A+E

Question 1

Typical picture of salycilate overdose

Answer 1

• A key concept for the exam is to understand that salicylate overdose leads to a mixed respiratory alkalosis and metabolic acidosis.
• Early stimulation of the respiratory centre leads to a respiratory alkalosis
• Following this, a metabolic acidosis develops along side the respiratory alkalosis due to the direct acid effects of salicylates (combined with acute renal failure).
• In children metabolic acidosis tends to predominate.

Features

• hyperventilation (centrally stimulates respiration)
• tinnitus
• lethargy
• sweating, pyrexia*
• nausea/vomiting
• hyperglycaemia and hypoglycaemia
• seizures
• coma

Question 2

treatment of salicylate overdose

Answer 2

• general (ABC, charcoal)
• urinary alkalinization with intravenous sodium bicarbonate - enhances elimination of aspirin in the urine
• haemodialysis

Indications for haemodialysis in salicylate overdose

• serum concentration > 700mg/L
• metabolic acidosis resistant to treatment
• acute renal failure
• pulmonary oedema
• seizures
• coma

Question 3

child abuse presentations:
- where do they present
- how might they present physically

Answer 3

Children may disclose abuse themselves. Other factors which point towards child abuse include:

• story inconsistent with injuries
• repeated attendances at A&E departments
• delayed presentation
• child with a frightened, withdrawn appearance - ‘frozen watchfulness’

Possible physical presentations of child abuse include:

• bruising
• fractures: particularly metaphyseal, posterior rib fractures or multiple fractures at different stages of healing
• torn frenulum: e.g. from forcing a bottle into a child’s mouth
• burns or scalds
• failure to thrive
• sexually transmitted infections e.g. Chlamydia, Gonorrhoea, Trichomonas

Question 4

testicular torsion signs and sx

Answer 4

• pain is usually severe and of sudden onset
• the pain may be referred to the lower abdomen
• nausea and vomiting may be present
• on examination, there is usually a swollen, tender testis retracted upwards. The skin may be reddened
• cremasteric reflex is lost
• elevation of the testis does not ease the pain (Prehn’s sign) [positive in epididymitis]

Question 5

testicular torsion Mx

Answer 5

treatment is with urgent surgical exploration
if a torted testis is identified then both testis should be fixed as the condition of bell clapper testis is often bilateral.

Question 6

acute DKA management

Answer 6

• fluid resus - saline
• fixed rate insulin [ 0.1 unit/kg/hour] whilst continuing regular injected long-acting insulin but stopping short actin injected insulin [if pt is known diabetic]
• later add in potassium according to their initial levels on presentation

Question 7

DKA diagnostic criteria

Answer 7

glucose > 11 mmol/l or known diabetes mellitus
pH < 7.3
bicarbonate < 15 mmol/l
ketones > 3 mmol/l or urine ketones ++ on dipstick

Question 8

what extra care should children and young adults get after treatment for DKA

Answer 8

they are at greater risk of cerebral oedema t4
1:1 nursing to monitor neuro-observations, headache, irritability, visual disturbance, focal neurology etc. It usually occurs 4-12 hours following commencement of treatment but can present at any time. If there is any suspicion a CT head and senior review should be sought

Question 9

DKA Complications may occur from DKA itself or the treatment:

Answer 9

• gastric stasis
• thromboembolism
• arrhythmias secondary to hyperkalaemia/iatrogenic hypokalaemia
• iatrogenic due to incorrect fluid therapy: cerebral oedema*, hypokalaemia, hypoglycaemia
• acute respiratory distress syndrome
• acute kidney injury

Question 10

a child presents to A+E with no signs of life - how do you proceed

Answer 10

5 rescue breaths then 15 chest compressions to every 2 ventilation breaths

• For a child under 1, the two-thumb encircling or two-finger techniques should be used.
• For a small child, the one-handed technique should be used.
• For a larger child, the two-handed technique can be used (as for adults).

