Accidents and Poisoning Flashcards
Primary Damage in Head Injury
Injury to neural tissues Focal cerebral contusions and lacerations Diffuse axonal injury Injury to blood vessels Penetrating injury
Secondary Damage in Head Injury
Cerebral Oedema Hypotension Hypoxia Seizures Hypoglycemia Infection
Indications for urgent CT in head injury
Suspicion of NAI Post-traumatic seizure GCS<14 initially / <15 after 2h Suspected open or depressed skull fracture Signs of basal skull fracture Focal neurological signs <1y with bruising and swelling >5cm
Signs of Basal skull fracture
Haemotympanum
Panda eyes
Battle sign
CSF leak from nose/ears
Indications for observation after head injury
Witnessed loss of consciousness >5m Abnormal drowsiness 3 or more discrete episodes of vomititng Dangerous mechanism of injury Amnesia >5m
Admit and observe for at least 6h: CT if further concern
Neck Injury and fractures
Rare in children
Associated with high speed RTAs
Most common is fracture of upper 2 cervical vertebrae
Elasticity of cervical spine allows spinal cord injury without bony damage
Abdominal injury
Caused by blunt force .e.g. seat belts, bicycle handles
Liver and spleen rupture present quickly
Bowel and pancreas injury have a delay in presentation
Abdominal sonography required
Contained splenic and hepatic haematomas can be managed conservatively
Chest Injuries
Due to blunt trauma
Pliable ribcage allows for soft tissue injury without fractures
Emergency management of choking in a child
Severe obstruction (ineffectuve cough): -5 abdominal thrusts -5 back blows -5 chest thrusts Mild airway obstruction (effective cough): -Encourage to cough until cleared
Drowning Mx
Commence CPR
In cooling: protective effect, continue CPR until warm
Features of airway brurns
Soot in nasal and oral cavity Cough, hoarseness or stridor Coughing black sputum Breathing/swallowing difficulty Blistering around mouth Scorched eyebrows or hair
Mx airway burns
Early intubation if evolving airway swelling
Burn First Aid
Cool with running water for 20m
chemical burns copiously irrigated
plastic wrapping after cooling to prevent fluid loss
Immediate pain relief (intranasal opiate)
Burn Surface area
Childs palm ~ 1% surface area Proportion of face, and legs changes with age Genitals ~ 1% Buttocks ~5% Face ~ 8.5% 1y // 6.5% 5y // 5.5% 10y // 4.5% 15y Rule of 9s: -Arms each 9% -Legs each 18% -Trunk front 18% -Trunk back 18%
Mx Burns
Pain relief .e.g. IV morphine/ketamine IV fluids if >10% burns Measuring urine output Referral: -partial thickness > 5% -face,eyes,ears, hand, feet, genitalia, perineum, major joint Monitor signs of infection
Features Superficial burns
Limited to epidermis Subunr, minor scalds Dry and erythematous Painful Rapid healing ~ 1w
Features Partial thickness superficial burns
Partial thickness into dermis Scald Moist, erythematous, blistered Painful Healing ~ 1-3w
Features Partial thickness deep burn
Partial thickness into dermis Scald, brief contact with flame Moist with whit slough Erythematous Mottled Painless Healing ~ 3-4w Likely requires grafting
Features Full Thickness Burn
Full thickness into subcut Significant flame contact Dry, charred, white Painless Needs skin grafting to heel
Mx posioning
Full history
consider intrinsic toxicity, reported dose, symptoms, time since ingestion
Activated charcoal within 1h of ingestion
-ineffective for iron, hydrocarbons and pesticide
FBC, renal function, liver functyion
ECG for drugs with cardiotoxicity
Blood conc- paracetamol, iron, salicylates, alcohol
Antidote/Supportive measures
Assessment by CAMHS if intentional
Symptoms of chronic lead poisoning
Behavioural changes Hyperactivity and decreased activity Developmental delay or loss of development Chronic lead neuropathy Abdominal pain vomiting constipation Headache Ataxia Lethargy Seizures Coma
Physical findings anticholinergics
↑ HR, BP, temp
↓ Sweating
Dilated pupils
Physical findings Opiods
↓ Sweating, HR, BP, RR, Temp
Constricted pupils
Physical findings sympathomimetics
↑ HR, BP, temp, sweating, RR
Dilated pupils
Physical findings sedative-hypnotic
↓ Sweating, HR, BP, Temp, RR, Sweating
Normal pupils
Paracetamol OD
Hx: abdo pain, vomiting, liver failure (12-24h)
MOA: gastric irritation, NAPQ toxic metabolite from liver metabolism
Ix: plasma paracetamol conc and LFTs
Mx: IV acetylcysteine
Button Batteries Ingestion
Hx: abdominal pain, gut perforation and strictures
MOA: leakage and corrosion of gut wall due to electrical circuit production
Ix: Chest and abdo Xray to confirm location
Mx: Endoscopic removal if in oesophagus, failure to pass, symptomatic
Carbon Monoxide Poisoning
Hx: headache, nausea, confusion, drowsiness, coma
MOA: binds to haemoglobin causing hypoxia of tissues
Mx: high flow O2 to hasten dissociation
Salicylate OD
Hx: vomiting, tinnitus, respiratory alkalosis progressing to metabolic acidosis
MOA: direct stimulation of respiratory centre, uncoupled oxidative phosphorylation causes metabolic acidosis and hypoglycaemia
Ix: plasma salicylate 2-4h post ingestion
Mx: alkalisation of urine to increase excretion, haemodialysis
TCA OD
Hx: tachycardia, drowsiness, dry mouth, arrythmia, seizures
MOA: anti-cholinergic effects on cardiac conduction pathway
Mx: sodium bicarbonate, support ventilation
Ethylene Glycol OD
Hx: intoxication, tachycardia, metabolic acidosis, renal failure
MOA: production of toxic metabolites affecting cellular energy production
Mx: fomepizole/alcohol to inhibit metabolite production, haemodialysis
Alcohol OD
Hx: Hypoglycaemia, coma, respiratory failure
MOA: inhibitory effect of glycolysis in the liver and neurotransmission in the brain
Ix: monitor blood glucose, and blood alcohol levels
Mx: regulate glucose, support ventilation
Iron OD
Hx: vomiting, diarrhoea, haematemesis, melaena, acute gastric ulceration, latent improvement for 6-12h, drowsiness, coma, shock, liver failure, hypoglycaemia, convulsions
MOA: corrosive on gut mucosa, disruption of oxidative phosphorylation in mitochondria
Ix: serum iron level 4h post ingestion (serious toxicity >75mg/Kg)
Mx: IV desferoxamine chelates iron
Hydrocarbon OD
Hx: pneumonitis, coma
MOA: easy aspiration and direct lung toxicity, inhibition of neurotransmission
Mx: supportive only
Organophosphorus Pesticides
CNS effects: seziures and coma
Anticholinergic effects: salivation, lacrimation, urination, D+V, cramps, paralysis, bradycardia, hypotension
MOA: acetylcholinesterase inhibitionand ACh accumulation
Mx: supportive care, atropine, pralidoxime (acetylcholinesterase activation)
