Acute and Emergency Flashcards
How does alcohol withdrawal present?
Signs of chronic or decompensated liver failure
Wernicke’s encephalopathy (confusion, ataxia, nystagmus)
Palpitations and anxiety
Sweating
Tremor
Generalised tonic-clonic seizures
Hallucinations
Delirium tremens
How is alcohol withdrawal treated?
IV benzodiazepines for seizures and delirium tremens
IV fluids
Pabrinex (IV thiamine)
Correct hypoglycaemia
What is anaphylaxis?
Type 1 IgE-mediated hypersensitivity reaction to certain triggers
What are the symptoms of anaphylaxis?
Widespread urticaria, itching and flushing
Angio-oedema
Sneezing
Wheeze
Abdominal pain, nausea, vomiting, diarrhoea
Tachycardia and hypotension
How is anaphylaxis managed?
IM adrenaline
Antihistamines, e.g. oral chlorphenamine or cetirizine
Steroids, e.g. IV hydrocortisone
Lie patient flat and raise legs
IV fluids if hypotensive
What are the features of aspirin overdose?
Tinnitus, deafness, dizziness
Hyperventilation
Hyperthermia and sweating
Nausea and vomiting, diarrhoea
Pulmonary oedema
Low GCS and seizures
How is aspirin overdose investigated?
ABG - initial respiratory alkalosis (hyperventilation), then metabolic acidosis (high lactate) with high anion gap
Salicylate levels (repeat every 2 hours until peak level)
How is aspirin overdose managed?
No antidote, mainly supportive
Activated charcoal if within 1 hour of ingestion
IV sodium bicarbonate (increases elimination of aspirin in urine)
Haemodialysis - if pulmonary oedema and severe metabolic acidosis
What are the features of paracetamol overdose?
Patients often asymptomatic
Nausea and vomiting
RUQ pain
Hepatomegaly
Jaundice
Altered conscious level
How is paracetamol dose investigated?
ABG (lactic acidosis)
Serum paracetamol concentration
LFTs (high ALT)
PT (elevated)
How is paracetamol overdose managed?
Activated charcoal if within 1 hour of ingestion
IV acetylcysteine
Liver transplant if pH <7.3 more than 24 hours after ingestion
What are the features of opioid overdose?
Reduced consciousness
Respiratory depression (bradypnoea)
Pinpoint pupils (bilateral miosis)
Low GCS and coma
How is opioid overdose managed?
IV nalaxone
Ventilation
