ddx for exertional chest pain that gets better w rest
CAD + AS/AR
51
When you call 2222 what call can you put out?
Cardiac Arrest (3mins), Peri Arrest (5mins), Major Haem, Trauma, Obs/Neo/Paeds
52
What do you need to say when you put out a major haemorrhage call?
Paed v Adult Med v Surg Hosp, Ward, Bed
53
Who will be alerted following a major haem call?
Porter, haem, blood bank, resus team, hosp coordinator, theatre
54
What can the critical care outreach team do?
Nurses who can support the airway and prescribe
55
Outline the CURB-65 scoring
Confusion Urea >7.0mmol/L Resp Rate >30 sBP>90 | dBP <60 >65yrs +1 point for each feature: 0-1 if stable discharge w PO amoxicillin 500mg/8h, 2 admit to wards, 3-5 admit to critical care unit
56
Outline the PERC rule: low prob of PE
If any of the below are +ve cannot rule out PE: age >50, HR >100, sats <95, unilateral leg swelling, haemoptysis, recent surgery/trauma, prior PE/DVT, hormone use
57
Outline the modified wells scoring: high prob of PE
>4 —> CTPA <=4 —> D-dimer
58
If the pt is tachy what ix do you need to do?
ECG
59
LOC DDx (5)
Reflex: vasovagal, carotid sinus hypersensitivity, situational (cough + micturition) Cardiac: arrhythmia, WPW, outflow obstrc, stokes-adams, orthostatic Neuro: seizure, narcolepsy, SAH/ICH Metabolic: hypoglycaemia, hypoNa, polypharm, benzos, alcohol/drugs Hypovolaemic: aortic dissection, AAA, ruptured ectopic
60
List the three broad categories of syncope
Reflex Cardiac Orthostatic
61
Syncope vs Seizure
Syncope: trigger, prodrome, a/w posture/twitch, short duration, rapidly reoriented Seizure: no trigger, deja/jamais vu, a/w jerking/tongue biting/incontinence, prolonged duration, prolonged post-ictal disorientation
62
What is the definition of syncope?
A sudden transient LOC due to a reduction in blood supply to brain w spontaneous recovery: reflex, stokes-adams, orthostatic
63
What are the 3 P’s of syncope?
Provoked, Prodrome, Postural
64
Workup for TLoC
Hx: collateral, SOB, dizxy, fhx sudden death, RFs, risk stratify O/E: A-E, GCS, cardio, neuro, head injury, fractures, AMTS Ix: obs, lying+standing BP, ECG, bm, preg test, bloods, CT head
65
What are the RFs in the hx for falls?
Prev hx, injuries, immobility, afraid, meds
66
What is the San Francisco syncope rule?
Predicts risk for srs outcome at 7d if the pt has any of: Congestive HF Haematocrit <30% EKG Abnormal Short of Breath SBP <90mmHg Do not use if definite seizure, head trauma, alcohol/drug related, persistent altered mental status or new neuro deficits
67
What is the OESIL score?
Predicts risk for 12m all cause mortality: CVD Age >65 Syncope w/o Prodrome EKG Abnormal
68
What is a sig change in lying and standing BP?
>20 Systolic >10 Diastolic
69
What are the ECG findings of Brugada syndrome?
Pseudo RBBB and persistent ST elevations in V1-2
70
How do you perform lying+standing BP properly?
Take the BP after the pt has been lying for 5mins then again after they’ve been standing for 1min and 3mins
71
What is a definitive airway?
It’s cuffed + below level of the vocal cords
72
What do you want to check if the pt has suspected infective endocarditis?
Obs: fever Heart: murmur Abdo: splenomegaly + microscopic haematuria
73
How do you measure up a guedel?
Soft-to-soft: tragus of ear to lateral edge of nostril Hard-to-hard: angle of mandible to the midpoint of incisors
74
Outline the GCS
E4: spontaneous, verbal, pain, none V5: oriented, confused, inappropriate, incomprehensible, none M6: obeys, localises, withdraws, flexion/decorticate, extension/decerebate, none
75
What safety issues should be considered for epileptics?
Looking after children, driving, bathing alone, working w heights/heavy machinery
76
How does AVPU match GCS?
A - 15 V - 13 P - 8 U - 6
77
How could you test if hypotension was secondary to fluid depletion?
Elevate the legs whilst lying down then take the BP again
78
RFs for Ectopic
Age Smoking Assisted Fertility Prev Ectopic, Abdo/Pelvic Surg, STI
79
On which side is an ovarian cyst rupture or torsion more likely?
Right as the rectosigmoid protects the L ovary
80
What are the comps of chlamydia infection?
Inc ectopic risk, dec fertility, PID, Fitz Hugh Curtis syndrome
81
Ddx for Miscarriage w Open/Closed Os
Open: Inevitable + Incomplete Closed: Threatened, Complete, Missed
82
Mx of Miscarriage
Expectant, Misoprostol, MVA
83
What are your ddx for ptosis?
