Acute Care - Anaphylaxis + Head Injury Flashcards
what happens in anaphylaxis?
immune system makes IgE against antigen
second time, cross linking of IgE on mast cells
widespread degranulation and histamine release
features of anaphylaxis (ABCDE)?
A = stridor, dysphagia, angioedema
B - dyspnoea, wheeze, cyanosis
C = pale, clammy, tachicardia, hypotension
D = confused
E = urticaria
Tx for anaphylaxis?
anaesthetist adrenaline oxygen IV fluids chlorephenamine hydrocortisone nebulised salbutamoll and ipratropium bromide
what is the adrenaline dosing?
0.5ml of 1:1000
child <12 0.3ml
<6yrs 0.15ml
what is the hydrocortisone dosing?
200mg
<12yrs 100mg
>6mnths 50mg
<6 months 25mg
what is the chlorphenamine dosing?
10mg
child <12 5mg
>6mnths 2.5mg
<6mnths 0.25mg/kg
what is the GCS definition of a coma?
<8
scoring for eyes on GCS?
4 spontaneous
3 to voice
2 to pain
1 none
scoring for verbal on GCS?
5 orientated 4 confused 3 words 2 sounds 1 none
scoring for motor on GCS?
6 spontaneous 5 localises pain 4 normal flexion 3 abnormal flexion (decorticate) 2 extention (decerebrate) 1 none
what is normal ICP range?
8-10
what does the equation involving CPP look like?
CPP =MAP - ICP
what does mannitol do?
sucks fluid out the brain to lower ICP
what does bruising under both eyes indicate?
anterior fossa #
what does battles sign indicate? where is it?
middle fossa #
behind the ear
features of a head injury?
headache memory problems loss of balance seizure loss of consciousness vomiting sensitive to light/noise emotional irritability
signs of a skull base #?
subconjunctival haemorrhage
blood from ear/nose
CSF from ear/nose
what are worrying features of a head injury?
hypertension (CPP = MAP - ICP)
bradycardia
irregular bleeding
why can BP increase in a head injury?
CPP decreases due to raised ICP
BP increases to try stop brain from becoming ischaemic
who gets a CT head?
GCS < 13
GCS < 15 at 2 hours on assessment in ED
Suspected skull fracture.
Posttraumatic seizure.
Focal neurological deficit.
vomiting
LOC or amnesia if >65, risk of bleeding or >30 minutes of memory loss.
Tx for head injury?
REMOVE FROM PLAY
oxygen BM warm mannitol neurosurgery intubation may be needed
if being sent home after a head injury, what do you advise?
don’t be left alone
don’t drink
don’t drive
features of a nose #?
deviated swollen bruising bleeding CSF leek difficulty breathing
tx for a nose #?
review and manipulate in 1 wk
if haematoma -> incide
if deviated -> septoplasty
what is a blow out #?
of the oribtal floor when the contents prolapse into the maxillary sinus
features of blow out #?
red eye
double vision
cant look up (IR trapped)
CNV2 sensation loss
Ix and Tx for blow out #?
Ix - XRAY (tear drop sign)
max fax referral
