Emergency Medicine Osces

Front 1

ABG interpretation in Severe Ashma:
1. A low PaO2 and a low PCO2.
2. Normal or elevating PCO2

Back 1

1. hyperventilation
2. respiratory muscle fatigue and possible immimnet respiratory failure.

Front 2

How do you make an initial asessment of Asthma severity and classify it into Moderate excaerbation, acute severe attack and life threatening attack?

Back 2

Moderate Exacerbation:
- increasing symptoms
- PEFR >50-75% best or predicted
- No features of acute severe Asthma

Acute severe attack: (any one of)
- Unable to complete sentences in one breath.
- PEFR 33-50% best or predicted
- Respiratory rate >= 25/min
- Heart Rate >= 110/min

Life Threatening: (any one of)
- PEFR <33% predicted
- SpO2 <92% or PaO2 <8 KPa
- PaCO2 normal or high
- Silent chest or feeble respiratory effort
- cyanosis
- bradycardia
- dysrhytmia
- hypotension
- Exhaustion
- Confusion and coma

Front 3

How do you treat a severe asthma attack?

Back 3

'O SHIT'
Oxygen at 40-60%, 100% if not improving

Sit the patinet up, Salbutamol nebulised 5mg every 4 hr

Hydrocortisone 100mg i.v. or prednisolone 40 mg PO

Ipratropium bromide 0.5mg qds, nebulised, inform ITU (life threatening)

Theophyline (aminophylline), CXR to exclude pneumoThorax

Front 4

Main differential in a pateint presenting with:
- respiratory distress
- distended neck veins
- unilateral decreased breath sounds
- Dropping blood pressure
- Hyperresonance
- Cyanosis (late)

Back 4

Tension Pneumothorax

Front 5

In a trauma patient:
- Reduced arterial blood pressure
- distended neck veins
- Muffled heat sounds

Back 5

Cardiac Tamponade

Front 6

List 7 causes of shock

Back 6

Haemmorrhagic: Blood loss

Nonhaemorrhagic
- Tension pneumothorax
- Cardiac tamponade
- Cardiogenic
- Neurogenic
- Septic
- Anaphylactic