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Year 3 MedEd > Acute > Flashcards

Acute Flashcards

Acute care and conditions

1
Q

What are the features of alcohol withdrawal syndrome?

A 
Autonomic hyperactivity
Tremulousness
Restlessness
Hallucinations
Seizures
Delirium tremens
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2
Q

What is the cause of AWS?

A

Body has increased levels of glutamate to balance the GABA/alcohol to glutamate ratio
Sudden withdrawal of alcohol means there is an imbalance of GABA to glutamate

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3
Q

What is delirium tremens?

A

Rapid onset of confusion and AWS features 2-3 days post-withdrawal

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4
Q

What are the investigations for AWS?

A

U+E
LFT
Toxicology screen

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5
Q

What is the management for an alcohol-dependant Pt who can be managed at home?

A

Advice to slowly reduce alcohol

Provide information on local alcohol support services

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6
Q

What is the management for a Pt with AWS?

A

Medically assisted alcohol withdrawal

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7
Q

What is the management for a Pt <16yrs with AWS?

A

Medically assisted alcohol withdrawal

Physical and psychological assessment

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8
Q

When should you admit a Pt with AWS?

A

Vulnerable Pts (frail, young, lack of social support, learning difficulties etc)

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9
Q

What is the CIWA-Ar?

A

10 item assessment tool used to quantify severity of AWS

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10
Q

What is the treatment for AWS?

A

1st line- benzodiazepines (chlordiazepoxide)/clomethiazole
-oral: mild
-IV: moderate/severe
Seizure- lorazepam

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11
Q

What are the features of anaphylaxis?

A

Wheeze
Hives
Facial swelling
Nausea/vomiting

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12
Q

What is the immediate management of anaphylaxis?

A 
Call for help
Position Pt with raised legs
ABC
IM adrenaline 1:100
100% oxygen
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13
Q

What is the post-resusitation management of anaphylaxis?

A

Slow chlorphenamine/diphenhydramine and ranitidine (antihistamine)
Slow hydrocortisone
Neb salbutamol/ipratropium if wheezy

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14
Q

What is the post-resusitation investigation of anaphylaxis?

A

Serum tryptase:
-at time of stabilisation
-1/2 hours later
Don’t need to do if diagnosis of anaphylaxis is definite

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15
Q

What is acute salicylate exposure?

A

Single dose equivalent of >150mg/kg or >6.5 g

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16
Q

What is chronic salicylate exposure?

A

Repeated exposure to high dose aspirin or equivalent (150 mg/kg/d)

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17
Q

What are the features of salicylate poisoning?

A

Fever+diaphoresis
SOB
Tachypnoea
Tinnitus and/or deafness
Malaise and/or dizziness
Neurological toxicity- movement disorders, asterixis, stupor
Confusion and/or delirium (+/- irritability, hallucinations)
Coma
Cerebral oedema (papilloedema)
Seizures (highly likely with salicylate levels of >80 mg/dL)
Dry mucous membranes, poor skin turgor

18
Q

What are the investigations for salicylate poisoning?

A

ABG- initially respiratory alkalosis, later metabolic acidosis (wide anion gap)
Serum electrolytes- hypokalaemia, hypocalcaemia +/- hypomagnesemia
Serum salicylate level- may be positive or negative
CXR- pulmonary oedema
ECG- sinus tachycardia, prolonged corrected QT interval

U+E- may show insufficiency 
Ketones- positive or negative
Blood glucose- hyper or hypo
FBC- ?elevated WBC
LFTs- ?elevated AST, ALT
PT, PTT, INR- coagulopathy 
Toxicology screen- variable
19
Q

What is a single acute overdose of acetaminophen?

A

> 4g in <1hr

20
Q

What is a staggered overdose of acetaminophen?

A

Multiple doses over 1hr

21
Q

What is a acetaminophen-induced hepatotoxicity?

A

Hepatotoxicity post-paracetamol overdose with serum AST >1000 IU/L

22
Q

What are the features of paracetamol overdose?

A

Asymptomatic for 24hrs

Nausea, vomiting abdo pain 2-3 days after ingestion

23
Q

What are the investigations for paracetamol overdose?

A

Serum paracetamol level ASAP
Serum AST/ALT
Arterial pH/lactate
U+E

24
Q

What are the causes of opiate overdose?

A

Substance abuse/recent abstinence
Self harm
Iatrogenic

25
Q

What are the features of opiate overdose?

