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Z MD 2 > acute care/ED > Flashcards

acute care/ED Flashcards

1
Q

normal anion gap

A

less than 18

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2
Q

what is the classification for open fractures

A

Gustilo-Anderson classification

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3
Q

cholinergic toxidrome

A

fluid comes out of everywhere (SLUD)

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4
Q

mechanism of amitiriptyline in analgesia

A

increases descending inhibitory signals

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5
Q

causes of shock in trauma situation

A

SHOC N A

Sepsis

hypovolaemic

obstructive

cardiogenic

neurogenic

anaphylactic

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6
Q

how much saline do you give someone in anaphylaxis

A

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

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7
Q

what is the toxic dose for paracetamol

A

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

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8
Q

what are the acute complications of fractures

A

bleeding

infection

nerve damage

deformity

compartment syndrome

vascular damage

surgery itself –> PE, pneumonia etc

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9
Q

what type of fibres carry pain

A

A-delta - sharp pain

C fibres

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10
Q

history red flags for fever

A

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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11
Q

what are the effects of adrenaline

A

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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12
Q

sedative toxidrome

A

drowsiness

ataxic

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13
Q

what are the risk factors for paracetamol toxicity

A
  • decreased glutathione (from malnutrition, eating disorders, HIV)
  • induction of liver cytochrome p450 2E1 and 3A4 (alcoholics, carbamazepine, phenytoin, rifampicin)
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14
Q

how long do you have to observe someone after anaphylaxis resolution

A

4-6 hours

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15
Q

where does pain perception occur

A

in the cortex

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16
Q

which two drugs are notorious for causing non-immunologic anaphylaxis

A

pethidine and vacomycin

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17
Q

what are the 3 diagnostic tests for allergy

A

skin prick test

serological assay

challenge test

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18
Q

definition of sepsis

A

SIRS + infection

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19
Q

treatment of tension pneumothorax

A

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

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20
Q

most common clinical findings with anaphylaxis

A

uticaria

angioedema

bronchospasm/laryngeal oedema

cardiovascular collapse

GI symptoms

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21
Q

which medications can cause neurogenic shock post op

A

epidurals, opiates

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22
Q

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

A

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

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23
Q

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

A

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

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24
Q

why is flumazenil not routinely used for benzo overdose

A

can precipitate:

  • arrhythmias and convulsions
  • withdrawal in chronic benzo users
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25
Q

which analgesics are good for neuropathic pain

A

amytriptyine

gabapentin

carbamazepine

sodium valproate

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26
Q

mechanism of action of opioids

A

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

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27
Q

mechanism of action of tramadol

A

weak opioid effect plus inhibits serotonin and noradrenaline reuptake

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28
Q

what does anaphylaxis cause

A
  • 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
29
Q

how does GHB work

A

metabolite of GABA - CNS inhibitory NT

30
Q

what is metabolic acidosis with normal anion gap due to

A

loosing bicarbonate

given too much IV fluid

31
Q

what are tjhe metabolic acidosis rules

A

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

32
Q

what is the dose for nebulised adrenaline during anaphylaxis

A

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

33
Q

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

A

ECG

glucose

paracetamol concentration

34
Q

what does SIRS stand for

A

systemic inflammatory response syndrome

35
Q

what is angioedema

A

non-pruritic swelling of the deep dermis or subcutaneous tissue

36
Q

what is the metabolic alkalosis rule

A

HCO3+ 15 is the same as the last 2 digits of the pH

CO2 increases by 6 for every HCO3 10

37
Q

what is the typical presentation of a red back spider bit

A

very painful very quickly

obvious piloerection and sweating at bite site

38
Q

what is anaphylaxis

A

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

39
Q

how do you calculate anion gap

A

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

40
Q

how does the blue ringed octopus cause muscle paralysis

A

injects tetrodotoxin

41
Q

how should you describe a fracture

A

site

open/closed

area of bone involved

type of fracture

deformity

42
Q

most common causes of metabolic alkaosis

A

vomiting

NG tube

aspirate

diuretics

43
Q

what is the definition of SIRS

A

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
44
Q

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

A

alkalinse the urine for aspirin/phenobarbitone overdose

dialysis

activated charcoal

45
Q

what signs must you look for in a fracture

A

deformity

open vs closed

NV status

swelling

46
Q

adverse effects of opiods

A
  • respiratory depression
  • sedation
  • N&V
  • euphoria
  • bradycardia
  • postural hypotension
  • urinary retention
  • miosis
47
Q

what are the respiratory alkalosis “rules”

A

every 10 CO2 decreases, HCO3 decreases by 2.5

48
Q

sympathethomimetic toxidrome

A

tachycardia

hypertension

sweating

dilated pupils

49
Q

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

A

glucagon - acts via non adrenergic pathway

50
Q

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

A

no tachycardia

51
Q

what is uticaria

A

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

52
Q

what is the antidote for benzodiazepines

A

flumazenil - but NOT used routinely

53
Q

management of shock

A

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

54
Q

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

A

rectal > pulmonary artery > tympanic membrane > oral

55
Q

management of anaphylaxis

A

AIRWAY

IV access for intravenous saline

monitoring

DRUGS - adrenaline!

56
Q

what are the respiratory acidosis “rules”

A

every 10 CO2 rises HCO3 rises by 1

57
Q

what are the 4 types of shock

A

hypovolaemic

obstructive

cardiogenic

distributive - neurogenic, septic, anaphylactic

58
Q

signs of tension pneumothorax

A

hyper-resonance

muffled heart sounds

hypotension

59
Q

adverse effects of NSAIDs

A
  • peptic ulceration
  • renal impairment
  • bronchoconstriction in asthmatics
  • anti-platelet effects
  • exacerbation of CCF
60
Q

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

A

0.01mg/kg - max 0.5mg (IM)

61
Q

anticholinergic toxidrome

A

tachycardia

hypertension

sweating

dilated pupils

dry skin

62
Q

how does NAC work to prevent paracetamol toxicity

A

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

63
Q

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

A

36-48 hours

64
Q

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

A

activated charcoal

whole bowel irrigation

gastric lavage

65
Q

4 causes of metabolic acidosis with increased anion gap

A

ketoacidosis

lactic acidosis

renal failure poisons

66
Q

what are the antidotes for paracetamol poisoning and opiates

A

opiates = naloxone

paracetamol = N-acetyl cysteine

67
Q

2 types of anaphylaxis

A

immunologic - IgE mediated reactions

non-immunologic - agent causes direct mast cell degradulation

68
Q

opioid toxidrome

A

reduced conscious state

fixed small pupils

reduced respiration rate

69
Q

definition of shock

A

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

Z MD 2 (15 decks)

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