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10 Cards in this Set
- Front
- Back
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Summarise the initial stabilization of your patient presenting with an undifferentiated problem
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ABCDE: -
A: patenc, obstruction, protect C-spine B: supplementary O2 C: pulse, BP, cap refill, evidence of haemorrhage, peripheral shutdown (mottling, coolness, lack of peripheral pulses), calf (soft, non-tender), hydration, RHF signs (JVP, oedema, basilar creps) > no pulse ocntinue to CPR. If indicated insert 2 large bore cannulas (16G), send off or FBC, baseline coags, x-match and G and H, commence fluid replacement is shocked (2-3L crystalloid or colloid in adults) D:GCS, PEARL?, limb movement, obvious deficits (plegia, posturing), assess for head and spinal injuries. Check for anxiety E: adequate exposure to rule out other minor injuries- avoid hypothermia. FAST exam as indicated and AMPLE history: allergies, medication, past MHx, last ate and drank, events leading to injury |
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Ix for undifferentiated patient
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Vitals
Sao2: Temperature A/VBG BSL As indicated: - Imaging CXR Cervical spine XR Pelvis xray Input/output: urine catheter orogastric/ nasogastric tube Cardiac/ circulation ECG Bloods: FBC +WCC differential, EUC, LFTs, culture, CK and troponin, CMP, ESR/CRP, drug levels Holter Monitor Spetic Screen - urine, stool, CXR +/- lumbar puncture |
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signs of impending airway obstruction
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Hoarse voice, inability to speak
snoring stridor gurlging or drooling increased WOB - tracheal tug, tripoding, accessory muscle use cyanosis, dropping Sao2 loss of consciousness neck swelling type of injury/event: inhalational burns, anaphylaxis, penetrating trauma, severe asthma, status epilepticus |
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4 main Causes of Cardiac Arrest
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4 T's
Tension pneumothorax (esp post trauma): clinical confirmation, needle decompression(2nd ICS midclav line), chest drain (4th ICS, between anterior and mid axillary line) Toxins/posions/drugs: Bloods to identify, give antidote, support Tamponade: Clinical confirmation, CXT,TTE and ECG, then pericardiocentesis Thrombosis - PE: D-Dimer (low risk), Venous Doppler +/- CTPA (high risk), high dose o2 via mask, IV NS, moprhine, anticoag: heparinise then warfarin (INR 2.5-3.5), fibrinolytic therapy: tPA with heparin +/- IVC filter, embolectomy ACS: ECG, Trop and CK, TTE, Rx: sublingual nitrates, aspirin, morphine, rapid cardiac catheterisation. |
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Indications for use of defibrillation
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shockable: SVT (pulseless), VF, VT
nn-shockable: PEA, asystole |
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5 Life threatening causes of SOB
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Airway: obstruction (oedema, foreign body, anaphyalxis),
pulmonary: pneumothorax, haemothorax, pulmonary oedema, status asthma cardiovascular: tamponade, PE, arrhythmias metabolic: DKA, sepsis neurological: myasthenia gravis, Guillan-Barre |
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5 Life threatening causes of chest pain
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Cardiac
ACS - STEMI, N-STEMI Acute Aortic Dissection Pericarditis Pulmonary Pulmonary Oedema Tension Pneumothorax PE pleurisy, pneumediastium |
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Initial investigations for chest pain
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ECG
Bloods - FBC, EUC, CRP/ESR, LFTS, Trops and CK, D-Dimer CXR TTE |
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5 main causes of lifethreatening abdominal pain
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exsanguinating haemorrhage with hypovolaemia shock, perforeated vsicus, necrosis of viscus, intrapertioneal septic focus, extra-abdominal causes (AMI, DKA, ruptured TA)
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List uses of abdo USS
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Abdo US essential to rule out AAA in those over 60. Also useful for kidney stones, ectopic pregnancy, biliary disease and testicular masses
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