32 Questions
What is the first step in assessing a patient in emergency internal medicine?
Check airway, breathing, and give oxygen
What should be done if the patient has no breathing and no pulse?
Start CPR
What is the purpose of monitoring patient vital signs?
To assess the patient's response to treatment
What investigation should be sent immediately in emergency internal medicine?
All of the above
When should gastric lavage and activated charcoal be administered?
In patients with suspected toxic ingestion
What should be checked immediately in emergency internal medicine?
Airway, breathing, and circulation
What is the purpose of admitting the patient to the ICU?
To provide close monitoring and support
What should be included in the patient's initial assessment?
Vital signs, medical history, and laboratory results
What is the first step in assessing a comatose patient?
Give glucose 50 ml 50% IV
What is the indication for administering naloxone or naltrexone in a comatose patient?
Evidence of pinpoint pupils
What is the primary goal of oxygen therapy in acute severe asthma attacks?
Maintain oxygen saturation at 94-98%
What is the dose of salbutamol given via nebulizer in acute severe asthma attacks?
5 mg/4hr
What is the primary cause of coma in patients with metabolic disorders?
All of the above
What is the treatment for acute severe asthma attacks if the patient does not respond to initial therapy?
Repeat the same dose of bronchodilators and reassess
What is the primary laboratory test used to assess the severity of asthma attacks?
Peak Expiratory Flow Rate (PEFR)
What is the indication for administering prednisolone in acute severe asthma attacks?
Severe bronchospasms
What is the initial step in managing an acute exacerbation of COPD?
Assess the patient and admit to the ICU if needed
What is the target oxygen saturation level in managing an acute exacerbation of COPD?
88% - 92%
What is the dose of salbutamol administered via nebulizer in managing an acute exacerbation of COPD?
5 mg / 4hr
What is the indication for considering magnesium sulphate administration in managing an acute exacerbation of COPD?
Patient not responding to initial treatment
What is the dose of prednisolone administered orally in managing an acute exacerbation of COPD?
40 - 50 mg
What is the frequency of reassessing the patient in managing an acute exacerbation of COPD?
Every 15 minutes
What is the indication for administering antibiotics in managing an acute exacerbation of COPD?
All of the above
What is the goal of repeating drugs in managing an acute exacerbation of COPD?
To achieve a PEFR of 75%
What is the initial treatment for a patient with an exacerbation of COPD?
Short course of oral steroids, inhaler steroids, and inhaler bronchodilators
What is the indication for considering NIPPV in COPD exacerbation?
pH less than 7.35
What is the drug that can be used as a respiratory stimulant in some individuals with COPD?
Doxapram
What is the condition that can cause respiratory failure, PTX, pulmonary hypertension, and Cor-pulmonale?
COPD
What is the next step in managing a patient with a simple pneumothorax?
Give O2 and send ABG, CXR, and pulse oximeter
What is the location for inserting a chest tube in a patient with a secondary pneumothorax?
5th ICS midaxillary line
What is the indication for inserting a chest tube in a patient with a pneumothorax?
SOB and rim
What is the differential diagnosis for a patient with a pneumothorax?
Acute bronchial asthma, acute COPD, pulmonary edema, anaphylaxis, pulmonary embolism, pneumonia
Study Notes
General Basics
- Assess patient and admit to ICU if necessary
- Check airway, breathing, and circulation (ABC)
- Give oxygen and support circulation with IV fluids and large cannula
- Send investigations: CBC, U&E, LFT, ABG, blood glucose, PCR, coagulation profile, blood culture, CXR, ECG, and urine and serum toxicology if suspected
- Monitor patient vital signs including temperature, HR, BP, RR, and urine input-output
- Perform CPR if patient has no breathing and no pulse
- Consider gastric lavage and activated charcoal if toxic ingestion
- Assess patient's GCS and give glucose 50 ml 50% IV if comatose
- Correct any ABG and electrolyte disturbances
Causes of Coma
- Metabolic (hypo/hyperglycemia, acidosis, and alkalosis, hypo/hypernatremia, renal failure)
- Toxic (alcohol, opioid, TCA, atropine, etc.)
- Infection (encephalitis, meningitis, brain abscess, cerebral malaria)
- Structural lesion (ischemic and hemorrhagic stroke, brain tumor)
- Encephalopathy (epileptic, uremic, hepatic, Wernicke's)
Acute Exacerbation of Bronchial Asthma
- Assess patient for acute severe attack or near-fatal attack
- Give oxygen via poly mask and bronchodilators (salbutamol 5 mg/4hr nebulizer and ipratropium bromide 0.5 mg/6 hr nebulizer)
- Administer steroids (prednisolone 40-50 mg orally or hydrocortisone 100-200 mg IV/6 hr)
- Consider antibiotics if there is evidence of infection
- Monitor patient's PEFR, ABG, and vital signs
- Reassess patient every 15 minutes and repeat drugs until PEFR reaches 75%
- Consider Mg sulphate 1.2-2 g IV over 20 min or aminophylline bolus 5 mg/kg over 20 min if not responding
Acute Exacerbation of COPD
- Assess patient and admit to ICU if needed
- Give oxygen via venturi mask and bronchodilators (salbutamol 5 mg/4hr nebulizer and ipratropium bromide 0.5 mg/6 hr nebulizer)
- Administer steroids (prednisolone 40-50 mg orally or hydrocortisone 100-200 mg IV/6 hr)
- Consider antibiotics if there is evidence of infection
- Monitor patient's PEFR, ABG, and vital signs
- Reassess patient every 15 minutes and repeat drugs until PEFR reaches 75%
- Consider aminophylline bolus 5 mg/kg over 20 min or IV salbutamol if not responding
- Consider NIPPV if PH < 7.35 and MV if PH < 7.26 or high CO2
Pneumothorax
- Assess patient for simple pneumothorax or tension pneumothorax
- Give oxygen and send ABG, CXR, and pulse oximeter
- Determine if it is primary or secondary pneumothorax
- Insert chest tube connected to underwater seal in 5th ICS mid-axillary line as soon as possible
This quiz covers the essential steps to be taken in emergency medicine, including assessing patients, checking vital signs, administering oxygen and IV fluids, and performing CPR when necessary.
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