Acute medicine Flashcards
ABCDE protocol
Airway
- assess: patency, secretions/vomit, obstruction
- manage: airway manoeuvres, suction, airway adjunct
Breathing
- assess: RR, O2 sats, palpation/percussion/auscultations, later CXR
- manage: O2
Circulation
- asses: HR + BP, cap refill/perfusion, cyanosis, auscultation
- manage: fluids, bloods/ABG
Disability
- asses: AVPU/GCS, glucose, PEARL
Exposure
- assess: whole body inspection
*Use SBAR for handover: situation, background, assessment, recommendation
Why does alcohol withdrawal occur?
Alcohol is a depressant (GABA agonist) so chronic use leads to upregulation of glutamate receptors
When alcohol is removed, the upregulation of glutamate receptors means there is an increase in CNS stimulation thus there is a gradula increase in CNS overactivity
Timeline of alcohol withdrawal
Minor 6hrs
- anxiety, tremor, palpitations, GI upset
Hallucinations 12hrs
Seizures 32 hrs
- short, generalised tonic-clonic seizures
Delirium tremens 48hrs
- delirium, severe tremor, fever, FATAL
Ddx of delirium tremens
Acute liver failure
- ammonia (encephalopathy), albumin (ascites + peripheral oedema), bilirubin (jaundice), blood factors (bruising)
Wernicke’s encephalopathy
- Confusion, Ataxia, Nystagmus
Hx and O/E of alcohol withdrawal
CAGE question./longer AUDTI question.
Signs of alcohol abuse (smell, hygiene etc.)
Chronic liver disease signs
Mx of alcohol withdrawal
1) Benzodiazepines (chlordianzepoxide, diazepam)
2) Pabrinex (B1 to prevent Wernicke’s)
3) Glucose (if hypo + needed with pabrinex)
4) Manage alcohol dependence (Drug+Alcohol Liaison specialist, therapy)
What scale is used to assess severity of alcohol withdrawal?
CIWA-Ar scale
- Nausea/vomiting
- Tremor
- Paroxysmal sweats
- Anxiety
- Agitation
- Tactile disturbances
- Auditory disturbances
- Visual disturbances
- Headache/fullness in head
- Orientation/clouding of sensorium
- dw don’t need to memorise
What should you also consider if you suspect alcohol withdrawal?
Hypoglycaemia
Electrolyte distubrances
Hepatic encephalopathy
Anaphylaxis presentation
Airway = throat/tongue swelling, stridor
Breathing = SOB, increased HR, decreased O2
Circulation = SHOCK; decreased BP, increased HR, low consciousness
Shin/mucosal = uritcaria + angioedema, flushing
Sense of impeding doom
What causes anaphlyaxis?
Life-threatening, systemic, hypersensitivity reaction
- mast-cell/basophil degranulation
- increased capillary permeability, bronchospasm, decreased vascular tone
3 common triggers
1) Food (child) - nuts
2) Drugs/chemicals (adults) - penicillin
3) Toxins - bee/wasp stings
* RF = Hx of atopy
Mx of anaphylaxis
I. HELP II. Remove trigger III. Lie flat and raise legs IV. IM adrenaline 0.5mg 1:1000 V. Airway, breathing, circulation VI. IV chlorpheniramine + IV hydrocortisone
What further ix could confirm anaphylaxis?
Increased serum tryptase and plasma histamine on blood tests
What should follow up involve after an anaphylaxis reaction?
Refer to immunology/allergy clinic
- RAST specific IgE testing to determine allergies
Provide EpiPen and education re anaphylaxis
Get a medic alert bracelet
Poisoning summary card
Administration of XS pharmaceutical agent
- accidental in <10yo, deliberate >10yo (typically alcohol in 15-35 yo)
Ix
- ABCDE, ABG, ECG, FBC, U&E, LFT, INR, glucose, paracetamol + salicylate levels
Mx
- TOXBASE, National Poisons Information Service
- consider activated charcoal if = 4hrs to reduce absorption of drug
- consider gastric lavage (rare)
Compare early and late presentations of aspirin overdose
Early
- N&V, diarrhoea
- ‘per-spirin-g’ = hyperthermia, sweating
- ‘raspi-irin’ = hyperpnoea (stimulates respiratory centre in medula)
- ‘aspirin-ging’ = tinnitus, deafness, dizziness
Late/severe
- pulmonary oedema
- decreased BP and heart block
- seizures + decreased GCS