A 
Miosis
Bradypnoea
Altered mental status
Needle marks
Decreased GI motility
Dramatic response to naloxone
26
Q

What are the investigations for opiate overdose

A

Therapeutic trial of naloxone

ECG- MI/QRS prolongation

27
Q

What are the indications for placing a catheter?

A 
Obstruction (BPH) 
Bladder weakness or nerve damage
Childbirth with epidural 
Before, during and after surgery 
Delivery of medication directly to bladder (chemo for bladder cancer) 
Urinary incontinence
28
Q

What are the complications of placing a catheter?

A 
Recurrent UTIs
Trauma
Accidental removal
Renal complications- kidney stones, hydronephrosis, scarring
Pain
Recurrent blockage
29
Q

What are the indications for epidural injections?

A

Analgesia

  • single injection for pain relief
  • post operative

Anaesthesia
-slower onset than spinal analgesia – gradual decrease in BP
-adjunct to general anaesthesia
sole anaesthetic technique: Cesarean sections

30
Q

What are the complications of epidural injections?

A 
Failure to achieve analgesia or anaesthesia 
Accidental dural puncture with headache 
Bloody tap 
Catheter placement into vein
Misplacement in subarachnoid space 
Neurological injury
Abscess
31
Q

What are the indications of ABGs?

A 
Respiratory failure- acute or chronic
Cardiac failure
Liver failure
Renal failure
Hyperglycaemic states- DM
Multiorgan failure
Sepsis
Burns
Poisons/toxins
Ventilated patients
Severely unwell patients
32
Q

What are the complications of ABGs?

A 
Local haematoma 
Arterial vasospasm
Arterial occlusion
Air or thrombus embolism
Local anaesthetic anaphylactic reaction 
Infection at puncture site
Vessel laceration 
Needlestick injury to health care professional
33
Q

How do you take a blood transfusion specimen?

A

2 G+S pink vials

Label at the bedside handwritten

34
Q

How do you monitor a blood transfusion?

A

Assess baseline observations
Monitor Pt vital signs
Document everything
Halt transfusion immediately if adverse reaction occurs

35
Q

A 21 yo M is brought in to A&E by his friends because he is unresponsive. On examination you find miosis and a respiratory rate of 8 bpm. The patient is deeply unresponsive to pain.
What is the most likely explanation for this presentation?

A. Aspirin overdose
B. Anaphylactic shock
C. Opiate overdose
D. Paracetamol overdose 
E. The patient is sleeping
A

C. Opiate overdose

36
Q

A 40 yo M is brought in to A&E by his friends because he is unresponsive. His friends tell you that he has just had a seizure before coming to A&E. They reluctantly tell you that he is now abstinent from alcohol for 1 week.
What is the best immediate management for this patient?

A. IV Lorazepam
B. Send to ITU  
C. Watch and wait 
D. Start 0.9% saline infusion 
E. Give oxygen 100%
A

A. IV Lorazepam

37
Q

A 50 yo M known alcoholic presents to A&E with restlessness and tremors. He is anxious, pacing in the hallway. His observations show a HR of 121 bpm, BP of 169/104 mmHg. On further questioning he states he is nauseous and you can see he is visibly shaking. He says his symptoms started to develop 5 hours after his last drink.
What is the best management for this patient?

A. Admit and give IV Lorazepam
B. Send him home with some information on contacting local alcohol support service
C. Admit and give oral Lorazepam   
D. Send him home with no treatment 
E. Watch and wait
A

C. Admit and give oral Lorazepam

38
Q

What is the definition of acute aspirin overdose?

A. Single dose equivalent of >150mg/kg or >6.5 g
B. Single dose equivalent of >100mg/kg or >4.5 g
C. Repeated exposure to high dose aspirin or equivalent
D. Taking more than a box of Boots aspirin in one sitting

A

A. Single dose equivalent of >150mg/kg or >6.5 g

39
Q

What are the first signs of paracetamol overdose?

A. Nausea and vomiting 
B. Stomach cramps 
C. RUQ pain 
D. Asymptomatic
E. Hallucinations
A

D. Asymptomatic

40
Q

What is the daily maximum recommended dose of paracetamol?

A. 1000 mg
B. 1500mg 
C. 4g
D. 5g 
E. 10g
A

C. 4g

Year 3 MedEd (29 decks)

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