Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Human Diseases Yr4 > Medical emergencies > Flashcards

Medical emergencies Flashcards

1
Q

What is shock?

A

Life-threatening failure of adequate oxygen delivery to the tissues due to decreased blood perfusion, inadequate oxygen saturation or increased oxygen demand. There is decreased end organ oxygenation and dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 4 types of shock?

A

Hypovolaemic, Distributive, Obstructive, Cardiogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is hypovolaemic shock?

A

Shock caused by loss of intravascular volume from haemorrhage e.g. trauma or GI bleed, 3rd space loss (fluid in extravascular and extracellular spaces), burns, GI loss from vomiting or diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the classification for haemorrhagic shock?

A

Class 1 - <15% blood lost, vitals normal, slightly anxious
Class 2 - 15-30% blood lost, resps 20-30/min, 100-120bpm, BP normal, pulse pressure decreased, may need blood
Class 3 - 30-40% blood lost, resps 30-40/min, 120-140bpm, BP decreased, pulse pressure v decreased, low urine output, anxious confused, needs blood
Class 4 - >40% blood lost, resps >35/min, >140bpm, BP very low, pulse pressure super decreased, negligable urine output, confused, lethargic, massive transfusion protocol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the end-organs damaged in shock?

A

Heart - decreased perfusion, risk of arrhythmias and ischaemia
Lungs - acute respiratory distress syndrome
Kidneys - reduced perfusion, reduced urine output, increased creatine, acute tubular necrosis
Brain - altered GCS e.g. confusion and can be unconscious

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is distributive shock?

A

Fluid in intravascular compartments moving to extravascular compartments - decreased systemic vascular resistance - vasodilation (warm peripheries on examination)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the causes of distributive shock?

A

Sepsis
Anaphylaxis
Neurogenic (injury to spinal cord - autonomic dysregulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is cardiogenic shock?

A

Pump dysfunction - results in reduced end organ perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is obstructive shock?

A

Physical obstruction of circulation into or out of heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the causes of cardiogenic shock?

A

MI - blood slow decreased to heart muscle - ischaemia
Acute dysrhythmia - tachy or brady
Cardiomyopathy - walls thickened/stiff - heart failure from long term high BP, metabolic disorder, nutritional def, alcohol, genetics, infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some examples of obstructive shock?

A

Tension pneumothorax - air trapped displacing mediastinal structures
Cardiac tamponade - blood/fluid between pericardium and sack, pressure on heart, ventricles cant expand
Pulmonary embolism - blood clot blocks pulmonary artery - increased pressure right ventricle and it fails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In the management of shock, what does A in ABCDE mean you should do?

A
  • Check patency of airway
  • Remove any obvious obstructions e.g. loose dentures
  • Airway manoeuvres - head tilt chin lift, jaw thrust
  • Airway adjuncts - oropharyngeal airway e.g. Guedel and nasopharyngeal airway
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

In the management of shock, what does B in ABCDE mean you should do?

A
  • High flow O2 via non-rebreathe mask
  • Pulse oximetry - O2 sats between 94-98%
  • Chest auscultation
  • Not excessive oxygenation as linked to coronary vasoconstriction in MI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What type of shock may be an issue when you are managing using ABCDE?

A

Obstructive shock - B - e.g. tension pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In the management of shock, what does C in ABCDE mean you should do?

A

Circulation - ausclatate heart, BP, ECG
IV access - bloods and fluids to increase intravascular volume
Urinary catheter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In the management of hypovolaemic shock what is required in the management (at C)?

A

Volume needs boosting -crystalloid fluid first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In the management of distributive shock what is required in the management (at C)?

A

May have issues with vasoregulation - may need isotropes (improve contractility e.g. dopamine) or vasopressors (tighten blood vessels e.g. noradrenaline)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

In the management of shock, what does D in ABCDE mean you should do?

A

Assess GCS/AVPU
If GCS<8 consider intubation
Temperature
Pupillary response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In the management of shock, what does E in ABCDE mean you should do?

A

Look for possible causes of haemorrhage: CLAP

Chest, Long bones, Abdomen, Pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How is hypovolaemic shock treated?

A

Identify and control bleeding. Replace fluids and bloods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is cardiogenic shock treated?

A

MI - revascularisation : PCI, coronary artery bypass graft (CABG), thrombolysis
Arrhythmias - correct chemically or electrically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is distributive shock treated?

A

Sepsis - sepsis 6

Anaphylaxis - resuscitation guidelines - adrenaline, steroids, antihistamine, airway and circulatory support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is obstructive shock treated?

A

Tension pneumothorax or cardiac tamponade - relieve pressure with chest drain, pericardiocentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the causes of burns?

A 
Thermal 
Radiation 
Chemical 
Friction/abrasion
Electrical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In a local burn, what is the zone of coagulation?

A

Rapid and irreversible cell death - in centre of burn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

In a local burn, what is the zone of stasis?

A

Tissue perfusion compromised and can become necrotic if untreated (middle ring of burn)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

In a local burn, what is the zone of hyperaemia?

