Acute and Trauma

Question 1

Who is anaphylaxis most common in

Answer 1

0-4 YEARS

Question 2

Most common anaphylaxis causes

Answer 2

Food
Drug
Toxins like venom etc

Question 3

Risk factor for anaphylaxis

Answer 3

Atopy

Question 4

Physiologically what happens in anaphylaxis

Answer 4

IgE mediated mast cell degranulation leading to bronchospasm, vasodilation and increased capillary permeability

Question 5

ABCDE presentation of anaphlaxis

Answer 5

A- throat and tongue swelling, stridor
B- increased RR, reduced O2
C- shock, tachy 
D- reduced consciousness from hypoperfusion
E- skin rashes, flushing

Question 6

Management of anaphylaxis 6 steps

Answer 6

1. Call for help
2. Remove trigger
3. Lie flat and raise legs
4. IM adrenaline 0.5mg 1/1000
5. ABC
6. IV hydrocortisone and chlorphenamine

Question 7

Blood investigations findings in anaphylaxis

Answer 7

Raised tryptase and histamine

Question 8

What is tryptase

Answer 8

Enzyme released by basal cells

Question 9

Further management of anaphlaxis

Answer 9

Follow up with immunological clinic for IgE testing to determine allergy
Epipen and education
Alert bracelet

Question 10

What are investigations for all suspected poisonings

Answer 10

ABCDE
ECG
FBC
U&Es
LFT, INR
Paracetamol, salicylate

Question 11

Extreme poisoning management

Answer 11

Activated charcoal if less than 4 hours

Gastric lavage

Question 12

Early presentation of aspirin OD

Answer 12

Tinnitus, deafness and vertigo
Tachypnoea
Nausea and vomitting
Sweating from hyperthermia

Question 13

Later presentation of aspirin OD

Answer 13

Heart block
Seizures
Low GCS
Pulmonary oedema
Shock

Question 14

ABG early finding aspirin OD

Answer 14

Resp alkalosis

Question 15

ABG late finding aspirin OD

Answer 15

Metabolic acidosis with large anion gap

Question 16

What causes resp alkalosis in early aspirin OD

Answer 16

Aspirin stimulates resp centre causing hyperventilation

Question 17

What causes metabolic acidosis in late aspirin OD

Answer 17

Leads to high levels of glucose metabolism that doesnt produce ATP ie glycolysis forming lactate. Ketogenesis is also stimulated

Question 18

Main blood test should do for suspected aspirin OD

Answer 18

Salicylate levels

Question 19

Management of aspirin OD

Answer 19

Urine alkalisation using IV sodium bicarbonate

Dialysis

Question 20

Pathophysiology of paracetamol OD

Answer 20

Glutathione gets used up so toxic NAPQI accumulates leading to hepatocyte damage

Question 21

Early presentation of paracetamol OD ( up to 24 hrs)

Answer 21

Nausea and vomiting

Lethargy

Question 22

Later presentation of paracetamol OD (24 hrs after OD)

Answer 22

RUQ pain
Hepatomegaly
Vomiting

Question 23

How long after paracetamol OD does acute liver failure start

Answer 23

After 72 hours

Question 24

Treatment for paracetamol OD

Answer 24

N-acetyl cysteine

Liver transplant may be needed

Question 25

Physiologically what happens with opiate OD

Answer 25

PNS activated

Question 26

What is presentation of opiate OD

Answer 26

Resp depression
Bradycardia
Shock
Pinpoint pupils
In later stages coma and seizures

Question 27

Management of opiate OD

Answer 27

IV naloxone

Question 28

What are some less common suicide attempt methods

Answer 28

Ethanol

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