Question 11

define hypothermia

Answer 11

unintentional reduction of core body temperature below the normal physiological limits

• Mild hypothermia: 32-35°C
• Moderate or severe hypothermia: < 32°C

Question 12

hypothermia risk factors

Answer 12

Risk factors:

• General anaesthesia
• Substance abuse
• Hypothyroidism
• Impaired mental status
• Homelessness
• Extremes of age

Question 13

Signs of hypothermia include:

Answer 13

• shivering
• cold and pale skin. Frostbite occurs when the skin and subcutaneous tissue freeze, causing damage to cells.
• slurred speech
• tachypnoea, tachycardia and hypertension (if mild)
• respiratory depression, bradycardia and hypotension (if moderate)
• confusion/ impaired mental state

Question 14

ECG signs of hypothermia

Answer 14

As the core temperature approaches 32°C to 33°C, acute ST-elevation and J waves or Osborn waves may appear

Question 15

hypothermia investigations

Answer 15

• Temperature. Special low-reading rectal thermometers or thermistor probes are preferred for measuring core body temperature. The patient’s temperature should be tracked over time, to check for improvement.
• 12 lead ECG. As the core temperature approaches 32°C to 33°C, acute ST-elevation and J waves or Osborn waves may appear
• FBC, serum electrolytes. Haemoglobin and haematocrit can be elevated (due to haemoconcentration). Platelets and WBCs are low due to sequestration in the spleen. Monitoring potassium is advised as hypothermic patients can be hypokalaemic due to a shift of potassium into the intracellular space.
• Blood glucose. Stress hormones are increased, and the body can have more peripheral resistance to insulin.
• Arterial blood gas
• Coagulation factors
• Chest X-ray

Question 16

T/F
rapid rewarming is the best treatment option for hypothermic pts

Answer 16

FALSE
this can lead to peripheral vasodilation and shock

Question 17

who should be treated with acetylcysteine in paracetmol OD

Answer 17

• the plasma paracetamol concentration is on or above a single treatment line joining points of 100 mg/L at 4 hours and 15 mg/L at 15 hours, regardless of risk factors of hepatotoxicity
• there is a staggered overdose or there is doubt over the time of paracetamol ingestion, regardless of the plasma paracetamol concentration; or
• patients who present 8-24 hours after ingestion of an acute overdose of more than 150 mg/kg of paracetamol even if the plasma-paracetamol concentration is not yet available
• patients who present > 24 hours if they are clearly jaundiced or have hepatic tenderness, their ALT is above the upper limit of normal
  
  • acetylcysteine should be continued if the paracetamol concentration or ALT remains elevated whilst seeking specialist advice

Question 18

how is acetylcysteine administered + why

Answer 18

IV infusion over 1 hour as it can cause anaphylactic reactions when given over shorter periods

Question 19

management of PE

Answer 19

HAEMODYNAMICALLY STABLE PTs

• DOACs first line for most people, including cancer patients. [apixaban or rivaroxiban]
  
  • 2nd line = LMWH –> dabigatran or edoxaban or warfarin.
• low risk patients are managed as outpatients and higher risk are admitted.
• PE severity index score [PESI] is used to determine risk.
• anti-coagulate for at least 3 months [provoked PE’s]
  
  • treat for 3 extra months for unprovoked PEs and active cancer pts.

HAEMODYNAMICALLY UNSTABLE PTs

• thrombolyse.
• massive PE presents with haemodynamic instability, particularly hypotension.

Question 20

Well’s score features

Answer 20

Clinical probability simplified score
DVT likely: 2 points or more
DVT unlikely: 1 point or less

Question 21

DVT Mx based on wells score

Answer 21

Question 22

signs of a PE on ECG

Answer 22

S1 Q3 T3

• a prominent S wave in lead I, a Q wave in lead III, and a T wave inversion in lead III
• indicates right heart strain which is associated with PE
  
  • can be seen in other conditions causing right ventricular strain, such as acute bronchospasm, pneumothorax, and other acute lung disorders t4 NOT specific
  • not always seen in PE t4 not sensitive
• used alongside clinical features

Question 23

what are the 3 determining factors for how you approach AF management

Answer 23

1. haemodynamic in/stability

• unstable pts are electrically cardioverted
• stable pts, see below.

