Acute Medicine Flashcards
alcohol withdrawal aetiology
in an alcohol dependent person body cannot immediately adapt to reduced ethanol conc. therefore there is an excess excitatory effect from the upregulation of NMDA receptors and downregulation of inhibitory GABA (type A) receptors
signs of chronic or decompensated liver disease
caput medusa
palmar erythema
hepatic encephalopathy
hepatomegaly
jaundice
ascites
signs of Wernicke’s encephalopathy
confusion
ataxia
nystagmus
alcohol withdrawal presentation
minor symptoms (SNS, 6hrs)
- anxiety/agitation
- palpitations
- GI upset
- sweating/tremor
alcoholic hallucinosis (mind, 12hrs)
- hallucinations
withdrawal seizures (body, 24hrs)
- generalised tonic-clonic seizures
withdrawal delirium (systematic, 48hrs)
- delirium tremens
- severe tremour
- fever
- high BP + HR
alcohol withdrawal Ix
CAGE/AUDIT-C
CIWA-AR scale
ECG
VBG
glucose (hypo)
FBC
U+E
LFT
coagulation
CT head
CXR
alcohol withdrawal Mx
urgent:
benzos
CT head - head injury, cognition, seizures
treat co-existing illness
supportive:
rehydrate - IV fluid
Pabrinex - vitB, for Wernicke’s
glucose if hypo
electrolyte imbalances
manage underlying alcohol dependence long-term
anaphylaxis aetiology
triggers: foods, drugs, chemicals
RF: Hx of atophy
systemic mast degranulation > vessel dilation, increase vessel permeability, bronchospasm
anaphylaxis Ix
medical emergency
A-E (with reassessment)
if uncertain elevated serum tryptase and plasma histamine
anaphylaxis presentation
shortness of breath
stridor
wheezing
pale and clammy
hypotension
flushing
urticaria
angio-oedema
anaphylaxis Mx
call for help, lie flat, IM adrenaline
monitoring, high flow O2, IV fluid, chlorphenamine, hydrocortisone
aftercare: observe, safety net, EpiPen, refer to allergy services
aspirin OD aetiology
OD >150mg/kg
severe if >500mg/kg
aspirin OD presentation
early:
tinnitus, deafness, dizziness
hyperpnoea
hyperthermia, sweating
N+V, diarrhoea
late/severe:
low BP and heart block
pulmonary oedema
low GCS and seizures
clinical examination findings for aspirin OD
warm peripheries and bounding pulse
tachypnoea and hyperventilation
cardiac arrythmia
acute pulmonary oedema
aspirin OD ix
ECG- arrythmia
CBG, ABG
plasma salicylate concentration
plasma paracetamol conc
FBC, LFT, U&Es, coagulation
CT head
aspirin OD mx
supportive
consider ICU
consider GI tract decontamination with charcoal
paracetamol OD aetiology
OD > 150mg/kg
paracetamol OD presentation
<24hrs
often asymptomatic
mild n+v and lethargy
24-72hrs
RUQ pain
vomiting
hepatomegaly
> 72hrs
acute liver failure (jaundice)
paracetamol OD ix
ABG - lactic acidosis bad sign
urinalysis - haematuria or proteinuria indicate kidney failure
serum paracetamol concentration
LFT
prothrombin time/INR
blood glucose
U&E- raised creatinine
FBC - leucocytosis, anaemia, thrombocytopenia
paracetamol OD Mx
supportive care according to symptoms
consider:
IV N-acetylcysteine
active charcoal if presenting within an hour of ingestion
opiate OD presentation
early:
reduced consciousness
respiratory distress
miosis
bradycardia, hypotension
late/severe:
low GCS
coma
opiate OD Ix
CBG, ABG
plasma paracetamol concentration
FBC
U+E
LFT
CT head
opiate OD mx
with cardiac arrest:
-CPR and advanced life support
-consider IV naloxone (not helpful if pulseless)
no cardiac arrest:
- first ventilation then IV naloxone
