Emergency

Question 1

Acute Glaucoma

Epidemiology

Aetiology

Clinical Features

Investigations

Treatment

Answer 1

Epidemiology

biological: predominantly Asian females

Aetiology

↑ age / family history / hyperopia / medication (mydratic,eye drops) / pseudoexfoliaton

Clinical Features

abrupt onset of severe eye pain / redness / blurry vision / headaches / nausea / halos around lights / fixed mid-dilated pupil / conjunctival redness / corneal edema

Investigations

gonioscopy (gold standard) / tonometry (>30mmHg)

Treatment

step 1: triad for reducing intraocular pressure

topical timolol / topical pilocarpine / oral or intravenous acetazolamide

step 2: surgical management for improvement aqueous humour outflow

bilateral peripheral iridotomy

Question 2

Epidemiology

Aetiology

Clinical Features

Investigations

Treatment

Answer 2

AAA | ABDOMINAL AORTIC ANEURYSM

• Epidemiology:

men>66 / women >70 / European descent

• Aetiology

COPD / family history / hyperlipidaemia / hypertension / smoking / coronary,cerebrovascular or peripheral arterial disease

• Clinical Features

abrupt onset of abdo/back pain, cardiovascular collapse / loss of conciusness

abdo aorta diameter > 3cm (5.5cm high rupture risk)

• AAA more likely to rupture in women than men*
• Investigations

single abdo ultrasound

• Treatment

3-4.4cm | small aneurysm | 12mo rescan

4.5-5.4cm | medium aneurysm | 3mo rescan

>=5.5cm | large aneurysm | refer within 2weeks to vascular surgery for intervention OR EVAR (elective endovascular repair) OR if ruptured open repair

Question 3

DKA

Aetiology

Clinical Features

Investigations

Treatment

Answer 3

• Aetiology
• Clinical Features
• Investigations
• Treatment

Question 4

Aetiology

Clinical Features

Investigations

Treatment

Complications

Answer 4

ACUTE COMPARTMENT SYNDROME

• Aetiology

fractures (most common)

other: hemorrhage, crush injuries, vascular puncture, severe circumferential burns / IV drugs / revascularization procedures / poor-fitting casts / ortopaedic intervention combined with patient taking anticoagulants
* Clinical Features

legs + forearm (most common)

early signs: severe deep pain (unless pt had anaesthetic nerve block/epidural)/ swelling / tense muscle compartment / parasthesias

late signs: ↓pulse / anesthesia / function loss / paralysis

• ↑ intracompartmental pressure > perfusion pressure (10-30mmHg) → arteriolar collapse → compromised blood flow*
• Investigations

measurement of intracompartmental pressure ( >20mmHg =abnormal / >40mmHg = diagnostic)

• Treatment

fasciotomy

• Complications

inexperienced clinician = inadequate decompression → myoglobinuria → renal failure (needs aggresive IV fluids)

death of muscle groups (withing 4-6h)

Question 5

CORD PROLAPSE

Epidemiology/

Aetiology/ risk fx

Clinical Features

Treatment

Complications

Answer 5

Epidemiology

male fetuses predisposed

Aetiology

transverse lie (20% ) / footling breech (15%) / prematurity / abnormality / 2nd twin / multiparity / low birth weight (<2.5kg) / placenta praevia / long umbilical cord / high fetal station

Clinical Features

abdo exam: ill-fitting (one possible cause)

VE: check after rupture of artificial membrane

OVERT : cord can be palpated in vaginal canal

OCCULT: (hesrt rate changes) dropping cord

FUNIC: loops of cord - palpated through membrane

Treatment

OVERT: 1.oxygen 4-6L/minute

2. (see image)
3. emergency C-section
4. Terbutaline 0.25mg subcutanesouly
5. vag delivery only if delivrty imminent (cervix fully dialted)
6. ensure resus is available if needed post-delivery

OCCULT: 1. place mom in left lateral position

2. fetal herat rate normal = labour with Oxygen admin. + fetal heart rate monitored
3. fetal heart rate abnormal = C-section

FUNIC: decision between C-sec. prior to membrane rupture OR ARM (artificial membrane rupture) + prep C-section (in case cord becomes overt

Complications

death

Question 6

Epidemiology

Aetiology

Clinical Features

Investigations

Treatment

Answer 6

CAUDA EQUINA

• Epidemiology:

RARE

• Aetiology

MOST COMMON: central disc prolapse (usually L4/5 OR L5/S1)

OTHER: tumors / infections (abcess,disctitis) / trauma / haematoma

• Clinical Features

low back pain / bilateral sciatica (50% of cases) / reduced sensation in the perianal area / incontinence (late sign : indicates irreversible damage) / decreased anal tone (good practice to check, however this is not done in primary care)

• Investigations

Urgent MRI

• Treatment

surgical decompression (followed by tests and investigations)

Question 7

Anaphylaxis

Clinical Features

Treatment

Answer 7

• Clinical Features

Sudden onset and rapid progression of symptoms (most reactions occur over several minutes)

Life-threatening airway and/or breathing and/or circulation problems

Skin and/or mucosal changes (flushing, urticaria, angioedema)

• Treatment

ABCDE approach

NOTES

Adrenaline can be repeated every 5 MINUTES

Best site for IM injection is ANTEROLATERAL aspect of the MIDDLE 3RD of THIGH

Question 8

Acute Glaucoma

Epidemiology

Aetiology

Clinical Features

Investigations

Treatment

Answer 8

Epidemiology

Aetiology

↑ age / family history / hyperopia / medication (mydratic,eye drops) / pseudoexfoliaton

Clinical Features

abrupt onset of severe eye pain / redness / blurry vision / headaches / nausea / halos around lights / fixed mid-dilated pupil / conjunctival redness / corneal edema

Investigations

gonioscopy (gold standard) / tonometry (>30mmHg)

Treatment

step 1: triad for reducing intraocular pressure

topical timolol / topical pilocarpine / oral or intravenous acetazolamide

step 2: surgical management for improvement aqueous humour outflow

bilateral peripheral iridotomy