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Year 3 > acute and emergency > Flashcards

acute and emergency Flashcards

1
Q

presenting symptoms of aspirin overdose

A

may be initially asymptomatic

early symptoms:

  • flushed
  • fever
  • sweating
  • hyperventilation
  • dizziness
  • tinnitus
  • deafness
  • vomiting

later symptoms:

  • lethargy
  • confusion
  • convulsions
  • drowsiness
  • respiratory depression
  • coma
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2
Q

key questions in aspirin overdose case

A

how much was taken

when was it taken

were any other drugs taken

any alcohol

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3
Q

pathophysiology of aspirin overdose

A

aspirin is a weak acid with poor water solubility

increases RR and depth buy stimulating respiratory centre and causes resp. alkalosis

increased urinary bicarb and potassium excretion causes dehydration and hypokalaemia

loss of bicarb, uncouples oxidative phosphorylation, and lactic acid build up can cause metabolic acidosis

CNS depression and resp failure in severe cases

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4
Q

toxicity levels of aspirin

A

150mg/kg = mild

250mg/kg = moderrate

>500mg/kg = severe

>700mg/kg = potentially fatal

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5
Q

physical examination findings in aspirin overdose

A

fever
tachycardia
hyperventilation
epigastric tenderness

rare:
reduced GCS
seizures
hypotension
heart block
pulmonary oedema
hyperthermia

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6
Q

investigations for aspirin overdose

A

bloods:
- salicylate/other drug levels
- FBC
- U&E (hypokalaemia)
- LFT (high AST/ALT)
- clotting screen (high PT)
- ABG

ECG: signs of hypokalaemia

  • flattened/inverted T waves
  • U waves
  • prolonged PR interval
  • ST depression
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7
Q

management of aspirin

A

sodium bicarbonate

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8
Q

define anaphylaxis

A

acute life-threatening multi system syndrome

caused by sudden release of mast cell and basophil derived mediators

type 1 IgE mediated hypersensitivity

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9
Q

aetiology of anaphylaxis

A

immunogenic:
- IgE mediated
- immune complex/complement-mediated

non-immunogenic:
- anaphylactoid reaction
- mast cell/basophil degranulation
* without involvement of antibodies

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10
Q

pathophysiology of anaphylaxis

A

inflammatory mediators released causing:

  • bronchospasm
  • increased capillary permeability
  • reduced vascular tone

tissue oedema affecting:

  • larynx
  • lids
  • tongue
  • lips
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11
Q

common allergens in anaphylaxis

A

drugs
latex
peanuts
shellfish
eggs
strawberries
semen

* repeated blood products in patients with selective IgA deficiency

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12
Q

presenting symptoms of anaphylaxis

A

wheeze
SoB
choking sensation

sweating
palpitations

pruritus
rash

diarrhoea and vomiting

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13
Q

physical examination findings in anaphylaxis

A

tachypnoea
hypotension
tachycardia

wheeze
swollen upper airways and eyes

cyanosis
urticarial rash
erythema

rhinitis
conjunctival infection

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14
Q

investigations for anaphylaxis

A

requires clinical dx

supporting investigations:

  • serum tryptase
  • histamine/urinary metabolites of histamine
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15
Q

investigations following an anaphylactic attack

A

allergen skin testing

IgE immunoassay (identifies food specific IgE)

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16
Q

immediate management for anaphylaxis

A

ABCDE
stop suspected cause

100% O2 +/- intubation if respiratory obstruction imminent

0.5mg adrenaline IM
10mg chlorpheniramine IV
100mg hydrocortisone IV

salbutamol +/- ipratropium (bronchospasm)

maintain fluids
if patient remains hypotensive:
- transfer to ICU
- IV adrenaline +/- aminophylline
- nebuliser salbutamol

pulse oximetry
ECG
BP

17
Q

post-attack management of anaphylaxis

A

ward admittance
monitor ECG

mast cell tryptase monitoring 1-6hrs after

continue chlorpheniramine

MedicAlert bracelet
self-injected adrenaline education
skin prick tests

18
Q

complications of anaphylaxis

A

shock
organ damage resulting from shock

19
Q

prognosis of anaphylaxis

A

good with prompt treatment

20
Q

what is a stroke?

