Acute Care - Anaphylaxis + Head Injury

Question 1

what happens in anaphylaxis?

Answer 1

immune system makes IgE against antigen

second time, cross linking of IgE on mast cells

widespread degranulation and histamine release

Question 2

features of anaphylaxis (ABCDE)?

Answer 2

A = stridor, dysphagia, angioedema

B - dyspnoea, wheeze, cyanosis

C = pale, clammy, tachicardia, hypotension

D = confused

E = urticaria

Question 3

Tx for anaphylaxis?

Answer 3

anaesthetist 
adrenaline 
oxygen 
IV fluids
chlorephenamine 
hydrocortisone 
nebulised salbutamoll and ipratropium bromide

Question 4

what is the adrenaline dosing?

Answer 4

0.5ml of 1:1000
child <12 0.3ml
<6yrs 0.15ml

Question 5

what is the hydrocortisone dosing?

Answer 5

200mg
<12yrs 100mg
>6mnths 50mg
<6 months 25mg

Question 6

what is the chlorphenamine dosing?

Answer 6

10mg
child <12 5mg
>6mnths 2.5mg
<6mnths 0.25mg/kg

Question 7

what is the GCS definition of a coma?

Answer 7

<8

Question 8

scoring for eyes on GCS?

Answer 8

4 spontaneous
3 to voice
2 to pain
1 none

Question 9

scoring for verbal on GCS?

Answer 9

5 orientated
4 confused
3 words
2 sounds
1 none

Question 10

scoring for motor on GCS?

Answer 10

6 spontaneous
5 localises pain
4 normal flexion
3 abnormal flexion (decorticate)
2 extention (decerebrate)
1 none

Question 11

what is normal ICP range?

Answer 11

8-10

Question 12

what does the equation involving CPP look like?

Answer 12

CPP =MAP - ICP

Question 13

what does mannitol do?

Answer 13

sucks fluid out the brain to lower ICP

Question 14

what does bruising under both eyes indicate?

Answer 14

anterior fossa #

Question 15

what does battles sign indicate? where is it?

Answer 15

middle fossa #

behind the ear

Question 16

features of a head injury?

Answer 16

headache
memory problems
loss of balance
seizure
loss of consciousness
vomiting 
sensitive to light/noise
emotional irritability

Question 17

signs of a skull base #?

Answer 17

subconjunctival haemorrhage
blood from ear/nose
CSF from ear/nose

Question 18

what are worrying features of a head injury?

Answer 18

hypertension (CPP = MAP - ICP)
bradycardia
irregular bleeding

Question 19

why can BP increase in a head injury?

Answer 19

CPP decreases due to raised ICP

BP increases to try stop brain from becoming ischaemic

Question 20

who gets a CT head?

Answer 20

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.

Question 21

Tx for head injury?

Answer 21

REMOVE FROM PLAY

oxygen 
BM
warm 
mannitol 
neurosurgery 
intubation may be needed

Question 22

if being sent home after a head injury, what do you advise?

Answer 22

don’t be left alone
don’t drink
don’t drive

Question 23

features of a nose #?

Answer 23

deviated
swollen
bruising
bleeding
CSF leek
difficulty breathing

Question 24

tx for a nose #?

Answer 24

review and manipulate in 1 wk

if haematoma -> incide
if deviated -> septoplasty

Question 25

what is a blow out #?

Answer 25

of the oribtal floor when the contents prolapse into the maxillary sinus

Question 26

features of blow out #?

Answer 26

red eye
double vision
cant look up (IR trapped)
CNV2 sensation loss

Question 27

Ix and Tx for blow out #?

Answer 27

Ix - XRAY (tear drop sign)

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