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Conditions > Acute Care and Trauma Conditions > Flashcards

Acute Care and Trauma Conditions Flashcards

1
Q

What is Alcohol withdrawal?

A

AWS or ‘the shakes’ occurs in patients with alcohol dependence when their daily ETOH consumption is decreased or stopped

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2
Q

What causes Alcohol withdrawal?

A

Removal of ETOH in diet
Chronic alcohol causes up-regulation of NMDA and down-regulation of GABA (inhibitory)
ETOH removal causes imbalance of stimulation and inhibition

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3
Q

What are the symptoms felt while withdrawing on alcohol?

A

Minor symptoms (insomnia, fatigue, tremor, mild anxiety, mild restlessness, nausea and vomiting, headache, excess sweating, palpitations, anorexia, depression, craving)
Alcohol hallucinations: Visual, audible + tactile hallucinations
Withdrawal seizures
Delirium tremens - lasts 3-4 days

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4
Q

What is the time frame for symptoms in alcohol withdrawal?

A 
Minor symptoms (6-12hrs)
Alcohol hallucinations (12-24hrs)
Withdrawal seizures (24-48hrs)
Delirious tremens (48-72hrs)
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5
Q

How do you manage alcohol withdrawal symptoms?

A

Decide whether they need hospital admission (previous DT or AW seizures)

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6
Q

What medications are used for acute alcohol withdrawal?

A 
Benzodiazepines (Chlordiazepoxide)
Thiamine
Others:
- Clomethiazole
- Carbamezapine
- Antipsychotic drugs
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7
Q

What is Delirium tremens?

A

Medical emergency, a hyperadrenergic state

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8
Q

How does someone with delirium tremens present?

A 
Tachycardia
Hyperthermia and excessive sweating
Hypertension
Tachypnoea
Tremor
Mydriasis
Ataxia
Altered mental status
Cardiovascular collapse
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9
Q

What are the Risk factors for Delirium tremens?

A 
Previous history
Co-existing infection
Recent higher than normal ETOH intake
Older age
Abnormal LFTs
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10
Q

What is the management for DT?

A

Admit to ICU
Treat hypoglycaemia
Sedate with Benzodiazepines
Add barbituates in those refractory to benzodiazepines

For Wernicke’s encephalopathy - 2 pairs of ampoules pabrinex (IV 3x daily for 3 days)

Magnesium to protect from seizures and arrhythmias

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11
Q

What is anaphylaxis?

A

Severe, life threatening, generalised or systemic hypersensitivity reaction

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12
Q

What are the 2 criteria needed for anaphylaxis?

A
  • Sudden onset and rapid progression of symptoms

- Life threatening airway and/or breathing /circulation problems

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13
Q

What are the exogenous causes of anaphylaxis?

A

Food (Peanuts, beans, tree nuts, fish, shellfish, eggs, milk, sesame)
Venom (Bee stings, wasp stings)
Drugs (ABx, Opioids, NSAIDs, IV contrast media, muscle relaxants, other anaesthetic drugs)

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14
Q

What is the cellular function behind anaphylaxis?

A

Allergen reacts with specific IgE Abs on mast cells and basophils
Causes capillary leakage, mucosal oedema and ultimarely shock and asphyxia
Rarely symptoms can be delayed by a few hours
Some are idiopathic

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15
Q

What are the symptoms of anaphylaxis?

A 
History of sensitivity of allergens, recent history of exposure to new drug/allergen
Skin symptoms (Pruritis, urticaria, erythema, rhinits, conjunctivitis, angio-oedema)
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16
Q

What are the signs of anaphylaxis?

A 
Itching of palate or ears
Dyspnoea
Laryngeal oedema (stridor)
Wheezing (Bronchospasm)
General symptoms (palpitation and tachycardia, nausea, vomiting and abdo pain)
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17
Q

What are the investigations for Anaphylaxis?

A

Serum mast cell tryptase ASAP

Obeserve patients

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18
Q

How do you generally manage anaphylaxis?

A 
ABCDE
A - Airway (clear and remove allergen)
B - Breathing (look for and treat bronchospasm)
C - Circulation (colour, pulse, BP)
D - Disability
E - Exposure
High-flow O2
Lay them flat 
Adrenaline 
IV fluids
Chlorphenamine
Hydrocortisone
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19
Q

What strength adrenaline, chlorphenamine and hydrocotsione do you give?

