medical emergencies Flashcards by Aamna Ahmad

What are normal ranges?

RR- 12-20 breaths per min
O2 saturation- over 95%, 88% in COPD
HR- 60-100bpm
Blood pressure- 110-140 systolic
Temperature- 36.1-38
Glucose- 4-7mmol/L

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How do you manage a medical emergency?

DRABCDE

Danger
Response
If not breathing- CPR, call 999
Airway
Breathing
Circulation
Disability

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What is adrenaline for?

Anaphylaxis

500mg IM
Repeated 5 min intervals if necessary

<6yrs 150mg
6-12yrs 300mg
>12 yrs 500mg

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What is a beta2 bronchodilator inhaler for?

Eg salbutamol

Asthma attack

2 actuations inhaled
Spacer device and repeats if necessary

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What is GTN spray for?

Angina/suspected heart attack

2 actuations sub lingually
May be repeated

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What is dispersible aspirin for?

Suspected heart attack

300mg oral chewed

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What is quick acting glucose for?

Hypoglycaemia (pt can swallow safely)

15-20g eg. 1.5-2 tubes of Glucogel

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What is glucagon for?

Hypoglycaemia (eg. Unconscious)

1mg IM

<8 yrs (<25kg) 0.5mg

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What is midazolam oromucosal solution for?

Prolonged convulsive seizures (>5mins)/repeated (>3 an hour)

Buccal, single dose 10mg

<5yrs 5mg
5-10yrs 7.5mg

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What are causes of loss of consciousness?

Meds (opiates, benzodiazepines, alcohol, drugs, anaphylaxis, poisoning)

Cardiac (arrhythmia, MI, cardiac arrest, vasovagal, hypovolaemia, orthostatic hypotension)

Neuro (seizure, intracranial haemorrhage)

Chest (PE, hypoxia, aortic dissection)

Ab (sepsis, ruptured AAA, ectopic pregnancy)

Endocrine (hypo/hyperglycaemia, Addisonian crisis)

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What is vasovagal syncope?

Most common
Overstimulation of vagus nerve +/- sympathetic tone loss

Posture
Provoking factors
Prodromal symptoms

Rapid recovery, headache, mild nausea

DRABCD Recovery position if unconscious, lie down and raise legs

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What are red flag signs of syncope?

Loss of consciousness during exertion
Hx of heart disease
Family hx of heart disease/sudden death
New/unexplained breathlessness
>65yrs w/o prodromal symptoms

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What are causes of seizures?

Epilepsy
Drug/alcohol intoxication/withdrawal
Intracranial infection
Metabolic disturbances
Intracranial lesion

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How do you manage seizure?

Don’t put anything in mouth

DRABCD
Position, consider airway when post-ictal, recovery position?
Give oxygen
Check glucose and give if low

Consider buccal midazolam

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What is sepsis?

Life threatening end organ dysfunction due to a dysregulated host immune response to infection

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How might sepsis present?

Fever/hypothermia
Hypotension
Confusion/reduced consciousness
Signs of infection
Difficulty breathing

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What are sepsis red flags?

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New reduction in consciousness
BP less than 90 systolic
HR >130
RR >25
Needs O2 to keep above 92%
Non blanching rash
Mottled/cyanotic/ashen rash
Not passed urine in last 18hrs
Chemo in last 6 weeks

How do you manage sepsis?

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DRABCD
Give oxygen
If BP low, lie down and raise legs
Check glucose and give if low

What is an adrenal crisis/Addisonian crisis?

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Sudden lack of steroids in someone w underlying adrenal insufficiency

Cortisol increases blood glucose
Fight/flight
Enhances brains use of glucose
Increases availability of substances that repair tissues

What are causes of adrenal crisis?

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Withdrawal of steroid therapy
Infection
Trauma
MI and cerebral infarction
Hypothermia
Surgery
Dehydration
Emotional distress

What are clinical features of Adrenal crisis?

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Lethargy/malaise
Muscle pains
Fever
Ab pain
Diarrhoea/vomiting
Hypotension/syncope
Hypoglycaemia
Confusion/slurred speech
Vitiligo/darkening of palmar creases

How is adrenal crisis managed?

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DRABCD
Consider recovery position
If low BP, lie down and raise legs
Check glucose and give if low

Hydrocortisone 100mg IM

What are causes of confusion?

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Mental health- anxiety, psychosis
Metabolic- hypo/hyperglycaemia, electrolyte disturbances
Delirium- infection, pain, meds, dehydration, unfamiliar environment
Meds- alcohol, drugs, opiates, benzodiazepines, poisoning
Acute illness- stroke, MI, sepsis, CNS infection, adrenal crisis

What are symptoms of hypoglycaemia?

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Hunger
Irritability
Headache
Altered/reduced consciousness
Difficulty speaking/slurred speech
Ataxia discoordination
Seizures

What are causes of hypoglycaemia?

Too little fuel Too much insulin Excess oral diabetes drugs/beta blockers, drug interactions Alcohol induced hypoglycaemia Sepsis Adrenal insufficiency

How do you manage hypoglycaemia?

DRABCD Give glucose if low Give carbs W increasing symptoms- oral gel Consider glucagon IM

What is a stroke?

An interruption of blood flow to the brain Due to clot/haemorrhage

How do you manage stroke?

DRABCD Consider recovery position Patient nil by mouth Give O2 Check glucose, give if low

What are causes of difficulty breathing?

Cranial- panic attack, CNS lesion Lungs- asthma, COPD, pneumothorax, pneumonia CVS- PE, pulmonary oedema Airway obstruction- choking, upper airway infection Metabolic- poisoning, anaphylaxis, acidosis

What is anaphylaxis?

Extreme allergy IgE mediated mast cell release of histamine Reaction to allergen (food/drugs esp antibiotics/NSAIDs)

What are clinical features of anaphylaxis?

Stridor, tachypnoea, wheeze, cyanosis Pallor, cool peripheries, tachycardia, hypotension Anxiety, agitation, reduced LOC Ab pain, D&V Urticaria, oedema of lips and tongue

How do you manage anaphylaxis?

DRABCD Give oxygen Lie down and raise legs if low BP Adrenaline IM (1:1000) 500mg

What are features of LA toxicity?

Tingling around the mouth Sudden agitation, confusion LOC, seizures CVS collapse w arrhythmias

How do you manage LA toxicity?

DRABCD Give O2 Lie down and raise legs if low BP Stop injecting

What is asthma?

Increased airway reactivity Atopic v non atopic Various triggers Acute attacks- wheezing, SOB, tight chest, coughing

How do you manage an asthma attack?

DRABCD Give O2 Salbutamol inhaler w so we Up to 10 puffs

What are signs of choking?

Evident distress Red face Inability to talk Wheezing/noisy breathing Coughing Watery eyes Holding throat Panicking

How do you manage choking?

DRA Effective cough- encourage to cough Ineffective cough- 5 back blows, 5 ab thrusts If unconscious- start CPR Paeds- if conscious- alternate 5 back blows, 5 chest thrusts If unconscious- open airways and rescue breaths- basic paeds life support

What are causes of chest pain?

Vascular- PE, aortic dissection Lung- pneumothorax, pleural effusion, pneumonia Heart- angina/ischaemia, myocarditis, pericarditis Muscles of chest wall- chest injury/strain Gastritis/reflux

What are symptoms of angina/MI symptoms?

Anxiety/fear Pallor Chest pain +/- radiation N&V Sweating/clammy

How would you manage angina/MI?

DRABCD Give O2 GTN spray 1-2 sublingual Aspirin 300mg crushed

medical emergencies Flashcards

(41 cards)