Acute Med Flashcards
4 signs of acute liver failure
Ammonia encephalopathy
Albumin ascites and peripheral oedema
Bilirubin jaundice
Blood factors bruising
Triad of Wernicke’s encephalopathy
Confusion
Ataxia
Nystagmus
What are the CAGE questions?
Have you ever felt you needed to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?
Mx of alcohol withdrawal (4)
Benzodiazepines (chlordiazepoxide, diazepam)
Pabrinex (B vitamins) to prevent Wernicke’s
Glucose (if hypoglycaemic)
- Manage alcohol dependence:
Drug and Alcohol Liaison Specialist (DALS)
Community services (e.g alcoholics anonymous)
Therapy etc.
Presentation of alcohol withdrawal (6, 12, 36 and 48hrs)
Agitation 6hrs
Hallucinations 12hrs
Seizures 36hrs
Delirium Tremens 48hrs
Ix for alcohol withdrawal (5)
CIWA-Ar to assess severity
FBC/U&E/LFT, INR, Glucose
Which Ig and cell is involved in immunologic human anaphylaxis
IgE
Mast-cell/basophil degranulation
Three parts of anaphylaxis
Increased capillary permeability
Bronchospasm
Reduced vascular tone
Mx of anaphylaxis
IM adrenaline 0.5mg 1:1000
ABC
IV chlorphenamine and IV hydrocortisone
Ix in suspected poisoning
ABCDE ECG FBC, U&E, LFT, INR, glucose Paracetamol and salicylate levels ABG
What should be considered to reduce absorption of drug if under 4hours
Activated charcoal
S/s of aspirin OD early (4)
Tinnitus, deafness, dizziness (aspiringing)
Hyperpnoea (rasp-irin)
N&V/diarrhoea (most poisonings)
Hyperthermia and speaking (Per-spirin-g)
S/s of aspirin OD late/severe (3)
Low BP and heart block
Pulmonary oedema
Low GCS + seizures
Blood gas findings of aspirin OD early and late
Early respiratory alkalosis
Late: high anion gap metabolic acidosis
Mx of aspirin OD
Urine alkalinisation with IV sodium bicarbonate
Dialysis
Pathophysiology of paracetamol OD
Physiology: XS paracetamol metabolised by CYP450 in liver to NAPQI, which is conjugated with glutathione and excreted
Pathophysiology: glutathione depleted, toxic NAPQI accumulates, hepatocyte necrosis
Presentation of paracetamol OD (under 24 hrs, 24-72hrs, after 72)
<24 hrs: mild N&V, lethargy
24-72 hrs: RUQ pain, vomiting, hepatomegaly
>72hrs: acute liver failure
How many grams/kg for a paracetamol OD
OD> 150mg/kg, 12g can be fatal
How many grams/kg of aspirin for OD and how many for serious OD
OD >150mg/kg, severe if >500mg/kg
Mx of paracetamol OD
IV N-acetyl cysteine if below treatment line
Liver transplant
Opiate OD presentation (5)
CNS depression (PNS effects): Respiratory depression Bradycardia, Hypotension Pinpoint pupils Late/severe: low GCS/coma
Mx of opiate OD
IV naloxone
What commonly causes catheter blockage
Can be due to biofilm formation (infection with Proteus mirabilis commonly)
Indication for a 3 way catheter
recurrent clots/haematuria
Indications of a suprapubic catheter (2)
Long-term use, urethral damage (trauma, surgery, stricture)
Three types of catheter
Foley
3 way
Suprapubic
Whats the indication for packed red cells
if Hb <70g/l or >30% loss of blood volume
Whats the indication for platelets
If platelets <20*109/L
Whats the indication for FFP
To correct clotting defects e.g DIC
Early complications of blood transfusion (5)
Anaphylaxis Acute haemolytic reaction Bacterial infection Febrile non-haemolytic reaction Transfusion associated circulatory overload (TACO) or transfusion associated lung injury (TRALI)
Late complications of blood transfusion (4)
Delayed haemolytic reaction
Infection
Transfusion associated graft vs host disease
Iron overload
How much does 1 unit of packed red cells increase Hb by
1 unit increases Hb by 10-15g/l
Complications of epidural (4)
Dural puncture
Vessel puncture
Hypoventilation
Epidural haematoma or abscess
