Acute Care Flashcards
Leading cause of trauma death is ______
Suffocation then MVA
Non-fatal is falls
Trauma causes _____ of deaths in 5 to 19yo
70%
Abdominal trauma attributes to ____ of fatal injuries in trauma cases
20%
But are the most common UNRECOGNISED cause of fatal injuries
What are causes of Neurogenic shock?
Spinal cord injury above T5, Spinal anaesthesia, Vasomotor centre depression
How does Neurogenic shock present?
Low systemic vascular resistance, increased parasympathetic activity and bradycardia
Warm, low BP and bradycardia
In orbital wall fracture which direction do you struggle to look in?
In the opposite direction!
Also pulsating = superior orbital fracture
Which bug causes infection slowly over a week after a punch to wall?
Eikenella Corrodens
Gram negative bug, slow infection/abscesses, infection from human bites
When does Pastuerella multicoda infections commonly occur?
Post cat or dog bites
When does streptobacillus moniliformis infections occur?
Post rat bite
Which head injury presents with brief period of LOC, comes around (lucid interval) and then gets worse?
Epidural haematoma
Most common chest injury in two year old post chest trauma?
Pulmonary contusion (bruising)
Toxocity = Bradycardia, diarrhea and lots of secretions?
How do you treat?
Cholnergic toxicity
Atropine!
SLUDGE + 3 killer B’s (bronchospasm, bronchorrea and bradycardia)
How to treat serotonin syndrome?
Cryptoheptadine
How to treat neuroleptic malignant syndrome?
Bromocriptine, Amantadine for dopamine blocker
Dantrolene as muscle relaxant
In TCA overdose:
If QRS >100ms risk of _____
If QRS >160ms risk of _______
If QRS >100ms risk of seizures
If QRS >160ms risk of ventricular arrhythmia
(Due to Sodium channel blockade)
How does tricyclic overdose present and how do you treat?
Presents as Coma, convulsion and cardiac manifestations
Treat with Sodium Bicarbonate
How do you treat benzodiazepine overdose?
Flumanezil
How do you treat Dystonic reactions (from metoclopramide)?
Benztropine
How do you treat malignant hyperthermia?
Dantrolene
How do you treat Methhaemaglobinaemia?
Methylene blue, Ascorbic acid
Toxicology of Altered GCS + Bradycardia + hypotension = _________
And how do you treat?
Betablocker or Ca blocker overdose
B blocker = treat with adrenaline or high dose insulin therapy
In Digoxin overdose do you get hypokalaemia or hyperkalaemia?
HyperK+
How would you manage 1 button battery in the stomach?
If single BB and patient asymptomatic -> advise patient for repeat XR in 48 hours and if still in stomach -> Endoscopic removal
Which toxidrome =
Agitation, picking at unseen objects, flushed face and tachycardia…?
Anticholinergic
A - Alice in wonderland - confused
B - Blind as a bat - dilated pupils (not reactive)
C - Mad as a hatter (picking or grabbing at objects that are not there)
D - Dry as a bone - urinary retention
Red as a beet
Main difference between anticholinergic and serotinergic?
Serotoninergic are more hypertonic, rigid and hyperreflexic
If paracetamol doseage is less than _______ then no treatment is required
200mg/kg
If a paracetamol overdose is more than 200mg/kg and the patient presents after 8 hours - what do you do?
Commence NAC, and do immediate paracetamol level and ALT
If a paracetamol overdose is more than 200mg/kg and the patient presents 2 hours - what do you do?
Paracetamol concentration at 4 hours post ingestion.
What do you do if >200mg/kg or ?10g of SR paracetamol is overdosed and it is less than 4 hours?
You give activated charcoal and commence NAC
If more than 4 hours - > commence NAC and two levels 4 hours apart needed
What is the mechanism of action of NAC?
N-Acetylcysteine is a sulfhydryl compound and acts to increase synthesis of glutathione in the liver.
Glutathione subsequently acts as an antioxidant and facilitates conjugation to toxic metabolites, particularly the toxic metabolites of acetaminophen.
Most common haematological anomaly with Nitric oxide
Platelet aggregation and methhemoglobinuria
What age group does Pethe’s normally present with?
Early school age or preschool age children
XRAY in SUFE - the ______ line does not dissect the ________-
The Klein line does not dissect the femoral head (slipped icecream)
What is the doseage of adrenaline in anaphylaxis?
0.01mg/kg IM Adrenaline 1:1,000 which is 0.01mL/kg
(Max 0.5mL)
In IV you use Adrenaline 1:10,000 with dose of 10microg/kg which is 0.1mL/kg
When is amiodarone given in the APLS algorhythm?
