acute care/ED Flashcards by Alaina Francis

normal anion gap

less than 18

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what is the classification for open fractures

Gustilo-Anderson classification

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cholinergic toxidrome

fluid comes out of everywhere (SLUD)

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mechanism of amitiriptyline in analgesia

increases descending inhibitory signals

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causes of shock in trauma situation

SHOC N A

Sepsis

hypovolaemic

obstructive

cardiogenic

neurogenic

anaphylactic

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how much saline do you give someone in anaphylaxis

20ml/kg body weight - repeated up to a total of 50ml/kg over the first half hour

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what is the toxic dose for paracetamol

10g or 200g/kilo (whichever is less)

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what are the acute complications of fractures

bleeding

infection

nerve damage

deformity

compartment syndrome

vascular damage

surgery itself –> PE, pneumonia etc

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what type of fibres carry pain

A-delta - sharp pain

C fibres

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history red flags for fever

rapid progression

patient presents for a second time within a short period

severe muscle pain - incapacitated

severe localised pain

repeated vomiting but no diarrhoea

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what are the effects of adrenaline

beta 1 agonist - inotrope and chronotrope

beta 2 agonist - bronchodilation

alpha agonist - vasoconstriction, reduces release of mediators from mast cells and basophils (increases BP and improves ventilation)

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sedative toxidrome

drowsiness

ataxic

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what are the risk factors for paracetamol toxicity

decreased glutathione (from malnutrition, eating disorders, HIV)
induction of liver cytochrome p450 2E1 and 3A4 (alcoholics, carbamazepine, phenytoin, rifampicin)

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how long do you have to observe someone after anaphylaxis resolution

4-6 hours

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where does pain perception occur

in the cortex

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which two drugs are notorious for causing non-immunologic anaphylaxis

pethidine and vacomycin

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what are the 3 diagnostic tests for allergy

skin prick test

serological assay

challenge test

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definition of sepsis

SIRS + infection

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treatment of tension pneumothorax

large bore needle into 2nd intercostal space, mid clavicular line

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most common clinical findings with anaphylaxis

uticaria

angioedema

bronchospasm/laryngeal oedema

cardiovascular collapse

GI symptoms

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which medications can cause neurogenic shock post op

epidurals, opiates

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how do we decide whether or not someone is administered N-acetyl cysteine for paracetamol toxicity

look at Nomogram - if above the line (after 4 hour mark after ingestion) - give drug

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which type of fluids are the best to give for shock and what volume

crystalloid - 1-2 L or 20ml/kg in children

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why is flumazenil not routinely used for benzo overdose

can precipitate:

arrhythmias and convulsions
withdrawal in chronic benzo users

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which analgesics are good for neuropathic pain

amytriptyine gabapentin carbamazepine sodium valproate

mechanism of action of opioids

acts on Mu opioid receptors to produce analgesia (receptors in periphery, dorsal horn, cortex and descending tracts)

mechanism of action of tramadol

weak opioid effect plus inhibits serotonin and noradrenaline reuptake

what does anaphylaxis cause

- increased vascular permeability --\> 30-40% of blood volume can leave the intravascular space - vasodilation - respiratory SM constriction - autonomic nervous stimulation - mucous secreiton - platelet aggregation -\> microvascular thrombus

how does GHB work

metabolite of GABA - CNS inhibitory NT

what is metabolic acidosis with normal anion gap due to

loosing bicarbonate given too much IV fluid

what are tjhe metabolic acidosis rules

CO2 should be the same as the last 2 digits of the pH HCO3- + 15 is the same as the last 2 digits of the pH

what is the dose for nebulised adrenaline during anaphylaxis

5mls of 1:1000 neat into nebuliser repeated every 10 minutes prn

3 routine investigations performed on all patients suspected of overdose/poisoning

