Acute and Trauma Flashcards
Who is anaphylaxis most common in
0-4 YEARS
Most common anaphylaxis causes
Food
Drug
Toxins like venom etc
Risk factor for anaphylaxis
Atopy
Physiologically what happens in anaphylaxis
IgE mediated mast cell degranulation leading to bronchospasm, vasodilation and increased capillary permeability
ABCDE presentation of anaphlaxis
A- throat and tongue swelling, stridor B- increased RR, reduced O2 C- shock, tachy D- reduced consciousness from hypoperfusion E- skin rashes, flushing
Management of anaphylaxis 6 steps
- Call for help
- Remove trigger
- Lie flat and raise legs
- IM adrenaline 0.5mg 1/1000
- ABC
- IV hydrocortisone and chlorphenamine
Blood investigations findings in anaphylaxis
Raised tryptase and histamine
What is tryptase
Enzyme released by basal cells
Further management of anaphlaxis
Follow up with immunological clinic for IgE testing to determine allergy
Epipen and education
Alert bracelet
What are investigations for all suspected poisonings
ABCDE ECG FBC U&Es LFT, INR Paracetamol, salicylate
Extreme poisoning management
Activated charcoal if less than 4 hours
Gastric lavage
Early presentation of aspirin OD
Tinnitus, deafness and vertigo
Tachypnoea
Nausea and vomitting
Sweating from hyperthermia
Later presentation of aspirin OD
Heart block Seizures Low GCS Pulmonary oedema Shock
ABG early finding aspirin OD
Resp alkalosis
ABG late finding aspirin OD
Metabolic acidosis with large anion gap
What causes resp alkalosis in early aspirin OD
Aspirin stimulates resp centre causing hyperventilation
What causes metabolic acidosis in late aspirin OD
Leads to high levels of glucose metabolism that doesnt produce ATP ie glycolysis forming lactate. Ketogenesis is also stimulated
Main blood test should do for suspected aspirin OD
Salicylate levels
Management of aspirin OD
Urine alkalisation using IV sodium bicarbonate
Dialysis
Pathophysiology of paracetamol OD
Glutathione gets used up so toxic NAPQI accumulates leading to hepatocyte damage
Early presentation of paracetamol OD ( up to 24 hrs)
Nausea and vomiting
Lethargy
Later presentation of paracetamol OD (24 hrs after OD)
RUQ pain
Hepatomegaly
Vomiting
How long after paracetamol OD does acute liver failure start
After 72 hours
Treatment for paracetamol OD
N-acetyl cysteine
Liver transplant may be needed
Physiologically what happens with opiate OD
PNS activated
What is presentation of opiate OD
Resp depression Bradycardia Shock Pinpoint pupils In later stages coma and seizures
Management of opiate OD
IV naloxone
What are some less common suicide attempt methods
Ethanol
Anti freeze