In pulseless VT or V fib (shockable rhythm) ->
- you give adrenaline after ever 2 second shock (then after 4th shock, 6th shock etc)
- you give amiodarone once after the 3 rd shock
In non-shcokable rhythm -> adrenaline after every 1st loop
In drowning -> the risk of death or poor outcome is 90% after __ mins and 100% after __ mins
90% after 5 mins
100% after 25 mins
Fun fact
Worse outcomes if resus if longer than 10minutes
What temperature do you aim to warm children that are cold?
Warm them upto 33 degrees
If under 30 degrees withhold all drugs, if 30-33 -> increase dosing interval of drugs to twice as long as you normally would
Comparing adrenaline and noradrenaline which -> differences in action?
Both have some effect on alpha and beta receptors
Adrenaline - Increased effect on Beta receptor =
- Beta 1 = Inotropy
- Beta 2 = Inotropy and bronchodilation and vasodilation
Noradrenaline - increased effect on alpha receptors =
- alpha 1 = Vasoconstriction and Ionotropy
- Alpha 2 = as above, but lesser effect
What are the two major absolute contraindication to LP?
- GCS <8 or deteriorating/fluctuating level of consciousness
- Signs of raised intracranial pressure (ICP): diplopia, abnormal pupillary responses, decerebrate or decorticate posture, low HR + elevated BP + irregular respirations, papilloedema
- A bulging fontanelle in the absence of other signs of raised ICP is not a contraindication
(As per RCH guidelines)
How does Eucalyptus oil toxidrome present as?
Drowsiness, stupor
If aspirated -> chemical pneumonitis
TCA overdose is similar to toxidrome of ______
anticholinergic effects
How does Theophylline overdose represent?
Tachycardia, ventricular arrhythmia, agitation and anxiety (caffeine)
90% of O2 saturation of haemoglobin is related to PaO2 of?
60mmHg
PaO2 of 50 = 89%
PaO2 of 95 = 97%
PaO2 of 40 = 75%
PaO2 27 = 50%
How do you treat Carbon Monoxide poisoning?
1) First Oxygen via non-rebreather (Hiflow O2 decreases the half life of CO from 300mins to 90mins)
2) Hyperbaric chamber
How does Carbon Monoxide poisoning affect your dissociation curve?
It shifts your curve to the left (thus increased affinity to oxygen and tissues less likely to receive oxygen
Most common cause of respiratory failure in paediatric trauma?
Head trauma
Grading of DKA?
Mild <7.3 and HCO3 <15
Moderate pH <7.2 and HCO3 <10
Severe: <7.1 and HCO3 <5
How do you correct sodium with glucose in DKA?
Corrected sodium = measured sodium + 0.3 x (glucose – 5.5) mmol/L
How do you differentiate erythema marginatum and erythema multiforme?
Marginatum - assoc with Acute rheumatic fever.
Multiforme - associated with mycoplasma and HSV - TARGET lesions
What is the doseage for shock?
4J/kg
High dose insulin euglycaemic therapy is used in?
SEVERE CCB or BB overdose
EDTA is used for ?
Chelating agent for metals?
Symptoms of dystonic reaction?
Difficulty with vision that affects your eyelids. Difficulty with jaw movement, swallowing or speech. Pain and fatigue,
Most common Salter Harris fracture?
Type II
What are the first two steps in managing iron overdose?
1) fluid resuscitation
2) Decontamination - WBI is indicated if the AXR reveals tablets or capsules ingested and more than 60 mg/kg ingested
What is the antidote used in Iron overdose?
Desferrioxamine is a chelating agent that forms a water soluble desferrioxamine-iron comple
What is the order of symptoms in iron overdose?
1) Gastrointestinal - 0.5 to 6 hours; abdominal symptoms
2) Quiescent/ latent - 6-24 hours; progressive absorption in iron, symptoms initially improve
3) Cardiogenic shock and acidosis - 6 to 72 hours; shock, metabolic acidosis, multisystem failure, coma
4) Hepatic necrosis - 12 to 96 hours; hepatotoxicity
5) Bowel obstruction - 2 to 8 weeks later
What is the doseasge of iron overdose that is typically concerning?
<20 mg/kg: asymptomatic
20-40 mg/kg: GI symptoms only. Symptoms usually last <6hrs
40-60 mg/kg: GI symptoms, systemic toxicity not expected. Symptoms usually last <8hrs
60-120 mg/kg: potential for systemic toxicity
>120 mg/kg potentially lethal