3rd Nerve, Horners, MG: check pupil size and if uni/bilateral
84
What are causes of UMN signs? (3)
Stroke Multiple Sclerosis Cord Compression
85
What would you like to ask pt w spinal back pain +/- neurology?
Bladder + Bowel Sx
86
What are the causes of small muscle wasting in the hands?
Spinal cord: compression, syphilis, MND Brachial plexus: trauma, cervical rib, pancoast tumour Peripheral nerve: median palsy, ulnar palsy, RA
87
What triad identifies virtually all NFT1?
Neurofibroma Lisch Nodules Cafe Au Lait Spots >15mm >6
88
What is the chromosomal involvement in NF type 1 and type 2?
1 - Chr17 2 - Chr22
89
What is loin to groin pain in the elderly until proven otherwise?
AAA
90
What are the LT causes of epigastric pain?
Inferior MI, AAA, perf ulcer
91
How do you distinguish clinically b/w the different causes of shock?
Peripheries Temp + JVP
92
How do you risk stratify PE pts?
PESI
93
Ddx of Atraumatic Back Pain
Disc Prolapse Muscle Spasm Cauda Equina Pott Disease Metastasis Plus: MI, AAA, perforated GU/DU, pancreatitis, renal colic
94
What are the red flags of back pain?
Age <20 or >55 Thoracic Saddle Anaesthesia Bladder/Bowel Dysfunction Progressive Neuro Deficit Disturbed Gait Hx of Carcinoma FLAWS
95
O/E of Back Pain
Neuro (LL) + MSK (Hip) Plus: SLR, Post Void Bladder Scan, DRE
96
Why is an ABG useful in the acute scenario?
Met Acidosis Resp Failure Lactate NB: always write how much O2 pt is on and compare the gas to any prev
97
What are the indications for a CXR in asthma?
Suspected pneumothorax/consolidation LT Failure to respond to initial therapy Require ventilation
98
How is hypothermia staged?
Mild 32-35 Mod 28-32 Sev <28
99
Tx of Hypothermia
‘Noone is dead until warm and dead’ Withhold adrenaline until >30° and give every 6-10mins Once above >35° every 3-5mins Treat arrhythmias Rewarm: passive, active, internal, external
100
What toxins cause cardiac arrest?
Opioids Benzos TCAs
101
What are the common iatrogenic causes of cardiac tamponade?
Cardiac Surgery Pacemaker Insertion Penetrating Trauma
102
Opioid Toxidrome
Red RR, GCS, Pinpoint Pupils Mx: naloxone 0.4mg if rapidly falling GCS, abnormal breathing pattern, T2RF - beware of opioid withdrawal and provoking seizures If sx relapse within 1hr run a naloxone infusion 10mg in 50ml dextrose, partial response consider doxapram, no effect intubate
103
Anticholinergic Toxidrome
Dry, Dilated, Delirious Obs: tachycardic, hypotensive, pyrexic Mx: bicarbonate 8.4% if QRS >120ms, refractory hypotension, cardiac arrest - aim for arterial pH 7.5 to promote binding of drug to plasma proteins and stabilise the myocardium If prolonged QT give magnesium + prolonged CPR can yield favourable neuro outcomes
104
Serotonin Syndrome
Overactive ie agitated, sweating, hyperreflexic Obs: tachycardic, hypertensive, hyperpyrexic Biochem: dec Na, inc CK, DIC, met acidosis Mx: external cooling, benzos for agitation and muscle rigidity, low threshold to intubate ventilate paralyse to control temp, dantrolene, avoid fluids and paracetamol
105
Benzodiazepine Toxidrome
Drowsy, Ataxic Obs: bradycardic, hypotensive, hypoventilation Mx: intubate and ventilate until the drug wears off + use flumazenil w caution only if pt develops T2RF and observe for seizures
106
What is the specific antidote for methanol/ethylene glycol?
Fomepizole
107
Salicylate OD
Tinnitus, N+V, Hyperventilation, Dehydration, Sweating Mild: <150mg/kg or <300mg/L Mod: 150-300mg/kg or 300-700mg/L Sev: 300-500mg/kg or >700mg/L
108
What is the oxygen content of the blood?
Hb x SaO2 x 1.3 x 10
109
What is the delivery of oxygen to tissues?
Hb x SaO2 x 1.3 x 10 x Cardiac Output
110
How can you improve DOT?
Inc 1. Hb 2. FiO2 3. CO
111
Oxygen Dissociation Curve
Left Shift: dec temp, 2-3 DPG, [H+] Right Shift: inc temp, 2-3 DPG, [H+]
112
How can you tell the different causes of shock apart?
The JVP will be elevated if the cause is cardiogenic and the peripheries will be warm if the cause is septic or neurogenic

Year 6 - MBBS COPY (35 decks)

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