Medical Emergencies Flashcards
(34 cards)
What details should be recorded on someone’s faint/collapse episode?
- ) Circumstances of event
- ) Posture just before loss of consciousness
- ) Prodromal symptoms (sweat/warmth)
- ) Presence or absence of movement during event
- ) Tongue biting?
- ) If injury occurred during event
- ) Duration
- ) Copies of the ECG and patient report form given on transfer of pt.
What 3 things can cause faints/collapse
- ) NEUROGENIC SYNCOPE
- ) CARDIOGENIC SYNCOPE
- ) NEUROCARDIOGENIC SYNCOPE ‘SIMPLE FAINT’
SYNCOPE = FALL IN BLOOD PRESSURE
What are the features of a Neurogenic Syncope (brain)
- Also known as a vasovagal syncope - natural mechanism of falling so blood goes back to the brain
- Occurs when body overreacts to triggers like intense emotion/sight of blood/heat/dehydration
- History of neurogenic problems: Epilepsy
- Loss of sphincter tone (urination)
- Tongue biting
- Prodrome (pre-expectancy)
- Clinical features
What is the difference between a faint and a collapse
Collapse - sudden loss of postural tone
Faint - transient loss of consciousness
What may be the cause of Neurogenic syncope
- Seizure / Epilepsy
- Sub-arachnoid haemorrhage
- Not stroke
What is a Cariogenic syncope (heart) and what may cause it
• 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
How diagnose a syncope as a Vasovagal one (Neurocardiogenic)
- Commonest type of faint
- 3 P’s - Posture, Provoking, Prodrome
- Transient LOC
- Rapid recovery, often ongoing headache, mild nausea
- Overstimulation of vagus nerve +/- sympathetic tone loss
Name the NICE Red Flag Signs with a syncope (leading to the belief that it is not vasovagal)
Refer within 24 hours for specialist IF:
- ECG abnormality
- Heart failure (history or clinical signs)
- TLoC during exertion
- Family history of sudden cardiac death in people aged 40 years
- Heart murmur
How do we treat faints
• Assess the Airway, Breathing, Circulation (ABC)
- Lay flat, elevate legs, recovery position if necessary
• If occurs after unpleasant stimulus (LA injection) and recovery rapid
What is Hypoglycaemia
- Lower than normal blood sugar
* Normal ranges 4 - 7
What are the features of Hypoglycaemia
- Hunger
- Irritability
- Headache
- Altered/reduced LOC
- Difficulty speaking
- Ataxia dyscoordination (drunkenness)
- Seizures
What are the causes of Hypoglycaemia
- Too little fuel
- Too much insulin
- Excess oral diabetic drugs
- Alcohol induced hypoglycaemia
- Sepsis
- Insulin-secreting pancreatic tumour
- Adrenal insufficiency / Hypopituitarism
How do we treat Hypoglycaemia
- SUGAR
- Carbohydrate if symptoms minimal (Jelly babies)
- Increasing symptoms use oral gel
- IV if significant symptoms (seizures - can’t swallow)
- Hospital assessment focused on treatment and identifying cause
What is Anaphylaxis
- Extreme allergy
- IgE mediated (anaphylactoid reactions clinically similar but not IgE mediated)
- Caused by reaction to allergen (food / drugs / NSAIDs)
Describe the pathophysiology of Anaphylaxis
- Antigen binds to IgE antibodies on mast cells based in connective tissue throughout the 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 an allergic reaction with respiratory symptoms and circulatory collapse - can be fatal if untreated in time
What are the 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
What does the Resuscitation guidelines say for an anaphylactic shock
1.) ABC
- ) - Call for help
- Lie pt. flat
- Raise pt. legs
3.) GIVE ADRENALINE 500mg
4.)
• Establish airway
- High flow oxygen
- Chlorphenamine
- Hydrocortisone
- Nebulised B agonist (salbutamol)
What is the treatment course if this happened in your practice
- Remove/Stop cause
- Assess A B C
- Intramuscular adrenaline 500mg
- Oxygen
- Nebulised B agonist (salbutamol)
- 999 to ED
What is Asthma
- Increased airway activity
- Atopic/non-atopic
- Various triggers
- Acute attacks - wheezing, SOB, ‘tight chest’, cough
How do we treat an Asthma Attack
- Try and prevent allergen
- Inhaled B-agonists - salbutamol, terbutaline (ventolin)
- Steroids if indicated to reduce airway inflammation - does not cause immediate relief in asthma attack
- Others - Magnesium, IV aminophylline, venitlation
How does Ischamemic Heart disease happen? What is the process?
- Coronary arteries around heart supplies it with O2 etc..
- High cholesterol and high blood pressure with turbulence can erode some of the lining of the blood vessel away.
- This exposes the tissue underneath and so a fatty streak is formed to reduce the blood flow around it. This narrows the vessel.
- This narrowing causes the protective layer to become necrotic plaque
- This plaque can rupture with flow of blood and exposes the vessel underneath leading to a clot - blockage of arteries - chest pain symptoms etc..
What are the 3 types of Ischaemic Heart Disease
• STABLE ANGINA:
- Pain on exercie, relieved by rest +/- GTN
• UNSTABLE ANGINA:
- Worsening pain esp at rest, increasing frequency of episodes
• MYOCARDIAL INFARCTION:
- Syptoms, ECG changes, biochemical markers (troponin) 10/10 pain.
What are the symptoms of someone with Angina / MI
- Chest pain +/- radiation
- Nausea/Vomiting
- Collapse
- Sweating
- Pallor
- Anxiety
How do we treat Angina/MI
- ABCDE
- GTN spray (nitrates)
- Aspirin (300mg) chew
- Oxygen (if indicated <94% SpO2)
- 999 to ED
•Primary PCI for AMI that meet criteria
STEMI more serious needs immediate treatment
• MONA:
- M = Morphine
- O = Oxygen
- N = Nitrates
- A = Aspirin
