acute and emergency Flashcards
salicylate OD: clinical features
- N+V
- tinnitus
- hyperventilation
- sweating/pyrexia
- lethargy
- hyperglycaemia/hypoglycaemia
- seizures
- coma
why do you get hyperventilation in salicylate OD
because the respiratory centres in the brain are stimulated
salicylate OD: usual ABG finding and explain why this occurs
ABG finding: mixed resp ALKALOSIS + metabolic ACIDOSIS
* initially respiratory ALKALOSIS - respiration stimulated centrally → blowing off CO2
* direct acid effects of the salicylates (+ acute renal failure) → metabolic ACIDOSIS
salicylate OD in children: ABG finding
metabolic acidosis predominates
salicylate OD: management
- general: ABC, charcoal
- urinary alkalinisation with IV sodium bicarbonate - enhances elimination of Aspirin in urine
- haemodialysis
salicylate OD: indications for haemodialysis
- serum conc > 700mg/L
- metabolic acidosis resistant to treatment
- acute renal failure
- pulmonary oedema
- seizures
- coma
witnessed cardiac arrest: management
- if cardiac arrest is witnessed (i.e. seen on cardiac monitoring) e.g. in the context of PCI in cath lab/coronary care unit → deliver up to 3 shocks (checking for ROSC in between each one) before CPR
this is done as opposed to the usual 1 shock → CPR
paracetamol OD management: pt presents within 1 hour
activated charcoal - to reduce absorption
criteria that needs to be met to give NAC
paracetamol OD management: when to give NAC
- ingested >150mg/kg 8-24 hours ago (even if plasma paracetamol conc not available)
- plasma paracetamol conc is above treatment line
- staggered OD/time of ingestion unknown (regardless of paracetamol conc)
- presented > 24 hrs but pt has hepatic tenderness/elevated ALT/jaundiced - NAC should be continued if paracetamol conc/ALT remains elevated - whilst seeking specialist advice
OD = staggered if all tablets not taken w/in 1 hr
King’s College Hospital criteria for liver transplantation (paracetamol liver failure)
- arterial pH < 7.3 after 24 hours
OR all of the following - PTT > 100s
- creatinine > 300 µmol/l
- grade III or IV encephalopathy
paracetamol OD: time over which NAC is infused
NAC is infused over 1 hour to reduce adverse effects
used to be 15 minutes
what type of reaction does NAC cause
anaphylactoid reaction: non-IgE mediated mast cell release
paracetamol OD: management of anaphylactoid reaction to NAC
stop infusion + restart at slower rate
PE: Ix of choice in renal impairment
V/Q scan (to avoid nephrotoxicity of contrast which is used in CTPA)
PE Wells score - give an example of an imaging that would help score points for ‘no Dx more likely than PE’
unremarkable CXR - as this would rule out PTX