A

Adrenaline (IM):
>12 - 500 micrograms
12-6 - 300 micrograms
<6 - 150 micrograms

Clorphenamine (IM or IV slowly):
>12 - 10milligrams
6-12 - 5milligrams 
6 - 6 months - 2.5milligrams
<6 months - 25 micrograms
Hydrocortisone (IM or IV slowly):
>12 - 200milligrams
12-6 - 100milligrams
6 - 6 months - 50 milligrams
<6 months - 25 milligrams
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20
Q

What is salicylate poisoning?

A

Result of indigestion of or exposure to checmials metabolised by salicylate e.g. Aspirin

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21
Q

What causes salicylate poisonsing?

A

150mg/kg or 6.5g (whichever is less)

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22
Q

What are the risk factors of salicylate poisoning?

A

Ingesting aspirin, oil of wintergreen, bismuth subsalicylate
Hx of self-harm / suicide
<3 or 70

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23
Q

What are the symptoms of Salicylate poisoning?

A 
Nausea
Vomiting
Haematemesis
Epigastric pain
Tachypnoea
Tinnitus/Deafness
Fever
Sweating
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24
Q

What are the signs of Salicylate poisoning?

A 
Abnormal behaviour
Kussmaul breathing
Hypovolaemia
Stupor 
Dizziness
Rales + LowO2 saturation
Rash
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25
Q

What investigations are done for Salicylate poisoning ?

A

ABG (Originally resp. alkalosis, then develop metabolic acidosis)
Serum electrolyte panel - Hypokalaemia, hypocalcaemia, hypomagnaemia
CXR - Pulmonary Oedema
Blood glucose - High or low
Serum Ketones - Positive in kids
LFT - AST and ALT raised
ECG - Tachy, prolonged QT, monomorphic ventricular tachy, torsade de point may be present

26
Q

How do you treat Salicylate poisoning?

A

Sodium Bicarbonate

27
Q

What is Diabetic ketoacidosis?

A

Medical emergency with a significant morbidity and mortality.

28
Q

What characterises DKA?

A

Hyperglycaemia
Acidosis
Ketonaemia

29
Q

Which conditions precipitate DKA?

A

Infection
Discontinuing insulin
Inadequate insulin
CVS disease
Drug treatments (Steroids, thiazide-like diuretics or SGLT2 inhibitors)
Menstruation
Phsyiological stress (pregnancy, trauma and/or stress)

30
Q

What symptoms and signs are found in DKA?

A 
Dehydration
Kussmaul breathing
Deteriorated mental state
Screening in neurological exam
Check surface for abscesses, boil or other rashes
31
Q

What invsetigations are done for Diabetic ketoacidosis?

A 
Capillary blood glucose
Urine dipstick (glycosuria and ketonuria)
Assay blood glucose (Ketonuria)
Glucose (Raised)
Urea and creatinine (Raised)
Cardiac enzymes 
Amylase
Blood cultures
12-lead ECG
CXR
Anion gap (>13)
Plasma osmolality  (>290)
32
Q

How do you calculate the anion gap?

A

[Na+] - [Cl-] + [HCO3-]

33
Q

How do you calculate the plasma osmolality?

A

2([Na+] + [K+]) + [Urea] + [Glucose]

34
Q

How do you manage Diabetic ketoacidosis?

A 
Assess severity
Immediate resuscitation
Large-bore IV 
LMWH and TED stocking
IV insulin and glucose
35
Q

How do you assess severity ?

A 
Check for the following:
- Blood ketones (>6)
- Bicarbonate level (<5)
Venous/arterial pH (<7)
Hypokalaemia (<3.5)
GCS (<12)
O2 sats <92%
SBP (<90)
Tachycardia
Anion gap >16
36
Q

What is a head injury

A

When you have an injury to the head

37
Q

What can be caused by a head injury?

A 
Soon after:
- Extradural/subdural haemorrhage
- Seixures
Late onset:
- Subdural haemorrhage
- Seizures
- Diabetes insipidus
- Parkinsonism
- Dementia
38
Q

What are the symptoms of a head injury?

