Accidents and Poisoning Flashcards

1
Q

Primary Damage in Head Injury

A
Injury to neural tissues
Focal cerebral contusions and lacerations
Diffuse axonal injury
Injury to blood vessels
Penetrating injury
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2
Q

Secondary Damage in Head Injury

A
Cerebral Oedema
Hypotension
Hypoxia
Seizures
Hypoglycemia
Infection
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3
Q

Indications for urgent CT in head injury

A
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
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4
Q

Signs of Basal skull fracture

A

Haemotympanum
Panda eyes
Battle sign
CSF leak from nose/ears

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5
Q

Indications for observation after head injury

A
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

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6
Q

Neck Injury and fractures

A

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

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7
Q

Abdominal injury

A

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

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8
Q

Chest Injuries

A

Due to blunt trauma

Pliable ribcage allows for soft tissue injury without fractures

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9
Q

Emergency management of choking in a child

A
Severe obstruction (ineffectuve cough):
-5 abdominal thrusts
-5 back blows
-5 chest thrusts
Mild airway obstruction (effective cough):
-Encourage to cough until cleared
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10
Q

Drowning Mx

A

Commence CPR

In cooling: protective effect, continue CPR until warm

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11
Q

Features of airway brurns

A
Soot in nasal and oral cavity
Cough, hoarseness or stridor
Coughing black sputum
Breathing/swallowing difficulty
Blistering around mouth
Scorched eyebrows or hair
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12
Q

Mx airway burns

A

Early intubation if evolving airway swelling

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13
Q

Burn First Aid

A

Cool with running water for 20m
chemical burns copiously irrigated
plastic wrapping after cooling to prevent fluid loss
Immediate pain relief (intranasal opiate)

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14
Q

Burn Surface area

A
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%
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15
Q

Mx Burns

A
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
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16
Q

Features Superficial burns

A
Limited to epidermis
Subunr, minor scalds
Dry and erythematous
Painful
Rapid healing ~ 1w
17
Q

Features Partial thickness superficial burns

A
Partial thickness into dermis
Scald
Moist, erythematous, blistered
Painful
Healing ~ 1-3w
18
Q

Features Partial thickness deep burn

A
Partial thickness into dermis
Scald, brief contact with flame
Moist with whit slough
Erythematous
Mottled
Painless
Healing ~ 3-4w
Likely requires grafting
19
Q

Features Full Thickness Burn

A
Full thickness into subcut 
Significant flame contact
Dry, charred, white
Painless
Needs skin grafting to heel
20
Q

Mx posioning

A

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

21
Q

Symptoms of chronic lead poisoning

A
Behavioural changes
Hyperactivity and decreased activity
Developmental delay or loss of development
Chronic lead neuropathy
Abdominal pain
vomiting
constipation
Headache
Ataxia
Lethargy
Seizures
Coma
22
Q

Physical findings anticholinergics

A

↑ HR, BP, temp
↓ Sweating
Dilated pupils

23
Q

Physical findings Opiods

A

↓ Sweating, HR, BP, RR, Temp

Constricted pupils

24
Q

Physical findings sympathomimetics

A

↑ HR, BP, temp, sweating, RR

Dilated pupils

25
Q

Physical findings sedative-hypnotic

A

↓ Sweating, HR, BP, Temp, RR, Sweating

Normal pupils

26
Q

Paracetamol OD

A

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

27
Q

Button Batteries Ingestion

A

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

28
Q

Carbon Monoxide Poisoning

A

Hx: headache, nausea, confusion, drowsiness, coma
MOA: binds to haemoglobin causing hypoxia of tissues
Mx: high flow O2 to hasten dissociation

29
Q

Salicylate OD

A

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

30
Q

TCA OD

A

Hx: tachycardia, drowsiness, dry mouth, arrythmia, seizures
MOA: anti-cholinergic effects on cardiac conduction pathway
Mx: sodium bicarbonate, support ventilation

31
Q

Ethylene Glycol OD

A

Hx: intoxication, tachycardia, metabolic acidosis, renal failure
MOA: production of toxic metabolites affecting cellular energy production
Mx: fomepizole/alcohol to inhibit metabolite production, haemodialysis

32
Q

Alcohol OD

A

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

33
Q

Iron OD

A

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

34
Q

Hydrocarbon OD

A

Hx: pneumonitis, coma
MOA: easy aspiration and direct lung toxicity, inhibition of neurotransmission
Mx: supportive only

35
Q

Organophosphorus Pesticides

A

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)