2. how acute the AF is:

• <48 hours; give rhythm control
• > 48 hours OR uncertain time frame; give rate control

3. anticoagulation - all pts require anticoagulation usually with a DOAC [1st line] or warfarin [2nd line]

Question 24

which AF pts receive rate control as treatment

Answer 24

all pts except:

• A reversible cause for their AF
• New onset atrial fibrillation (within the last 48 hours)
• Heart failure caused by atrial fibrillation
• Symptoms despite being effectively rate controlled

Question 25

which AF pts receive rhythm control as treatment

Answer 25

* A reversible cause for their AF * New onset atrial fibrillation (within the last 48 hours) * Heart failure caused by atrial fibrillation * Symptoms despite being effectively rate controlled (probs wrong tbh)

Question 26

rate control options in AF

Answer 26

Rate control aims to get the heart rate below 100 and extend the time during diastole for the ventricles to fill with blood. 1. Beta blocker first-line (e.g., atenolol or bisoprolol) 2. Calcium-channel blocker (e.g., diltiazem or verapamil) (not preferable in heart failure) 3. Digoxin - NOT 1st line(only in sedentary people with persistent atrial fibrillation, requires monitoring and has a risk of toxicity, may be useful in coexistent HF)

Question 27

Rhythm control options in AF

Answer 27

Rhythm control aims to return the patient to normal sinus rhythm. This can be achieved through: - Cardioversion - electrical or pharmacological - electrical is done with a defibrilator and can be done immediately or after 3 weeks of anticoagulation if the pt is stable. always done under sedation or GA - pharmacological cardioversion is done with **Flecainide** or **Amiodarone** (the drug of choice in patients with structural heart disease) - immediate or delayed - done immediately if the AF is new onset and present for <48 hours OR if pt is lifethreatening haemodynamically unstable. - delayed can be used if the atrial fibrillation has been present for more than 48 hours and they are stable - Long-term rhythm control using medications

Question 28

AF treatment option for pts that don't respond to rate or rhythm drug treatment

Answer 28

Catheter ablation: burning areas of abnormal electrical activity. Used when drug treatment for rate or rhythm control is not adequate or tolerated, there are two options for ablation: - Left atrial ablation - AV node ablation + pace maker all pts must be anti-coagulated before hand Anticoagulation afterwards depends on CHADsVASc score

Question 29

what are the 4H's and 4T's

Answer 29

reversible causes of cardiac arrest

Question 30

reversible causes of cardiac arrest

Answer 30

4H's and 4T's - 4 hypo's

Question 31

indication for emergency endoscope in haematemesis

Answer 31

* Hemodynamic instability: Ongoing hypotension (SBP <90 mmHg), tachycardia, or shock that persists despite initial resuscitation. * Active, severe bleeding: Profuse or ongoing hematemesis (bright red blood) or persistent melena. * Suspected variceal hemorrhage: Known or suspected esophageal/gastric varices, usually accompanied by liver cirrhosis, where endoscopy should be done within 12 hours. * High-risk stratification: A high Glasgow-Blatchford Score (GBS) (e.g., >7 or >12 in some studies) indicating a high risk of needing intervention

Question 32

anti coagulant reversal

Answer 32

Warfarin: vit K or beriplex DOAC [apixaban and rivaroxiban]: andexanet alfa for life threatening GI bleeding. dabigatran: idarucizumab

Question 33

Pneumothorax management: the high-risk characteristics that determine the need for a chest drain are

Answer 33

* Haemodynamic compromise (suggesting a tension pneumothorax) * Significant hypoxia * Bilateral pneumothorax * Underlying lung disease * ≥ 50 years of age with significant smoking history * Haemothorax

Question 34

what is massive PE

Answer 34

PE causing haemodynamic instability, typically defined by: * Persistent hypotension: systolic blood pressure <90 mmHg or a drop of ≥40 mmHg for >15 minutes, not due to other causes. * Cardiogenic shock: signs of end-organ hypoperfusion such as altered mental status, oliguria, or cool extremities

Question 35

DKA Mx in kids vs adults [fluids]

Answer 35

When treating DKA in children, there is some evidence that cerebral oedema is more common if insulin is started early. Therefore, it is recommended to wait for at least an hour after IV fluids have been running before starting insulin treatment. There is no need to delay insulin treatment in adults.

