Acute Care Flashcards
What scores are the GCS components out of?
Eyes 4
Verbal 5
Motor 6
What are the GCS values for Eyes
Eyes
- Spontaneously
- Speech
- Pain
- None
What is the GCS for verbal response
5 Orientation to time, person and place
4 Confused
3 Inappropriate words
2 Incomprehensible
1 None
What is the GCS for motor
6 Obeys command
5 Moves to localised pain
4 Withdraws from pain
3 Abnormal flexion
2 Abnormal extension
1 None
What posture is this and what is the
a) Signifiance
b) Potential progression
![](https://s3.amazonaws.com/brainscape-prod/system/cm/388/714/095/q_image_thumb.jpg?1656161030)
Decorticate: Abnormal flexion due to significant head trauma
Can progress to decererbate, indicating brain herniation (uncal)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/388/714/095/a_image_thumb.jpg?1656161488)
Who gets a 1hour CT following a head injury?
GCS <13 on initial assessment
GCS <15 after 2 hours
Suspected skull or basilar skull fracture
Post-traumatic seizure
Focal neuro deficit
>1 episode of vomiting
Who gets an 8 hour CT following head injury
>65 years
Bleeding/clotting disorders
High velocity/height (>1m or 5 stairs)
>30 mins retrograde amnesia of events prior to injury
What criteria indicates immediate CT for children?
GCS < 14, <15 if under 1 year
LOC or amnesia >5 mins
>3 vomiting episodes
Sign of skull, basilar fracture
Dangerous mechanism (fall >3m, high velocity)
SUSPICION OF NAI
How do you manage a GCS of
<8
3-8
<8 means intubate
ICP monitoring (must do if CT abnormal)
How do toxidromes affect pupil responses
Dilate: Anticholinergics, sympathomimetic
Pinpoint: Cholinergics, opioids
No change: Sedative hypnotic
How do you distinguish between overdoses of
anticholinergics (atropine, antihistamine, tricyclics, olazapine, quetiapine)
sympathomimetic (Caffeine, cocaine, (meth)amphetamines, ritalin, LSD, theophylline, MDMA)
Anticholinergics: no RR change, bowel sounds or sweating
Sympathomimetics: Raised RR, bowel sounds present and sweating
Both have dilated pupils, raised HR and warm skin
How do you tell the difference between
cholinergics (mushrooms, pilocarpine, -cholines)
opioids (morphine, codeine, tramadol, heroin, fentanyl)
sedative-hypnotics (benzodiazepines, muscle relaxants, antiepileptics, anti-anxiety meds
Both cholinergics and opioids have pinpoint pupils
Cholinergics: Bowel sounds + sweaty; no changes to numbers (HR,RR, temp)
Opioids: No bowel sounds, dry skin. Reduced HR, RR and skin temp
Sedative-hypnotics: As per opioids but no pupil changes
![](https://s3.amazonaws.com/brainscape-prod/system/cm/388/715/998/a_image_thumb.png?1656163951)
Toxin Treatments
Paracetamol
N-acetylcysteine (+activated charcoal if <1hr)
Toxin treatments
Aspirin/salicylates
IV bircarbonate
+/- haemodialysis
Toxin treatments
Opioids/opiates
Naloxone
Toxin Treatments
Benzodiazepines
Flumazenil
The majority of overdoses are managed with supportive care only due to the risk of seizures with flumazenil. It is generally only used with severe or iatrogenic overdoses.
Toxin treatments
Tricyclic antidepressants
Prevent arrythmias: IV bicarbonate
Manage arrhythmias
lignocaine (NOT quinidine, flecainide)
Toxin treatments
Lithium
mild-moderate: fluid resuscitation
Severe: haemodialysis
Toxin treatments
Warfarin
Vitamin K, prothrombin complex
Toxin treatments
Heparin
Protamine sulphate
Toxin treatments
Beta-blockers
bradycardic then atropine
Glucagon if resistant
Ethylene glycol
fomepizole 1st line
Haemodialysis if refractory