Emergency

1 Pregnant with solid organ injury FAST false -ve , CT better

2 Widened mediastinum CXR, deceleration injury Aortic transection distal to ligamentum arteriosum
3 Deceleration injury, tender abdomen, free fluid, DJ disruption
hemodynamic stable
4 Muffled heart sounds, jugular vein distention, paradoxical Hemopericardium, may be with 100ml only
pulse
5 ABO incompatibility Shock, hemoglobinuria, loin pain
6 PE scenario (-Sat O2, -BP, +HR, collapse) Alteplase
7 PO bleeding, epistaxis, menorrhagia Von Willibrand disease
8 Elderly, malignancy, auto immune, pregnancy Aquired hemophilia
9 Thromboembolism, bleeding miscarriage Antiphospholipid syndrome
10 Acute hypocalcemia (initial management) IV CaCl2 10ml, 10% in 10min
11 Nose tissue loss Debridement and rotational flap
12 Wound of scalp with dirt Wound excision and primary closure
13 If survival after aortic injury Distal to lt subclavian
14 Low risk CS inj (pain, no neuro) 3 view xray, if high risk CT
15 If suspected skull base fracture CT within 1 hour
16 GCS=<8 Urgent neurosurgical consultation, intubation
17 Anemia + reticulocytosis Sickle cell disease
18 Anemia + reticulocytopenia Parvovirus aplastic crisis
19 Blood transfusion in immunocompromised, reaction 4-30 Graft vs host disease
days
20 Transfusion + fever + hypotension + dark urine within 24 Acute hemolytic reaction
hours
21 Orbital apex syndrome Superior orbital fissure syndrome + afferent pupillary
defect (CN II)
22 Not recommended in compartment syndrome Anticoagulation
23 High voltage electrical burn Hyperkalemia, +CK, rhabomyolysis, ATN
24 Circumferential burn Compartment syndrome
25 Recurrent shoulder dislocation Bankart lesion
26 When patient needs access to both lungs and mediastinum Calmshell thoracotomy

27 If risk of MI, symptoms Aspirin 300 then clopidogrel then thrombolysis and PCI if
there are signufucant ECG change
28 J wave ECG (osborn, camel-hump, late delta, hathook hypothermia <32
junction)
29 Rewarming in severe hypothermia <30 Peritoneal lavage, dialysis, cardiac bypass
30 Addisonian crisis Hydrocortisone 100mg IV
31 Traumatic pneumothorax, even simple Chest drain until no evidence of air leak (lung injury
sealed)
32 ER thoracotomy Ventricular penetration, hilar lung injuries, great vessel
disruption
33 Hemopneumothorax Chest drain (risk of tension)
34 Anaphylactic shock Adrenaline IM 1:1000 (0.5ml)
35 Homonymous hemianopia only Occipital infarct (posterior CA), carotid endarterectomy
not appropriate
36 Numbness of face, contralateral hemisensory loss+ ataxia, Lateral medullary syndrome
nystagmus, dysphagia, CN palsy
37 Isolated hemisensory loss, hemiparesis Lacunar infarction
38 Diagnostic test for CSF leakage Beta 2 transferrin assay
39 Vertigo, dysarthria Posterior circulation event
40 Vertigo, dysarthria+sudden deterioration of conscious Basilar artery occlusion

41 Opiate overdose Naloxone IV

42 RT coronary occlusion Arrhythmia (ischemia of sinoatrial node)
43 ECG changes required to do PCI 2 ant leads > 2mm, 3 inf leads > 1mm, new LBBB
44 Degloved skin Degloved segment shouldn’t be left in situ as skin graft

45 Post-traumatic large volume loss Fresh blood better than colloids

46 ,, + using blood > 3w Mortality is doubled
47 Features of traumatic aortic disruption in CXR
48 VT AVOID verapamil (VF)
49 Supraventrucular tachycardia with aberrant conduction Adenosine

