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Flashcards in Medical emergencies Deck (45)
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1

Faints and collapse of unknown cause

Collapse - sudden loss of postural tone
Faint - transient loss of consciousness
Common
Divided into several groups

2

NICE assessment for faints or collapse of unknown cause: record details about

Circumstances of event
Pt's posture immediately before LoC
Prodromal symptoms
Appearance
Presence/ absence of movement during event
Any tongue-biting
Injury occurring during event
Presence / absence of confusion during recovery period
Weakness down one side during recovery period

3

Causes of faints and collapse

Neurogenic Syncope
Cardiogenic Syncope
Neurocardiogenic Syncope including “Simple Faint”

4

Neurogenic syncope causes

Seizures / Epilepsy
Sub-Arachnoid Haemoarrhage
Not stroke

5

Features of neurogenic syncope

History of Neurogenic problems: Epilepsy
Loss of sphincter tone
Tongue Biting
Prodrome
Clinical features

6

Cardiogenic syncope causes

Arrhythmias: Bradycardia, Tachycardia
Valvular Pathology: Aortic Stenosis, Mitral Stenosis
Structural Heart Disease: Hypertrophic Cardiomyopathy (HCM)
Pulmonary Embolus
Primary Electrophysiological Abnormalities:
-Brugada Syndrome
-Long QT Syndrome

7

Vasovagal syncope - neurocardiogenic syncope

Commonest type of faint
3 P’s: Posture Provoking Prodrome
-prolonged standing, or similar episodes that have been prevented by lying down)
-pain or medical procedure
-sweating or feeling warm/ hot before TLoC
Transient LOC
Rapid recovery, often ongoing headache, mild nausea
Overstimulation of vagus nerve +/- sympathetic tone loss

8

Diagnose situational syncope when

There are no features that suggest alternative diagnosis AND
Synope is clearly and consistently provoked by straining during micturition (usually whilst standing) or by coughing or swallowing

9

NICE red flag signs - collapse or faint

Refer within 24 hrs for specialist CV assessment if TLoC and any of following:
-ECG abnormality
-heart failure
-TLoC during exertion
-family history of sudden cardiac death in people aged <40yrs and/ or inherited cardiac condition
-heart murmur
Consider referring anyone >65yrs who has experienced TLoC without prodromal symptoms

10

Assessment and treatment of faints

Assess the Airway, Breathing and Circulation
-lay flat, elevate legs (if tolerated), recovery position if necessary
If occurs after an unpleasant stimulus (e.g. LA injection) and recovery rapid - likely ‘simple’ faint
If any doubt - emergency department assessment

11

Hypoglycaemia

Lower than normal blood sugar
-normal blood sugar (BM) ~ 4-7
Differing thresholds for symptoms

12

Causes of hypoglycaemia

Too little fuel
Too much insulin (e.g. diabetics)
Excess oral diabetes drugs
Alcohol induced hypoglycemia
Sepsis
Insulin-secreting pancreatic tumor
Adrenal insufficiency / hypopituitarism

13

Symptoms of hypoglycaemia

Hunger
Irritability
Headache
Altered / reduced LOC
Difficulty speaking, slurred speech
Ataxia dyscoordination, (drunkenness)
Seizures

14

Treatment of hypoglycaemia

Sugar!
If symptoms minimal - carbohydrate (e.g. sandwich, sugary drink)
With increasing symptoms - oral gel e.g. “hypostop”
IV if significant symptoms (reduced LOC / seizures)
Hospital assessment focused on treatment and identifying cause

15

Anaphylaxis

Extreme allergy
IgE mediated (anaphylactoid reactions clinically similar, but not IgE mediated)
Caused by reaction to allergen (food / drugs esp. antibiotics / NSAIDS)

16

Pathophysiology of anaphylaxis

Antigen binds to IgE antibodies on mast cells based in CT throughout body
Degranulation of mast cells with release of inflammatory mediators
Inflammatory mediators cause common symptoms of allergic reactions, such as itching, rash, and swelling
Can also cause bronchial constriction, vasodilation
Anaphylactic shock is allergic reaction with respiratory symptoms and circulatory collapse

17

Clinical features of anaphylaxis

Respiratory distress – stridor, tachypnoea, wheeze, cyanosis
Circulatory signs - pallor, cool peripheries, tachycardia, hypotension
CNS - anxiety, agitation, reduced LOC
GI - abdominal pain, D&V
Skin - urticaria

18

Treatment of anaphylaxis

Remove / stop cause (e.g. LA injection)
Assess Airway, Breathing and Circulation
Intramuscular adrenaline (0.5mg)
Oxygen
Nebulised ß agonist (salbutamol)
999 to ED

19

Asthma

Increased airway reactivity
Atopic / non - atopic (atopy - triad of atopic eczema, allergic rhinitis (hay fever) and asthma)
Various triggers
Acute attacks - wheezing, SOB, ‘tight chest’, coughing

20

Treatment of asthma

Try and prevent - avoid precipitants
Inhaled B-agonists - salbutamol, terbutaline (ventolin / bricanyl) – Patients own or Nebulised
Steroids if indicated - reduce airway inflammation
British Thoracic Society guidelines for hospital management
Others - magnesium, IV aminophylline, ventilation

21

Ischaemic heart disease

Angina/ MI
Common in Western world
Coronary artery disease
Complicated pathogenesis
Risk factors (fixed & modifiable)
Clinical manifestations variable

22

Preventative measures for ischaemic heart disease

BP control
Metabolic control
Stop smoking
Ca xP control
Infection screnning

23

Pharmacological measures for ischaemic heart disease

ACE inhibitors
Statins
Aspiring
PPAR-gamma agonists
Anti-oxidants

24

Mechanical measures for ischaemic heart disease

By-pass surgery
Coronary angioplasty
Endarterectomy

25

measures for acute coronary event

Thrombolysis
Coronary angioplasty

26

'Stable' angina symptoms

-pain on exercise
-relieved by rest +/- GTN

27

'Unstable' angina symptoms

Worsening pain esp. at rest
> frequency of episodes

28

MI symptoms

Chest pain – sensation of pressure, tightness or squeezing in centre of chest
Pain in other parts of the body – can feel as if pain is travelling from chest to arms, jaw, neck, back and abdomen
-usually left arm is affected, but can affect both arms
feeling lightheaded or dizzy
sweating
SOB
Feeling sick (nausea) or being sick (vomiting)
Overwhelming sense of anxiety (similar to having a panic attack)
Coughing or wheezing
Collapse
Pallor

29

Signs of MI

Symptoms
ECG changes
Biochemical markers

30

Angina/ MI treatment

GTN spray / tablet
Aspirin 300mg (chew / dispersible)
Oxygen (if indicated)
999 to ED
Primary PCI (STH) for AMI that meet criteria
MONA