Question 36

Features of lithium toxicity + Mx

Answer 36

Features of toxicity * coarse tremor (a fine tremor is seen in therapeutic levels) * hyperreflexia * acute confusion * polyuria * seizure * coma Mx - mild-moderate toxicity may respond to volume resuscitation with normal saline - haemodialysis may be needed in severe toxicity

Question 37

Complications of aneurysmal SAH:

Answer 37

***re-bleeding*** * happens in around 10% of cases and most common in the first 12 hours * if rebleeding is suspected (e.g. sudden worsening of neurological symptoms) then a repeat CT should be arranged * associated with a high mortality (up to 70%) ***hydrocephalus*** * hydrocephalus is temporarily treated with an external ventricular drain (CSF diverted into a bag at the bedside) or, if required, a long-term ventriculoperitoneal shunt * ***vasospasm*** (also termed delayed cerebral ischaemia), typically 7-14 days after onset * ensure euvolaemia (normal blood volume) * consider treatment with a vasopressor if symptoms persist ***hyponatraemia*** (most typically due to syndrome inappropriate anti-diuretic hormone (SIADH)) ***seizures***

Question 38

anaphylaxis adrenaline doses + optimal location

Answer 38

Adrenaline can be repeated every 5 minutes if necessary. The best site for IM injection is the anterolateral aspect of the middle third of the thigh.

Question 39

DKA resolution is defined as:

Answer 39

* pH >7.3 and * blood ketones < 0.6 mmol/L and * bicarbonate > 15.0mmol/L

Question 40

when should you initiate nitrates with caution

Answer 40

in a hypotensive pt - this include GTN

Question 41

immediate and long term Mx for NSTEMI and UA

Answer 41

Question 42

Wells score interpretation

Answer 42

DVT likely: 2 points or more DVT unlikely: 1 point or less

Question 43

how do you proceed if a Wells score deems DVT to be likely

Answer 43

1. a proximal leg vein ultrasound scan should be carried out within 4 hours * if the result is positive then a diagnosis of DVT is made and anticoagulant treatment should start * if the result is negative a D-dimer test should be arranged. A negative scan and negative D-dimer makes the diagnosis unlikely and alternative diagnoses should be considered 1. if a proximal leg vein ultrasound scan cannot be carried out within 4 hours a D-dimer test should be performed and interim therapeutic anticoagulation [DOAC] administered whilst waiting for the proximal leg vein ultrasound scan (which should be performed within 24 hours) 1. if the scan is negative but the D-dimer is positive: - stop interim therapeutic anticoagulation - offer a repeat proximal leg vein ultrasound scan 6 to 8 days later

Question 44

how do you proceed if a Wells score deems DVT to be unlikely

Answer 44

* perform a D-dimer test * this should be done within 4 hours. If not, interim therapeutic anticoagulation should be given until the result is available * if the result is negative then DVT is unlikely and alternative diagnoses should be considered * if the result is positive then a proximal leg vein ultrasound scan should be carried out within 4 hours * if a proximal leg vein ultrasound scan cannot be carried out within 4 hours interim therapeutic anticoagulation should be administered whilst waiting for the proximal leg vein ultrasound scan (which should be performed within 24 hours)

