Acute Care & Trauma Flashcards
What is the pathophysiology of biochemical derangements in Aspirin overdose
Increase RR and depth
Hyperventilation –> Respiratory alkalosis
Increase bicarbonate loss in urine and K excretion
This leads to dehydration and hypokalaemia and then eventually a metabolic acidosis
What are the signs and symptoms of Aspirin overdose
Early
- Tinnitus
- Flush
- Fever
- Sweating
- Hyperventilation
- Dizziness
- Deafness
Later
- Lethargy
- Confusion
- Convulsions
- Drowsiness
- Respiratory depression
- Coma
Tachycardia
Epigastric tenderness
How is an Aspirin overdose diagnosed
FBC
U+Es
LFTs (high AST/ALT)
Clotting screen (high PT)
ABG: Respiratory alkalosis –> metabolic acidosis
ECG: Hypokalaemia (flat/inverted T, prominent U waves, prolonged PR, ST depression)
Salicylate levels: Elevated - Gold standard
What are possible signs and symptoms of Head injury
- LOC
- Persistent headache or headache that worsens
- Repeated vomiting or nausea
- Convulsions or seizures
- Dilation of one or both pupils of the eyes
- Clear fluids draining from the nose or ears
- Inability to awaken from sleep
- Weakness or numbness in fingers and toes
- Loss of coordination
- Profound confusion
- Agitation, combativeness or other unusual behavior
- Slurred speech
- Coma and other disorders of consciousness
When should someone be admitted for a Head injury
- New, clinically significant abnormalities on imaging.
- Not returned to GCS equal to 15 after imaging, regardless of the imaging results.
- When a patient fulfils the criteria for CT scanning but this cannot be done.
- Continuing worrying signs (eg, persistent vomiting, severe headaches).
- Other sources of concern - eg, drug or alcohol intoxication, other injuries, shock, suspected non-accidental injury, meningism, CSF leak).
How should a Head injury investigated
CT head within 1 hour if:
- GCS <13 when first assessed of GCS <15 2 hours after injury
- Suspected open or depressed skull fracture
- Signs of base of skull fracture
- Post-traumatic seizure
- Focal neurological deficit
- > 1 episode of vomiting
All patients with a coagulopathy or on anticoagulants should have a CT brain within eight hours of the injury, provided there are no other identified risk factors, as listed above.
CT Cervical spine within 1hr if:
- GCS is <13
- The patient is intubated
- Plain X rays are abnormal or technically inadequate
- A definitive diagnosis is needed - eg, before surgery
The patient is alert and stable and there is a clinical suspicion of cervical injury with any one of the following:
- Age 65 years or older
- Dangerous mechanism of injury - eg, a fall of height >1 m, a fall down five stairs, axial load to head
- Focal neurological deficit
- Paraesthesia in the upper or lower limbs
Other areas are also to be scanned - eg, multi-region trauma
What are signs of a base of skull fracture
Haemotympanum
Bruising around the eyes
CSF leakage (Ears or nose)
Battle’s sign (Brusing which sometimes occurs behind the ear)
What is Multi-organ dysfunction syndrome (MODS)
The development of progressive and potentially reversible physiologic dysfunction of 2 or more organs or organ systems that is induced by a variety of insults, including sepsis
What are causes of MODS
Infection
Injury
Hypo-perfusion
Hyper-metabolism
The primary cause can trigger a systemic inflammatory response
MODS is the final stage in a continuum beginning with systemic inflammatory response syndrome (SIRS) + infection
SIRS+Infection –> Sepsis –> Severe sepsis –> MODS
What are the signs and symptoms of MODS
Stage 1: Increased volume requirements, mild respiratory alkalosis, oliguria, hyperglycaemia, increased insulin requirements
Stage 2: Tachypnoea, Hypocapnia, Hypoxaemia, moderate liver dysfunction and haematological abnormalities
Stage 3: Shock, Azotaemia, acid-base disturbance, significant coagulation abnormalities
Stage 4: Vasopressor dependant, oliguria or anuria, development of ischaemic colitis and lactic acidosis
What are the risk factors for Opiate overdose
Drugs:
- Codeine
- Diamorphine
- Dihydrocodeine
- Fentanyl
- Loperamide
- Methadone
- Morphine
RFs: Mental health conditions Alcoholics Morphine toxicity at a lower dose due to: - Asthma - Renal impairment - Hepatic impairment - Hypotension - Hypothyroidism
Older patients due to them being more likely to be on opiates
What are signs and symptoms of Opiate overdose
Constipation N+V Anorexia Sedation Craving the next dose Drowsiness
Respiratory depression
Hypotension and tachycardia
Pinpoint pupils
How are Opiate overdoses investigated
- Toxicology screen - Positive opioids in urine
- Trail if naloxone
What is the threshold for Paracetamol overdose
Max recommended dose is 4g in a day. 2x500mg 4x in 24hrs
Intake of >12g can be hepatotoxic
What are risk factors for Paracetamol overdose
Alcoholic Patient on enzyme inducer - Anticonvulsant Malnourished Anorexia nervosa HIV
