Module 7 - Medical Emergencies

  1. Conditions which may cause a
    Decreased Level Of Consciousness?
    • Inadequate Perfusion:
    • - Hypovoleamia
    • - Cardiac Arrhythmias
    • - Distributive shock
    • - Neurogenic Shock
    • - Raised ICP
    • Altered Metabolic States
    • - Hypoglycaemia & Hyperglycaemia
    • - Hypoxia
    • Intoxication or poisoning
    • - Drug overdose
    • - Alcohol Intoxication
    • - Carbon Monoxide poisoning
    • Medical Conditions
    • - Stroke
    • - Subarachnoid Haemorrhage
    • - Epilepsy
    • - Meningitis
    • - Hypo & Hyperthermia
    • Head Injury
  2. What are the four elements of eyes in GCS scoring?
    • 4 - Opens spontaneously
    • 3 - Opens to voice
    • 2 - Opens to pain
    • 1 - None
  3. What are the five elements of voice in GCS scoring?
    • 5 - Orientated
    • 4 - Confused
    • 3 - Inappropriate words
    • 2 - Incomprehensible sounds
    • 1 - No Verbal Response
  4. What are the six elements of motor GCS scoring?
    • 6 - Obeys Commands
    • 5 - Localises Pain
    • 4 - Withdraws from pain
    • 3 - Decorticate posturing
    • 2 - Decerebrate posturing
    • 1 - No response to pain
  5. Headache Red Flags
    • - Headache of severe, sudden (thunderclap) onset
    • - Headache localised to the vertex
    • - Escalating headache of unusual nature
    • - Changed visual acuity
    • - Changed mental state and inappropriate behaviour
    • - Newly presenting ataxia
  6. Headache Treatment:
    • - Assess GCS
    • - Only give O2 if Hypoxaemic
    • - Consider symptomatic pain relief
    • - Avoid morphine
    • - Time critical transfer to nearest A&E
  7. Which diagnoses should be specifically considered in the febrile child?
    • - Meningococcal Septicaemia
    • - UTI
    • - Pneumonia
    • - Herpes Simplex encephalitis
    • - Septic Arthritis
    • - Kawasaki's disease
  8. Management of febrile child
    • - Antipyretics should not be given purely to treat fever.
    • - Antipyretics are not proven to decrease the risk of seizure
    • - Antipyretics may relieve other unpleasant symptoms of febrile illness
    • - Antibiotics should not be given unless diagnosis is known.
  9. Which children MUST be transported to hospital?
    • - Any child under 5 fulfilling the red criteria
    • - Any febrile baby <1 month old.
    • - Any febrile child less than <3 months, unless obvious cause (as a minimum a urgent urine sample would be required)
    • - Those aged under 3 years without an obvious cause, if a urine sample cannot ne obtained through GP.
    • - Those with any signs of serious illness.
    • - Any child with significant fever but not localising symptoms or signs, who has received antibiotics within 48 hours.
  10. What is the croup scoring system?
    • Stridor
    • 0 - None
    • 1 - Only on crying
    • 2 - At rest
    • 3 - Severe (Biphasic)
    • Recession
    • 0 - None
    • 1 - Only on crying, exertion
    • 2 - At rest
    • 3 - Severe (Biphasic)

    Mild = 1-2 Moderate = 3-4 Severe = 5-6
  11. What are the features of heat exhaustion?
    • -Systemic reaction to prolonged heat exposure (hours to days)
    • -Temperature >37 and <40
    • - Headache, dizziness, nausea, vommiting and tachycadia
    • - Hypotension, sweating, muscle pain, weakness and cramps.
  12. Definition of heat stoke?
    A 'Systemic inflammatory response' to a core body temperature >40.6°C in addtion to a change in mental status and organ dysfunction (European resuscitation guidelines)
  13. Features of heat stroke
    • - Core temperature >40°C
    • - Hot, dry skin (Sweating is present in about 50% of cases of exertional heat stroke)
    • - Early signs and symptoms e.g. extreme fatigue, headache, fainting, facial flushing, vommiting and diahorrhea.
    • - Cardiovascular dysfunction including arrythmias and hypotension
    • - Respiratory disfunction including seizures and coma.
    • - Liver and renal failure
    • - Coagulopathy
    • - Rhabdomyolysis.
  14. Sickle Cell Anemia Management Principles
    • - Adults Aim for target O2 saturations of 94-98%
    • - Children Administer high flow Oxygen
    • - Perform 12 Lead ECG
    • - Entonox initally, but not for long periods of time.
    • - Opiates should be administered orally or subcutaneously rather than IV, dose should be guided by the patients hand held record.
  15. When should you consider anaphylaxis?
    • Sudden onset or rapid progression
    • Airway and/or Breathing problems (e.g. dyspnoea, hoarseness, stridor, wheeze, throat or chest tightness)
    • and/or Circulation (e.g. hypotension, syncope, prnounded tachycardia)
    • and/or Skin (e.g. erythema, uticaria, mucosal changes) problems
  16. Management of Anaphylaxis
    • - Administer high levels of supplimentary Oxygen
    • - Administer Adrenaline IM
    • - Consider fluid therapy
    • - Consider chlophenamine
    • - Consider administering hydrocortisone
    • - Consider nebulised Salbutamol for bronchospasm.
    • - Monitor - reassess ABC
  17. Signs of severe asthma
    • - PEF 33-50% of best or predicted
    • - Respiratory rate >25 BPM
    • - Heart Rate > 110 BPM
    • - Inability to complete sentances in one breath 
  18. Signs of life threatening asthma
    • - Altered LOC
    • - Exhaustion
    • - Arrythmia
    • - Hypotension
    • - Cyanosis
    • - Silent Chest
    • - Poor respiratory effort
    • - PEF <33% Predicted
    • - SPO2 <92%
  19. Treatment of Life Threatening asthma
    • - Administer Adrenaline
    • - Positive pressure ventiallation with bag-valve-mask and 'T' piece
  20. Asthma Casecade
    • Mild to Moderate Asthma
    • - Move to calm enviroment
    • - Encourage use of own inhaler, preferibly using spacer. Ensure correct technique is used; two puffs followed by two puffs every 2 minutes to a maximum of ten puffs.
    • - Administer high levels of supplimentary oxygen
    • - Administer nebulised salbutamol using oxygen driven nebuliser
    • Severe Asthma
    • - If no improvement, administer ipratropium bromide by nebuliser
    • - Administer steroids
    • - Continous Salbutamol nebulisation may be administered unless clinically significatn side effects occour.
    • Life Threatning Asthma
    • - Administer IM adrenaline
    • - PPV with T piece neb
Author
boyblue666
ID
241662
Card Set
Module 7 - Medical Emergencies
Description
Medical Emergencies - JRCALC 2013
Updated