Question 45

CT head Ix rules

Answer 45

***CT head within 1 hour*** [GCS, fractures and neuro stuff] * GCS < 13 on initial assessment * GCS < 15 at 2 hours post-injury * suspected open or depressed skull fracture * any sign of basal skull fracture (haemotympanum, 'panda' eyes, cerebrospinal fluid leakage from the ear or nose, Battle's sign). * post-traumatic seizure. * focal neurological deficit. * more than 1 episode of vomiting ***CT head scan within 8 hours*** of the head injury - for adults with any of the following risk factors who have experienced some loss of consciousness or amnesia since the injury: * age 65 years or older * any history of bleeding or clotting disorders including anticogulants * dangerous mechanism of injury (a pedestrian or cyclist struck by a motor vehicle, an occupant ejected from a motor vehicle or a fall from a height of greater than 1 metre or 5 stairs) * more than 30 minutes' retrograde amnesia of events immediately before the head injury

Question 46

consequence of correcting hyponatremia too quickly

Answer 46

Demyelination of the pons (central pontine myelinolysis) is caused by correcting hyponatremia too quickly. (‘From low (hyponatremia) to high (hypernatremia), your pons will die’)

Question 47

Tx options for raised ICP

Answer 47

hyperventilation => reduced/ normal pCO2. This is important because high carbon dioxide levels cause cerebral vessels to dilate, increasing the blood flow to the brain and increasing ICP further

Question 48

when is dextrose used in DKA Mx

Answer 48

Once blood glucose is below 14, a 10% glucose infusion should be started alongside ongoing saline and insulin

Question 49

what criteria is used to decide if a pt need liver transplant after a paracetamol OD and what are the factors

Answer 49

Question 50

what additional meds are given to pneumonia pts with COPD

Answer 50

* Patients diagnosed with pneumonia who have COPD should be given corticosteroids even if no evidence of the COPD being exacerbated. * this helps improve x of pneumonia in these pts and prevents lung tissue damage.

Question 51

pneumonia severity assessment tool - primary care

Answer 51

* 0: low risk (less than 1% mortality risk) NICE recommend that treatment at home should be considered (alongside clinical judgement) * 1 or 2: intermediate risk (1-10% mortality risk) NICE recommend that ' hospital assessment should be considered (particularly for people with a score of 2)' * 3 or 4: high risk (more than 10% mortality risk) NICE recommend urgent admission to hospital

Question 52

pneumonia severity assessment tool - secondary care

Answer 52

* consider home-based care for patients with a CURB65 score of 0 or 1 - low risk (less than 3% mortality risk) * consider hospital-based care for patients with a CURB65 score of 2 or more - intermediate risk (3-15% mortality risk) * consider intensive care assessment for patients with a CURB65 score of 3 or more - high risk (more than 15% mortality risk)

Question 53

HF pt with acute decompensated pulmonary oedema- what is the initial Mx

Answer 53

sit them up and give loop diuretic IV - stop their regular meds [ACEi + BBs] as this can compromise their haemodynamic stability further - as a general rule ACEis and BBs should be witheld or used with caution where there are signs of hypoperfusion or haemodynamic instability

Question 55

wernickes: - cause - signs - mx

Answer 55

* cause: thiamine deficientcy due to poor nutrtional intake and impaired absorption * triad = confusion, ataxia and ophthalmoplegia * Mx = pabrinex [high-dose intravenous thiamine and other B vitamins]

Question 56

alcohol withdrawal: - main concern - signs - mx

Answer 56

- delirium tremens signs: - Tremors sweating, anxiety, tachycardia, seizures, HTN, fever, hallucinations [visual and auditory] - symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety * peak incidence of seizures at 36 hours * peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

Question 57

when is NIV considered in COPD

Answer 57

* If despite optimal medical treatment the patient remains acidotic pts with type 2 resp failure with a pH of 7.25 - 7.35 are put on NIV. * <7.25 - use NIV with increased monitoring or intubate.