A 
Unconscious
Headache
Dizziness
Blurred vision
Confused and disorientated
Nausea and vomiting
Varies on severity
39
Q

What are the signs of a head injury?

A

Low GCS
Blurred vision
Papilloedema
Varied pupil size

40
Q

What investigations are done for a head injury?

A 
ABG
FBC
Basic obs
Pupils
Anterograde amnesia
U&amp;E
Glucose
Blood alcohol/toxicology screen
If indicated, CT head
41
Q

What is Multi-organ dysfunction syndrome?

A

A hypometabolic, immunodepressed state with clinical and biochemical evidence of decreased functioning of the body’s organ systems (2 or more systems) that develops after an acute injury or illness

42
Q

What causes Multi-organ dysfucntion syndrome?

A

Complex interplay of interdependent factors

  • Genetics
  • Comborbidities
  • Medication, therapies and ICU supports
  • Macrocirculatory changes
  • Inflammation
  • Coagulation cascade
  • Neuro-endocrine factors
  • Mitochondrial dysfunction
43
Q

Which conditions causes MODS?

A
  • Sepsis
  • Major trauma
  • Burns
  • Pancreatitis
  • Aspiration syndromes
  • Extracorporeal circulation
  • Multiple blood transfusion
  • Ischaemia-reperfusion injury
  • AI disease
  • Eclampsia
  • Poisoning
44
Q

What are the symptoms of MODS?

A

Varies on organ affected

45
Q

What are the signs of MODS?

A

Presence of a Systemic inflammatory response and dysfunction of atleast 2 organs

  • AKI
  • ARDS
  • Cardiomyopathy
  • Encephalopathy
  • GI dysfunction
  • Hepatic dysfunction
  • Coagulopathy and bone marrow suppression
46
Q

What are the investigations for MODS?

A

FBC with relevant added tests according to signs e.g. LFTs, amylase
Monitor closely

47
Q

What is Opiate overdose?

A

Take more opiates than you should

48
Q

What causes opiate overdose?

A

Opiates with widespread disease

  • Codeine
  • Diamorphine
  • Dihydrocodeine
  • Fentanyl
  • Loperamide
  • Methadone
  • Morphine
49
Q

What are the risk factors for opiate overdose?

A 
Mental health condition
Alcoholics
Morphine toxicity at lower dose due to:
- Hepatic impairment
- Renal impairment
- Hypotension
- Hypothyroidism
- Asthma
50
Q

What are the symptoms of opiate overdose?

A 
Constipation
Nausea and vomiting
Loss of appetite
Sedation
Craving next dose 
Drowsiness
Urticarial like rash and itching
51
Q

What are the signs of opiate overdose?

A

Respiratory depression
Hypotension
Tachycardia
Pinpoint pupils

52
Q

What investigations are done for opiate overdose?

A

Toxicology screen
Paracetamol blood level
If in doubt, give a test dose of naloxone

53
Q

How do you treat opiate overdose?

A

Naloxone

54
Q

What is a paracetamol overdose?

A

Excessive ingestion of paracetamol causing toxicity

55
Q

What causes a paracetamol overdose?

A

Intake of 150mg/kg or >12g in adults can cause hepatic necrosis

56
Q

What are the risk factors for paracetamol overdose?

A 
Chronic alcohol abusers
Patients on enzyme-inducing drugs
Malnourished
Anorexia nervosa
HIV
Paracetamol overdose
57
Q

What are the symptoms of paracetamol overdose?

A 
0-24 hours:
- Asymptomatic
- Mild nausea/vomiting
- Lethargy
- Malaise
24-72 hours
- RUQ pain
- Vomiting
72+ hours
- Increased confusion (encephalopathy)
- Jaundice
- AKI
58
Q

What are the signs of paracetamol overdose?

A 
0-24 hours
- No signs
24-72 hours
- Hepatomegaly and tenderness
72+ hours
- Jaundice
- coagulopathy
- Hypoglycaemia
- Renal angle tenderness
59
Q

What investigations are done for paracetamol overdose?

A

Measure paracetamol levels
- Peaks at 4hrs after ingestion
Others: FBCs, U&Es, LFTs, Glucose, LFTs, Clotting screen, Lactate and ABG

60
Q

How do you treat paracetamol overdose?

A

N-acteylcysteine

Conditions (18 decks)

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