Acute Medicine Flashcards
Acute Medicine primary actions?
ABCDE
Disability e.g. AVPU
Airway management?
Assess: patency, secretions and vomit or obstruction
Manage: airway manouvres, suction or aiway adjuncts
Breathing management?
Assess: RR or O2, palpations, percussion, auscultations, later CXR
Manage: Oxygen
Circulation management?
HR and BP, cap refill perfusion, cyanosis, aucultation
Manage: fluids, bloods or ABG
Disability management?
Assess: AVPU or GCS, or glucose, PEARL
Exposure management?
Assess: whole body inspection
SBAR for handover
What is alcohol withdrawal?
physical and psychological symptoms associated with sudden decrease in alcohol consumption
What causes alcohol withdrawal symptoms?
Alcohol is a CNS depressant so increased CNS stimulation through upregulated glutamate causes it
How does alcohol withdrawal present?
Day 1: anxiety, palpitations, GI upset, sweating and tremor
12hours = visual tactile (little people and insects on skin) hallucinations and normal mental stus
Day 2: 36hrs = short, generalised tonic-clonic seizures
Day 3 48 to 72hrs can be delirium tremens (fatal) -> delirium, severe tremor, fever and high BP and HR
Alcohol withdrawal DDx of delirium tremens (confusion)
Acute liver failure so Ammonia, albumin, bilirubin, blood factors
Ammonia -> encephalopathy
Albumin -> Ascites + peripheral oedema
Bilirubin -> jaundice
Blood factors -> bruising
What is wernickes encephalopathy?
CAN = Confusion, ataxia, nystagmus due to vitamin B1 deficiency
Hx + Exam for alcohol withdrawal?
Hx + exam: screen for alcohol use disorder e.g. CAGE
Severity of withdrawal = CIWA-Ar scale
)/E signs of alcohol abuse (chronic liver disease) e.g. spider naevi, gynaecomastia
Bedisde Obvs for alcohol withdrawal?
Obvs -> tachycardia, temperatuer urine distick and U&Es
Bloods for alcohol withdrawal?
FBC, U&Es, LFTs, INR and glucose
Management of alcohol withdrawal?
1) Benzodiazepine se.g. chlordiazepoxide, diazepam)
2) Pabrinex (b vitamines to prevent wernickes)
3) glucose if hypoglycaemic
4) manage alcohol dependece
What is anaphylaxis?
Life-threatening, systemic, hypersensitivity reaction characterised by airway +/- breathing +/- circulation problems. Usually associated with skin/mucosal changes
What are common triggers for anaphylaxis?
0-4YO
1) food e.g. nuts
2) Drugs/chemics e.g. penicillin, NSAIDs, latex, contrast
3) Toxins e.g. beewasp, venom
Rf for anaphylaxis?
Hx of atopy e.g. hayfever or asthma
What pathophysiological cause of anaphylaxis symptoms?
Mast cell and basophil degranulation = increased cap permeability, bronchospasm and reduced vascular tone
Anaphylaxis presentation?
Airway = angioedema of throat, swelling and stridor Breathing = SOB, increased RR decreased O2 Circulation = SHOCK -> low bp, high hr, decreased consciousness
Skin mucousal = urticaria and angioedema, flushing
SENSE OF IMPENDING DOOM
Management for anaphylaxis?
1) HELP
2) Remove trigger
3) Lie flat and raise legs
4) IM adrenaline 0.5mg 1:1000
5) airway, breathing, circulation
6) IV chlorphenamine + IV hydrocortisone
Further investigation = serum tryptase and plasma histamine
What follow up for anaphlaxis?
Refer to allergy or immunology e.g. RAST specifiv IgE testing
Provide epipen and education re anaphylaxis
Medic alert bracelet
RFs for overdose?
<10 usually accidental
>10 usually deliberate and associated with alcohol abuse
What to use in management?
TOXBASE
NPIS helpline
Consider activated charcoal if <4hours
Consider gastric lavage
How much for aspiring OD?
Usually 300mg tablets so OD >150mg/kg, sever if >500mg/kg
Early aspirin OD presentation?
Tinnitus, deafnes, dizziness, hyperpnoea, N+V, diarrhoea + hyperthermia, sweating
Per-spiring-g
Late Aspiring OD presentation?
Low bp + Heart block, pulmonary oedema and low GCS + seizire
Lab findings for Aspirin OD?
Early respiratory alkalosis
Late high anion gap metabolic acidosis
Aspirin OD management?
urine alkalinisation with IV sodium bicard
Dialysis
Supportive
Paracetamol OD Amount?
Usually 500mg so OD 150mg/KG, 12g can be fatal
Pathophysiology of paracetamol OD?
Normally metabolised by CYP450 in liver to NAPQi, conjucated to glutathione and excreted. Therefore, run out of glutathionine and toxic NAPQi accumulates and hepatocyte necrosis
Paracetamol OD presentation?
Often asymptomatic
<24hrs : mild N+V, lethargy
24-72 hrs: RUQ, vomiting and hepatomgealy
>72hrs : acute liver failure
Management of paracetamol OD?
IV N-acetyl cysteine if below treatment line
Liver transplant if above on paracetamol normogram
Presentation of Opiate OD?
CNS depressants = resp depression, bradycardia, hypotension, pinpoint pupils,.
Late severe = low GCS and coma
Management of Opiate OD?
IV Naloxone