ECG glucose paracetamol concentration

what does SIRS stand for

systemic inflammatory response syndrome

what is angioedema

non-pruritic swelling of the deep dermis or subcutaneous tissue

what is the metabolic alkalosis rule

HCO3+ 15 is the same as the last 2 digits of the pH CO2 increases by 6 for every HCO3 10

what is the typical presentation of a red back spider bit

very painful very quickly obvious piloerection and sweating at bite site

what is anaphylaxis

a rapidly evolving generalised multi system allergic reaction characterised by one or more Sx or signs of respiratory and/or cardiovascular involvement AND involvement of other systems such as skin and/or GI tract

how do you calculate anion gap

((Na+) + (K+)) - ((Cl-) + (HCO3-))

how does the blue ringed octopus cause muscle paralysis

injects tetrodotoxin

how should you describe a fracture

site open/closed area of bone involved type of fracture deformity

most common causes of metabolic alkaosis

vomiting NG tube aspirate diuretics

what is the definition of SIRS

a clinical syndrome that is a form of DYSREGULATED inflammation. Need two of the following: - temp \> 38 or - RR \> 20 bpm - HR \> 90 per minutes - WCC \> 12 x 10^9 or 10% band forms

how can we increase the elimination of a drug that is renally excreted

alkalinse the urine for aspirin/phenobarbitone overdose dialysis activated charcoal

what signs must you look for in a fracture

deformity open vs closed NV status swelling

adverse effects of opiods

- respiratory depression - sedation - N&V - euphoria - bradycardia - postural hypotension - urinary retention - miosis

what are the respiratory alkalosis "rules"

every 10 CO2 decreases, HCO3 decreases by 2.5

sympathethomimetic toxidrome

tachycardia hypertension sweating dilated pupils

what addition drug may you give someone in anaphylactic shock other than adrenaline if they have had previous beta blockade

glucagon - acts via non adrenergic pathway

what is the difference in presentation of shock caused by neurogenic cause

no tachycardia

what is uticaria

circumscribed, slightly elevated lesions that are intensely pruritic and erythematous occuring due to allergy

what is the antidote for benzodiazepines

flumazenil - but NOT used routinely

management of shock

resuscitate patient - ABCs, IV, O2, monitor figure out cause

order of the best ways to take a patient's temperature

rectal \> pulmonary artery \> tympanic membrane \> oral

management of anaphylaxis

AIRWAY IV access for intravenous saline monitoring DRUGS - adrenaline!

what are the respiratory acidosis "rules"

every 10 CO2 rises HCO3 rises by 1

what are the 4 types of shock

hypovolaemic obstructive cardiogenic distributive - neurogenic, septic, anaphylactic

signs of tension pneumothorax

hyper-resonance muffled heart sounds hypotension

adverse effects of NSAIDs

- peptic ulceration - renal impairment - bronchoconstriction in asthmatics - anti-platelet effects - exacerbation of CCF

what dose of adrenaline do you give someone with anaphylaxis (not already in CV collapse)

0.01mg/kg - max 0.5mg (IM)

anticholinergic toxidrome

tachycardia hypertension sweating dilated pupils dry skin

how does NAC work to prevent paracetamol toxicity

acts as a glutathione donor - thiol groups bind with it and scavenge the toxic metabolite

how long does it take to present with symptoms of paracetamol toxicity

36-48 hours

how can the effects of an ingested agent be reduced (decontamination)

activated charcoal whole bowel irrigation gastric lavage

4 causes of metabolic acidosis with increased anion gap

ketoacidosis lactic acidosis renal failure poisons

what are the antidotes for paracetamol poisoning and opiates

opiates = naloxone paracetamol = N-acetyl cysteine

2 types of anaphylaxis

immunologic - IgE mediated reactions non-immunologic - agent causes direct mast cell degradulation

opioid toxidrome

reduced conscious state fixed small pupils reduced respiration rate

definition of shock

mismatch of supply and demand at the tissue level -\> leading to reduced tissue perfusion and oxygenation