Question 58

Mx algorithm of bradycardia

Answer 58

Question 59

Mx algorithm of tachycardia

Answer 59

Question 60

when is thrombolysis used in PE

Answer 60

**hamodynamic instability** - *massive PE + hypotension* massive PE is characterised by: * Systolic blood pressure <90 mmHg for >15 minutes or requiring vasopressors * a drop in systolic blood pressure of at least 40 mmHg for more than 15 minutes * Signs of **cardiogenic shock** or **persistent hypotension**

Question 61

The most common organism causing infective exacerbations of COPD is...

Answer 61

Haemophilus influenzae

Question 62

High risk pneumothorax management

Answer 62

The high-risk characteristics that determine the need for a chest drain are: * Haemodynamic compromise (suggesting a tension pneumothorax) * Significant hypoxia * Bilateral pneumothorax * Underlying lung disease * ≥ 50 years of age with significant smoking history * Haemothorax

Question 63

pseudohyponatremia - key features - key lab findings

Answer 63

Key features of pseudohyponatremia: - absence of symptoms typical of true hyponatremia (such as neurological dysfunction or cerebral edema), even when laboratory sodium values are markedly low - patients often have underlying conditions associated with severe hyperlipidemia (e.g., nephrotic syndrome, familial hypertriglyceridemia) or hyperproteinemia (e.g., multiple myeloma, Waldenström macroglobulinemia) Key lab findings: - Low measured serum sodium - Normal plasma osmolality (275–295 mOsm/kg), which distinguishes pseudohyponatremia from true hypotonic hyponatremia - Markedly elevated serum lipids or proteins on laboratory testing.

Question 64

Maintenance fluid requirements for adults

Answer 64

* Water: 25 to 30 mL/kg * K+, Na+, Cl-: 1 mmol/kg * Glucose: 50 to 100g - limits starvation ketosis but not enough nutritionally.

Question 65

what is fomepizole used for

Answer 65

- methanol or ethylene glycol poisoning [antifreeze] - works by inhibiting alcohol dehrdrogenase - NOT used for ethanol [regular alcohol] poisoning

Question 66

Immunosuppressed patient with a dry cough and exercise-induced desaturation - what is your main differential - Mx

Answer 66

* should be suspected of having Pneumocystis jirovecii pneumonia, due to immunosupression * This requires co-trimoxazole for treatment.

Question 67

ecstasy poisoning * CFs * Mx

Answer 67

CFs * neurological: agitation, anxiety, confusion, ataxia * cardiovascular: tachycardia, hypertension * hyponatraemia * this may result from either syndrome of inappropriate ADH secretion or excessive water consumption whilst taking MDMA * hyperthermia * rhabdomyolysis Mx - supportive care - dantrolene for hyperthermia

Question 69

neutropenic sepsis - definition - cause - Ix - Mx

Answer 69

**Definition** * MC occurs *7-14 days* after chemotherapy * defined as a neutrophil count of **< 0.5 * 109** in a patient who is having anticancer treatment and has one of the following: * a temperature higher than 38ºC or * other signs or symptoms consistent with clinically significant sepsis **Cause** MC causative organism = ***Staphylococcus epidermidis*** **Ix** - Bloods: FBC - neutropenia [always present regardless of WCC], low or normal WCC **MX** - IMMEDIATE Abx - never wait for blood results - piperacillin with tazobactam (Tazocin) * prophylaxis = fluoroquinolone. given when neutropenia is anticipated // - if patients are not responding after 4-6 days the Christie guidelines suggest ordering investigations for fungal infections

Question 70

key transfusion adverse reactions and their CFs + Mx

Answer 70

**Transfusion-associated circulatory overload (TACO)** - Usually presents in patients with pre-existing heart failure. - volume overload = main issue - CFs = pulmonary oedema + HTN - Mx = slow or stop the transfusion + can also give IV loop diuretics **Transfusion-related acute lung injury (TRALI)** - pulmonary oedema caused by increased pulmonary capillary permeability due to activation of host neutrophils - TRALI is non-cardiogenic with normal cardiac function - CFs = Sudden onset hypoxia, dyspnoea, fever, hypotension + NO signs of cardiac overload or failure.