A

Perfusion increased with local inflammatory mediators

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the systemic effects when a burn covers more than 20% of the body?

A

Respiratory - bronchoconstriction, adult respiratory distress syndrome
Metabolic - rate increased 3x, muscle wasting, hypocalcaemia, hypovolaemia
Immune - reduced, increase risk sepsis
CVS - reduced contractility, increased capillary permeability, loss of proteins
GI - breakdown of GI barriers, translocation of bacterial and ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How are burns assessed?

A

Total body surface area - Wallis rules

Palmer surface method for smaller burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is a superficial burn/1st degree burn?

A

Erythema involving epidermis only. Dry painful no ulceration. Sunburn. Sensation intact. Heals 7 days no scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a partial thickness burn/2nd degree?

A

Involves epidermis and upper dermis. Wet painful and blistered. Scalds. Sensation intact. Heals 10-14 days with little or no scarring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is a deep partial thickness burn/3rd degree?

A

Involves epidermis, dermis and damage to appendages. Dry and insensate - not as painful. Typical of flame or contact injury. Healing longer - if not healed 14 days will scar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is a full thickness burn/4th degree?

A

Involves underlying subcutaneous tissue, tendon and bone. Thick white, black, charred, no sensation. Typical of high voltage electrical injury. Will scar

34
Q

What is the first aid procedure for burns?

A 
Stop burning 
Remove clothing 
Cool burn with lukewarm water 
Keep pt warm 
Cover with clingfilm 
Relieve pain - analgesia
35
Q

What is the definitive treatment for burns?

A

Excision with skingrafting

Escharotomy for some full-thickness burns

36
Q

What is the minimum threshold for referring burns?

A

> 2% TBSA in children >3% in adults
All full thickness burns
All circumferential burns
Any burns not healed in 2 weeks

37
Q

What is NEWS for vital signs?

A

National Early Warning Score
Normal pt = 0 (unless e.g. COPD so normal could be 1)
If >0 then pt out of normal range for vitals e.g. pyrexic

38
Q

What is the normal pulse rate?
Bradycardia?
Tachycardia?
Normal for a newborn

A

60-90bpm
<50 bpm
>100bpm
180bpm

39
Q

What sites can you take a pulse from? Where would you take a pulse from if child small?

A

Radial pulse. Ulner pulse (weaker). Carotid pulse. Limbs = popliteal (behind knee), post-tibial (inside ankle), dorsalis pedis (on top of foot)

Small child - brachial pulse

40
Q

What non-medical emergency reasons may someone be a) bradycardic b) tachycardic?

A

a) beta-blockers (propranolol for anxiety or atenolol for heart). Athletes
b) Anxious, caffeine, exercise

41
Q

What 3 things should you say when describing a pulse?

A

Rate: normal, brady or tachy?
Regular or irregular e.g. atrial fibrillation (irregularly irregular pulse)
Strength: strong, weak, absent

42
Q

What is the normal respiratory rate? Why would you worry if a pt is breathing too quickly?

A

14 breaths per min

Could be acidotic - too much CO2 in bloodstream

43
Q

Describe how taking a blood pressure works

A

Listen over the brachial artery. Pump cuff until radial artery pulse disappears. Listen for karofkoff sounds: sound = systolic, disappears = diastolic

44
Q

What does hyperdynamic circulation sound like from taking a BP and when can this happen?

A

Sound never fully disappears e.g. in pregnancy

45
Q

What is the normal value for BP?

A

120/80 mm/Hg

46
Q

How would you test cranial nerve I (olfactory)?

A

Standard smell bottles one nostril at a time

47
Q

How would you test cranial nerve II (optic)?

A 
Test acuity (ask prior if usually wear glasses) by asking them to read 
Test visual fields to confrontation - cover one eye and test temporal and nasal fields
48
Q

How would you test cranial nerve III (oculomotor)?

A

Look for dilated pupil, ptosis (drooping of upper eyelid), problems with eye movements. Use a light and test reaction

49
Q

How would you test cranial nerve IV (trochlear)?

A

Ask patient if they have double vision. Move pen in H shape and ask if double vision when following

50
Q

How would you test cranial nerve V (trigeminal)?

A

Test sensation in all 3 nerve divisions. Start above eye L-R, below eye L-R and chin L-R
Test MOM - push on chin and ask pt to push against, clench teeth

51
Q

How would you test cranial nerve VI (abducens)?

A

Eye is deviated towards the nose

52
Q

How would you test cranial nerve VII (Facial)?

A

Raise eyebrows, scrunch eyes and use fingers to try to open, blow out cheeks, smile, tense neck
Look for symmetry

53
Q

How would you test cranial nerve VIII (vestibulo-cochlear)?

A

Rinnes and Webers (air and bone conduction of sound waves)

Audiometric testing

54
Q

How would you test cranial nerve IX (glossopharyngeal)?

A

Stick on tongue and say ahhh - need symmetry

55
Q

How would you test cranial nerve X (vagus)?

