Acute Care Flashcards
Anticholinergic poisoning
eg. oxybutynin, ipratropium
effects:
- increased HR/BP
- increased temperature
- dilated pupils
- decreased bowel sounds
- decreased diaphoresis
antidote: physostigmine (AchE inhibitor)
Antidotes
Beta blocker: glucagon
Calcium channel blocker: glucagon, insulin
Ethylene glycol: fomipazole
Local anaesthetic: IV lipid emulsion
Iron: desferroximine
Methemoglobinaemia: methylene blue
Sulfonylureas: octreotide
TCA: sodium bicarbonate
Burns
treatment: cooling: 20 mins at 15 degrees within first 3 hours
prognosis: cooling will not change zone of coagulation/stasis but will improve zone of hyperaemia
Cholinergic poisoning
eg. organophosphate, ACh receptor agonist
effects:
- pupillary constriction
- increased bowel sounds
- diaphoresis
antidote: atropine
Dexmedetomidine
mechanism: alpha 2 adrenoreceptor agonist
effect: sedation, analgesia, NO respiratory depression
use: sedation for intubated patient
side effects: HTN, bradycardia
Ecstacy
class: sympathomimetic amphetamine
mechanism: presynaptic serotonin, noradrenaline, dopamine
symptoms:
- CVS: increased and decreased BP
- CNS: agitation, coma, convulsions, disinhibition
- Msk: ridigity, rhabdomyosis
- urinary failure
- cerebral oedema, hepatitis, hyperpyrexia, hyponatraemia
treatment: benzodiazepine, antihypertensive
Ibuprofen
mechanism: proprionic acid derivative inhibits COX
effect: analgesic, antipyretic, antiinflammatory
half life: 2 hours
drug elimination: hepatic
SEs: GI
overdose: life threatening >400mg/kg, nausea, vomiting, drowsiness, blurred vision, dizziness
treatment OD: charcoal
- limited use in alkalinisation urine/diuresis as minimal renal excretion
Ketamine
mechanism: NMDA antagonist blocking afferent impulses causing dissociation of the limbic system
effect: amnesia, analgesia
side effects: LARYNGOSPASM, HTN, tachycardia, vomiting, nightmares, increased ICP, increased bronchial secretions
Lead poisoning
symptoms:
- decreased appetite, weight loss
- vomiting, abdominal pain
- constipation
- anaemia
- renal failure
- lethargy
- learning/behavioural issues
Lignocaine
mechanism: blocks Na channels in peripheral nerves inhibiting depolarisation
Midazolam
mechanism: potentiates inhibitory effects of GABA throughout the CNS
- SHORT duraiton
effect: anxiolytic, sedative, hypnotic, muscle relaxant, antiepileptic
side effects: apnoea, hypotension, decreased myocardial function
Nitric oxide
mixture: entonox 50:50 oxygen and N20
CI: gas filled space (PTX, BO), severe head injuries, decreased GCS, pregnancy
adverse effects: vomiting 10%, dysphoria 1%
Cholinergic toxidromes
*organophosphates inhibit AChE and produce muscurinic symptoms
- treatment with anticholinergic eg. atropine
Propofol
mechanism: CNS depressant by GABA + blocking Na channels
use: induction of GA, NO ANALGESIA
side effects: bradycardia, hypotension, pain at IV site
Sedative poisoning
eg. benzodiazapines, antihistamines
effect:
- bradycardia/hypotension
- bradypnoea
- hypothermia
- decreased bowel sounds
- decreased sweating
antidote: flumazenil
Serotonin Syndrome
mechanism: serotonergic drugs
effects:
- anxiety/restlessness
- HTN/tachycardia
- hyperthermia
- myoclonus
treatment: serotonergic antagonist eg. cyproheptadine
Spinal shock
clinical: hypotension, bradycardia, warm skin
Sympathomimetic poisoning
eg. adrenaline, cocaine
effect:
- increased HR/HTN
- tachypnoea
- hyperthermia
- pupillary dilation
- increased bowel sounds
- diaphoresis
antidote:
TCA overdose
drug mechanism: therapeutic effect by SNRI and NET
- additionally potent antihistamine/anticholinergic
half life: 24 hours
symptoms overdose:
- anticholinergic: CNS (agitation, confusion, lethargy), tachycardia, dry mouth, mydriasis, fever, urinary retention, vomiting
- antiadrenergic: vasodilation
- Na channel blockade: wide QRS, long QT, arrythmias
- CNS depression: seizures, coma
diagnosis:
- ECG: prolonged PR, QRS, QT
treatment: IV sodium bicarb if wide QRS
Wound infection
cat: Pasteurella multicoda
dogs: Streptobacillus moniliformis
human: Eikenella corrodens
Gastric Foreign Bodies
- most will pass 4-6 days
conservative management EXCEPT:
- button batteries
- magnets
- objects longer 5cm or diameter 2.5cm
management: weekly radiographs
Spinal injury
-fulcrum-
cervical mobility changes with age:
- <8yrs: C1-C3
- 8-12yrs: C3-C5
- >12yrs: C5-C6
Spinal injury
-micturition-
pontine micturition centre: coordinates sacral centre
PSNS (S2-S4): innervates detrusor
SNS (T11-L2): innervates trigone/neck, proximal urethra
somatic NS (S2-S4): innervates muscles including external sphincter
Spinal injury level
C1-3: ventilator dependent
C5: hand to mouth activities
C6: hand function
C7: independent ADLs
Autonomic Dysreflexia
injury: C6 and above
pathogenesis: widespread reflex activaty of SNS triggered by ascending sensory stimulus
clinical:
- vasoconstriction, pallor, diaphoresis, goose bumps
- bradycardia, hypertension, headache, blurred vision
Solution to dilution
1: 1000 = 1% = 1mg/ml
1: 10,000 = 0.1% = 0.1ml
ETT Formula
ETT length from lips= age/2 + 12
ETT size= age/4 + 4mm
* Cuffed for >8 years
* Straight blade for <1 year
Rapid Sequence Intubation
1st: Hypnotic agent:
- eg. thiopentone (3-5mg/kg), midazolam (0.5 mg/ kg) or propofol (2-4 mg/kg);
2nd Muscle relaxant:
- eg. suxamethonium (1 mg/kg), rocuronium (1mg/kg).