50 Stroke symptoms < 3 hours Thrombolysis urgently

51 In hyperkalemia management First priority to stabilize the myocardium (IV Ca
glauconate)
52 Handlebar injury Duodenum or pancreas
53 Retroperitineal air, with abdomen trauma Duodenal injury
54 Flail chest injury, hypoxic hours after mechanical Tension pneumothorax
ventilation
55 Full thickness burn Usually insensate, pain only after healing following skin
grafting, leathery appearance, scarring, no blanching, no
blisters
56 Blunt injury RTA to the side Diaphragmatic rupture, CXR bowel loops in left
hemithorax
57 If pneumothorax( no hemothorax) 14F chest drain
58 If hemothorax 36F chest drain
59 Stroke in >60y, deteriorated conscious with deficit in Hemicraniotomy to decompress cerebral edema
MMA branch
60 Severe systemic illness and low thyroid profile Sick euthyroid syndrome
61 In extensive hemorrhage due to trauma Hemostatic transfusion RBCs, FFP, Platelets 1:1:1
62 Toxicity of local anesthesia (tinnitus, drowsiness) Intralipid 20%
63 RTA, chest pain, stable then sudden death Aortic disruption (delayed due to contained hematoma)

64 Raised ICP, Cushing response HTN, bradycardia, resp depression

65 Pt prepared to surgery, known to be on steroids, now Addisonian crisis
hypoNa, hyperK, hypoglycemia
66 IMN of tibia, signs of -circulation Compartment $
67 Metoclopramide, haloperidol (D2 antagonist) Oculogyric crisis (acute dystonic reaction) ttt: procyclidine

68 Superficial partial burn Preserved hair follicle, sweat glands, painful, vesicles, heal
by re-epith, erythema, blisters, no ext beyond ptoximal
dermal papillae, good capillary refille

69 VTach in short gut $ HypoCa, hypoK, hypoMg

70 Head injuries Opiates, CT if>1 vomit, GCS check/30 min
71 Burn resuscitation Hartman
72 Facial fracture assessment CT head
73 Liver laceration, profuse bleeding, unstable Pack and close abdomen
74 Torsade de pointes IV MgSO4
75 Penetrating gunshot inj to artery, distal parathesia Immediate exploration and repair even if weak pulse (by
hematoma)
76 Child with non-life threatening FB, not tolerating Operate next emergency list
77 Child with life-threatening FB Immediate emergency OR
78 Child with FB, with no serious inj, Conservative
79 Diagnosis of acute hemolytic reaction, due to ABO incomp Direct Coomb’s test

80 Increased BT, APTT von Willinrand disease

81 Compartment $ Keep limb level with bod, pain control, IV fluids,
fascitomy
82 Superior orbital fissure $ Altered forehead sense, ptosis, ophthalmoplegia,
enophthalmos
83 Transfusion, dyspnea, chest pain, -sat, crepitation, Transfusion associated lung inj
hypoTN, normal PCWP, no response to IV frusemide
84 Skull base fracture Urgent CT within 1 hour
85 Neck trauma, intact neuro, painful movement 3 way c-spine x-ray
86 Wound with cutaneous defect and dusky skin (not face) Debridement and 2ry healing

87 RTA, hypoxia despite O2, Rt chest hyperresonance, - Tension pneumothorax

breath sound, trachea deviated to left
88 Electrical burn, hyperK, high CK Rhabdomyolysis, risk of ATN, give IV fluids
89 ECG of PE P pulmonale, Rt vent strain, Atrial arrhythmia, T wave
inversion
90 MI Aspirin 300, then clopidogrel, then LMWH
91 Chest wall full thickness burn, hypoxemia Escharotomy
92 Aftr crush injury of limb Myoglobin in urine
93 Aortic rupture x-ray Trachea deviated to the left
94 Neck trauma, neuro compromise CT C S
95 Head inj, vomiting> 1 time CT within 1 hour
96 Penetrating head shot Urgent neurosurgical consultation
97 Adomen shot, stable hemodynamic, large abdominal free Ileum injury
fluid
 98 Deceleration injury, hypoTN, depressed lt main bronchus, Aortic disruption
right tracheal deviation
99 Head inj in children, CT mmediate Drowsiness, large hematoma, numb arm, suspected non
accidental inj,, seizures, >=3vomits, amnesia>5min,

100 Osteomyelitis in DM, healthy skin, first attack, foot IV Ab

101 Osteomyelitis in femur with sinus with no sequestration Lautenbach regime

102 Lefort type II No affection on inf alv N

103 Stab, hemoptysis, no improvement after 4 u of blood, high Cardiac tamponade- ttt pericardiocentesis
CVP
104 Burn to the face Transfer to burn center
105 Painful burn with blister (superficial) Discharge and review
106 Anterior cord syndrome Loss of motor+pain & temperature
107 Posterior cord syndrome Loss of touch & proprioception
108 Central cord syndrome Upper limb loss of motor + pain & temperature
109 Intubation in trauma High risk of aspiration & regurgitation
110 Uncuffed tube If <7y