Question 71

Wells score system for PE

Answer 71

Question 72

Hypercalcaemia: features

Answer 72

* 'bones, stones, groans and psychic moans' * corneal calcification * shortened QT interval on ECG * hypertension

Question 73

Ix to determine if a reaction was anaphylaxis

Answer 73

Serum tryptase levels may remain elevated for up to 12 hours following an acute episode of anaphylaxis.

Question 74

TRALI Vs TACO

Answer 74

TRALI is differentiated from TACO by the presence of hypotension in TRALI vs hypertension in TACO

Question 75

what induction agent for anaesthesia is useful in hypotensive pts

Answer 75

ketamine doesn't cause a drop in blood pressure so useful in trauma

Question 76

beta blocker OD Mx

Answer 76

treat if bradycardic 1. atropine 2. glucagon if no response to atropine

Question 77

Mx of benzo OD

Answer 77

Flumezanil

Question 78

Tricyclic antidepressants OD

Answer 78

IV bicarbonate may reduce the risk of seizures and arrhythmias in severe toxicity - to correct acidosis

Question 79

heparin reversal agent

Answer 79

protamine sulphate

Question 80

iron overload Mx

Answer 80

Desferrioxamine, a chelating agent

Question 81

anaphylaxis CFs

Answer 81

anaphylaxis is defined ABC symptoms but think of presentation in A-E format * Airway: Hoarse voice, lip swelling, stridor indicative of upper airway obstruction and laryngeal oedema * Breathing: Wheezing, shortness of breath, fatigue, SpO2 < 94% * Circulation: Tachycardia, hypotension/shock, angioedema, confusion * Disability: Confusion * Everything else: * Gastrointestinal: Abdominal pain, diarrhoea, vomiting * Urticaria

Question 82

how is body percentage calculated in burns pts

Answer 82

Wallace's Rule of Nine: Each of the following is 9% of the body when calculating surface area % if a burn: * Head + neck, * each arm, * each anterior part of leg, * each posterior part of leg, * anterior chest, * posterior chest, * anterior abdomen, * posterior abdomen

Question 83

why is total body surface area required in burns pt management

Answer 83

Accurate TBSA calculation is crucial for determining fluid resuscitation requirements in burn patients - using the parkland formula

Question 84

initial Mx for burns pts

Answer 84

Fluid resuscitation * Accurate TBSA calculation is crucial for determining fluid resuscitation requirements in burn patients. * calculated using the **Parkland formula** * **(4 mL × weight in kg × %TBSA)** * half given in the first 8 hours and the remainder over the next 16 hours

Question 85

how is the depth of a burn categorised?

Answer 85

Question 86

which burns are reffered to secondary care

Answer 86

1. all deep dermal and full-thickness burns. 1. superficial dermal burns of more than 3% TBSA in adults, or more than 2% TBSA in children 1. superficial dermal burns involving the face, hands, feet, perineum, genitalia, or any flexure, or circumferential burns of the limbs, torso, or neck 1. any inhalation injury 1. any electrical or chemical burn injury 1. suspicion of non-accidental injury

Question 87

initial burn Mx

Answer 87

Immediate first aid: * airway, breathing, circulation * If smoke inhalation has occured, then must secure airway as airway oedema can occur * early intubation should be considered * burns caused by heat: * remove the person from the source. * Within 20 minutes of the injury irrigate the burn with cool (not iced) water for between 10 and 30 minutes. * Cover the burn using cling film, layered, rather than wrapped around a limb * burns caused by electricity: turn off electricity and remove pt from source * burns caused by chemicals: * brush off powder and irrigate as with heat FLUIDS: >15% TBSA burn: * all major burns require fluids as pt is at risk of dehydration due to epidermal fluid loss and third spacing as a response * parkland formula

Question 88

hyper glycaemia 1st and 2nd line Mx

Answer 88

- 1st line = IV NaCl as sodium drives the renal excretion of calcium - 2nd line = IV bisphosphonates e.g. zolendronic acid