A

focal/neurological disturbance to the brain lasting >24hrs

21
Q

Types of stroke

A
  1. ischaemic (85%)- neurological disturbance caused by ischaemia causing brain/ spinal chord death due to vessel occlusion/ stenosis (larger extracranial carotid/ vertebral arteries, intracranial arteries, smaller lacunar arteries)
  2. Haemorrhagic (15%)- caused by blood collection due to ruptured blood vessel in brain
  3. Silent strokes- pathological infarction without neuroloical
22
Q

causes of ischaemic stroke

A
  • thrombus (also in prothrombotic state - dehydration/ pregnancy/malignancy)
  • embolus of fatty deposit from larger arteries cause occlusion (from carotid dissection/ atherosclerosis/ venous blood clots pass through VSD)
  • hypotension
  • vasculitis
  • cocaine (arterial spasm)
23
Q

causes of haemorrhagic stroke

A
  • intracerebral haemorrhage (usually due to hypertension)
  • subarachnoid haemorrhage (bleeding into subarachnoid space from cerebral vessels, burst aneurysm, vascular malformations)
24
Q

What is a silent stroke?

A

pathological sign of infarction without neurological disturbance

25
Q

presenting symptoms of stroke

A
  • SUDDEN ONSET *(motor, sensation, speech, balance, vision)
  • impaired fine motor co-ordination and gait
  • weakness
  • confusion
  • sensory loss (numbness/ parathesia)
  • visual impairment (loss/ diplopia)
  • headache
  • face + neck pain
  • dizziness/ vertigo/ loss of balance
  • speech problems (dysarthria)
  • nausea/ vomiting
26
Q

examination findings of a stroke

A
  • FASt (facial weakness, arm weakness, slurred speech)

Neurological examination

  • Specific cranial nerve deficits such as unilateral tongue weakness or Horner’s syndrome (miosis, ptosis, and facial anhidrosis)
  • sensory/ visual/ cognitive impairment
  • impaired fine motor coordination + gait

-

27
Q

investigations + findings for stroke

A
  • Blood pressure + pulse (check for AF/ hypertension)
  • Bloods: Clotting profile (check for thrombophillia) + blood glucose
  • ECG (check for arrythmias)
  • Echocardiogram (check for cardiac thrombus/ endocarditis/ emboli source)
  • Doppler ultrasound (check for carotid artery disease-atherosclerosis)
  • CT brain (check for haemorrhages)
  • MRI brain (check for infarction - less available)
  • CT cerebral Angiogram (look for carotid dissection/ stenosis)
28
Q

management for suspected acute stroke:

A
  • maintain homestasis (control blood glucose 4-11mmol/L)
  • Nil by mouth until swallowing assessment
  • CT/MRI <1hr- exclude haemorrhage so can start on thrombolysis
    1. anti-platelets- ASPIRIN 300mg for 2 weeks, then long term antithrombotics
    2. thrombolysis (ALTEPLASE)
    3. thrombectomy - for large artery occlusion in proximal anterior circulation
29
Q

secondary prevention for future stroke

A

lifestyle (reduce CVD risk): stop smoking, improve diet (less salt/sat fat), exercise, reduce alcohol

drugs: anti-platelets (clopidogrel), statin (atorvostatin), anti-hypertensives (thiazide-like diuretic/ CCBs)

*persistant AF => warfarin anti-coagulation

30
Q

prognosis for stroke

A

10% mortality

50% of survivors after stroke dependant

10% risk of recurrence

haemorrhagic worse than ischaemic

31
Q

What scoring system is used to identify sepsis?

A

NEWS2

  • score >5
  • score >3 in one parameter
32
Q

Presenting symptoms + signs of sepsis

A

ABCDE approach to assess + manage

  • B- tachypnoea- raised RR >20
  • C- tachycardia (raised HR)
  • D-altered mental status/ confusion
  • E- raised temp, rigors (sudden fever + chills)

Infection cause specific:

Lung - cough, sputum, chest pain

Genitourinary- dysuria, discharge abdo pain

Skin- rashes, join pain, erythema

CVS- headaches, photophobia

GI- vomiting, diarrhoea, abdo pain, jaundice

33
Q

Investigations for sepsis

A

First-line

  • blood cultures
  • raised serum lactate- due to increased aerobic glycolysis causing imbalanced O2 delivery/use
  • hourly Urine output (reduced = poor perfusion/ cardiac output)
  • Bloods- FBC, U&Es, CRP, glucose
  • clotting
  • ECG

Second line

  • urinalysis
  • CXR
  • lumbar puncture- analyse CSF for infection
  • CT/ MRI
34
Q

Management of sepsis

A

Give:

  1. IV antibiotics
  2. IV fluids- 500ml saline max 30ml/kg
  3. oxygen (maintain >94%) for CELLULAR HYPOXIA

Take

  1. blood cultures- identify pathogen
  2. lactate level- sign of severe sepsis
  3. urine output

Further:

  • increase bp (catecolamine vasopressors - NA/ metariminol)
  • reduced cardiac function (inotropes- Adrenaline)

Year 3 (27 decks)

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