Acute Care and Trauma Conditions Flashcards

Question

What investigations are done for Salicylate poisoning ?

Answer 1

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

Answer 2

Sodium Bicarbonate

Answer 3

Medical emergency with a significant morbidity and mortality.

Answer 4

Hyperglycaemia Acidosis Ketonaemia

Answer 5

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

Answer 6

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

Answer 7

``` 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) ```

Answer 8

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

Answer 9

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

Answer 10

``` Assess severity Immediate resuscitation Large-bore IV LMWH and TED stocking IV insulin and glucose ```

Answer 11

``` 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 ```

Answer 12

When you have an injury to the head

Answer 13

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

Answer 14

``` Unconscious Headache Dizziness Blurred vision Confused and disorientated Nausea and vomiting Varies on severity ```

Answer 15

Low GCS Blurred vision Papilloedema Varied pupil size

Answer 16

``` ABG FBC Basic obs Pupils Anterograde amnesia U&E Glucose Blood alcohol/toxicology screen If indicated, CT head ```

Answer 17

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

Answer 18

Complex interplay of interdependent factors - Genetics - Comborbidities - Medication, therapies and ICU supports - Macrocirculatory changes - Inflammation - Coagulation cascade - Neuro-endocrine factors - Mitochondrial dysfunction

Answer 19

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

Answer 20

Varies on organ affected

Answer 21

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

Answer 22

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

Answer 23

Take more opiates than you should

Answer 24

Opiates with widespread disease - Codeine - Diamorphine - Dihydrocodeine - Fentanyl - Loperamide - Methadone - Morphine

Answer 25

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

Answer 26

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

Answer 27

Respiratory depression Hypotension Tachycardia Pinpoint pupils

Answer 28

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

Answer 29

Excessive ingestion of paracetamol causing toxicity

Answer 30

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

Answer 31

``` Chronic alcohol abusers Patients on enzyme-inducing drugs Malnourished Anorexia nervosa HIV Paracetamol overdose ```

Answer 32

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

Answer 33

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

Answer 34

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

Answer 35

N-acteylcysteine