A

Soft palate moves to the normal side on saying ahhh

56
Q

How would you test cranial nerve XI (accessory)?

A

Test trapezius by pushing against the side of head and asking to resist or shrug shoulders

57
Q

How would you test cranial nerve XII (hypoglossal)?

A

Tongue deviated to affected side on protrusion - stick tongue out

58
Q

What are the possible problems with the olfactory nerve CNI?

A

Trauma

Tumour

59
Q

What are the possible problems with the optic nerve CNII?

A

Trauma
Tumour
Multiple sclerosis
Stroke

60
Q

What are the possible problems with the occulomotor nerve CNIII?

A

This is the motor nerve to the extrinsic eye muscles except the superior oblique.
Diabetes
Increased intracranial pressure

61
Q

What are the possible problems with the trochlear nerve CNIV?

A

Supplies superior oblique muscle around eye

Trauma

62
Q

What are the possible problems with the trigeminal nerve CNV?

A 
Sensory = idiopathic (numbness e.g. post viral), trauma, IDN/lingual nerve damage 
Motor = bulbar palsy
63
Q

If there are problems with V, IX, X, XI, XII, what condition may have occured?

A

Bulbar palsy

64
Q

What are the possible problems with the abducens nerve CNVI?

A

Supplies lateral rectus so an inability to look laterally
Multiple sclerosis
Stroke

65
Q

What are the possible problems with the facial nerve CNVII?

A

LMN = bell’s palsy (idiopathic), skull fracture, parotid tumour. There will be total facial weakness on that side

UMN = stroke, tumour. This is forehead sparing weakness.

66
Q

What are the possible problems with the vestibulo-cochlear nerve CNVIII?

A

Balance and hearing
Excess noise
Paget’s
Acoustic neuroma (Benign brain tumour pressing on nerve)

67
Q

What are the possible problems with the glossopharyngeal nerve CN IX?

A

Trauma
Tumour
Leads to impaired gag reflex

68
Q

What are the possible problems with the vagus nerve CNX?

A

Trauma

Brainstem lesion

69
Q

What are the possible problems with the accessory nerve CNXI?

A

Polio
Stroke
Leads to weakness turning head away from affected side

70
Q

What are the possible problems with the hypoglossal CN XII?

A

Trauma

Brainstem lesion

71
Q

On the medical risk assessment ASA, what do the following mean?

a) ASA 1
b) ASA II
c) ASA III
d) ASA IV
e) ASA V
f) ASA VI

A

a) Healthy
b) Mild systemic disease e.g. well controlled asthma
c) Severe systemic disease (functional limitation)
d) Severe disease (constant threat)
e) Moribund
F) Bread dead

72
Q

What should you tell the ambulance in a medical emergency?

A 
Is the pt conscious? 
Is the pt breathing? 
Location 
Brief history/background 
Initial measures, what you've tried and if its effective
73
Q

What documentation is required after a medical emergency?

A

Date, location and time
Action taken, patient positioning and any drugs you administered and time given
ABCDE and comment on each
Information given to team at hand-over and time of hand-over
Team debrief

74
Q

How often are the emergency equipment and drugs checked?

A

Weekly

75
Q

How do you open the airway? What airway adjuncts can you use in a medical emergency?

A

Head tilt chin lift or jaw thrust

Guedel Airway - put in upside down until back of throat then twist (to avoid pushing tongue back)

76
Q

What position should the patient be put in if

a) Losing consciousness
b) Struggling to breathe
c) In anaphylaxis
d) If pregnant?

A

a) Lie flat and raise legs
b) Keep pt sitting
c) Lie flat to support circulation as go into shock more quickly otherwise
d) Left lateral position (if laid flat can go into cardiac arrest as uterus presses on inferior vena cava which is slightly to the right)

77
Q

What is in the emergency drug box?

A
  • Adrenaline 1:1000 (Epi-pen)
  • Aspirin 300mg
  • Glucagon 1mg (inject water into bottle shake bottle and draw up)
  • GTN spray
  • Oxygen
  • Salbutamol inhaler (given via spacer)
  • Midazolam 10mg buccal liquid
78
Q

Give examples of drugs that are administered by the following routes:

a) Oral
b) Sublingual
c) Subcutaneous
d) Intramuscular
e) Inhalation
f) Rectal
g) Topical
h) Intravenous

A

a) Glucogel, aspirin
b) GTN
c) Glucagon - 45 degrees to skin
d) Adrenaline - 90 degrees to skin
e) Oxygen, salbutamol
f) Diazepam
g) Midazolam
h) Only if experienced

79
Q

What are the signs of anaphylaxis?

A

Uticaria, erythema, rhinitis, conjunctivitis
Abdo pain/vomiting/diarrhoea
Flushing
Marked upper airway oedema and bronchospasm (stridor/wheeze/hoarseness)
Breathing rapid
Clammy, faint, drowsy

80
Q

What are the signs of vaso-vagal syncope?

A

Pt feels faint, dizzy or lightheaded
Pallor and sweating
Nausea and vomiting

Human Diseases Yr4 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions