14. KFP: Emergency Flashcards
What is a management for anaphylaxis?
IM adrenaline 1:1000 0.01mL/kg [or 10microg/kg] (Max 0.5mL) in the lateral thigh
* it should be repeated after 5 minutes if not improving
What are the clinical features of an anorectal abscess?
- Severe pain in the anal or rectal area, with fever or malaise
- Superficial: perianal erythema and a palpable, fluctuant mass
- Deep: tender, often fluctuant mass internally on digital rectal exam
What is the management of an anorectal abscess?
- Surgical drainage
- All skin incisions should be made as close to the anal verge as possible to minimise the length of a potential fistula while still providing adequate drainage of the abscess
- Give antibiotics to all patients after incision and drainage
- Mild infection: augmentin DF (875/125mg) BD for 5 days
- Severe infection: Gentamicin IV + metronidazole 500mg IV BD + Amoxicillin/Ampicillin 2g IV Q6hourly
What is the management for a patella fracture that is non-displaced or minimally displaced with an intact extensor mechanism (patient able to perform straight leg raise)?
- Immobilise in knee extension with a Zimmer knee splint for four to six weeks
- The patient is usually allowed to weight bear in the splint during this time
What is the initial management for a snakebite?
- Apply a pressure bandage over the bite site and whole affected limb, and completely immobilised limb and the patient
- Arrange urgent hospital transfer - hospital must have adequate anti venom and critical care facilities in which the anti venom can be safely administered and anaphylaxis can be treated
What are the clinical features of serotonin syndrome?
- Neuromuscular excitation - hyperreflexia, clonus, ocular clonus, myoclonus, shivering, tremor, hypertonia, rigidity
- Autonomic effects - hyperthermia, sweating, flushing, mydriasis (pupil dilation), tachycardia
- Central nervous system effects - agitation, anxiety, confusion, altered conscious state
Describe the hunter serotonin toxicity criteria
Clinical diagnosis of surat synergic toxidrome can be made if the patient has taken a service allergic drug and meets one of the following criteria
* Spontaneous clonus
* Inducible clonus plus either agitation or sweating
* Ocular clonus plus either agitation or sweating
* Tremor plus hyperreflexia
* Hypertonia plus Temperature more than 38°c plus either inducible clonus or ocular clonus
What are the clinical features of mild serotonin syndrome?
- Tremor
- Mild tachycardia
- Inducible clonus
- Lower limb hyperreflexia
What are the clinical features of moderate serotonin syndrome?
- Agitation
- Sustained clonus
- Tachycardia
- Hyperthermia less than 39°c
What are the clinical features of severe serotonin syndrome?
- Rapidly progressive hyperthermia
- Muscle rigidity with sustained clonus
- Seizures
What is the management for moderate serotonin syndrome?
- Cease the offending medication
- If distressed by symptoms: 5 to 20 mg PO; repeat after 30 minutes if required; usually no more than 120 mg is required in 24 hours
Management for severe serotonin syndrome?
- Urgent transfer to hospital
- Seek advice from a clinical toxicologist
- For rapidly progressive hyperthermia: rapid cooling techniques eg cold IV fluid
- For muscle rigidity was sustained clonus: sedate the patient
- For seizures: benzodiazepines
When should silver sulphadiazine (Flamazine) cream be used for wound management?
- Initial short term use only as it only provides antimicrobial activity for 8 hours
- May delay healing compared to other antiseptics
- Can impair reassessment of the wound
When is silver dressing (Acticoat) indicated in wound care?
Indicated if wounds are contaminated or deep
When is a silicone foam dressing (Mepilex) indicated?
- Moderately exudative wound
- Useful in the first 72 hours when superficial dermal burns often produce significant exudate
