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Guide to Essentials in Emergency Medicine > Chapter 9: Misc stuff > Flashcards

Chapter 9: Misc stuff Flashcards

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1
Q

What clinical manifestations of alcohol poisoning?

A

1) Diminished gag reflex and resp depression
2) AMS (But GCS is not classically affected till pthas min blood level of 200mg%.
3) Wernicke’s encephalopathy
- Ataxia
- Ophthalmoplegia(horizontal nystagmus/lateral gaze palsy)
- Confusion(look for depression, apathy)
4) Alcohol Withdrawal syndrome

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2
Q

What is the supportive care instituted in suspected alcoholics/drunken pt?

A

1) ABC
-Maintain airway and C-spine evaluation
-OPA/NPA depending on gag reflex
-Suctioning equip
-C-collar if trauma is suspected
-IV access
2) IV crystalloids (IV D5W 500ml)
3) Use physical restraints
4) Measure body temp
5) Invg
Bloods: CBG, FBC, U/E/Cr(Anion gap), +-ABG, +-Blood ethanol levels, +-Amylase, +-LFT, +-Tox screen, Serum Osmolality
Imaging: +-Trauma series X rays, Head CT(if evidence of head trauma w LOC, mental state is inconsistent with the blood alcohol level and worsening neuro status)
Others:+-Urinalysis(for ketones, blood, sugar), ECG
5) Drug RX:
-IV Thiamine 100mg
-IV D50W 40ml in hypogly
-Haloperidol in agitated pt
-Naloxone 2mg IV if narcotic use

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3
Q

What is the Rx of Alcohol withdrawal syndrome(AWS)?

A

1) Supportive Rx:
-ABC, IV D5W, correct electrolytes
2) Invg:
Focal seziure: Head CT
Febrile seizure: LP, Head Ct, antibiotics
Status seizure: Head CT+Metabolic screen
3) Drug Rx:
1) Thiamine IV and MgSO4 prophylactically
2) BZD: IV diazepam 5mg
3) Haloperidol Im 5-10mg
+- B-blockers(if multiple BZD doses used)

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4
Q

What is anaphylaxis?

A

A severe, systemic allergic reaction to an antigen ppt by abrupt release of mediators in a prev sensitized pt and is IgE mediated.

2 or more of the following occur:

1) Involvement of skin/mucosal tissue
2) Resp compromise
3) GI symptoms
4) Hypotension/related symp

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5
Q

What are some early signs of impending anaphylaxis?

A

1) Nasal itching
2) A lump in the throat
3) Giddiness/syncope
4) CP, SOB, Tachypnoea
5) Warmth and tingling of the face
6) N/V, Diarrhea w tenesmus, crampy abdo pain

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6
Q

Full-Blown anaphylaxis:

A

1) Angioedema(Stridor)
2) AMS
3) Cyanosis
4) Cardiopulmonary arrest

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7
Q

What is the definitive mgmnt of anaphylaxis?

A

1) ABC
- Supp O2
- Be prepared for intubation(awake)/cricothyroidotomy
- ENT consult
- IV Fluid resus 2L N/S
2) Consider use of vasopressors
3) Allergen removal
- Stop all blood trnx
- Flick out the insect stinger
- If allergen was ingested, consider charcoal, lavage

Drug Rx:

  • Adrenaline: If Hypotensive pt(0.1mg of a 1: 10 000 solution IV over 5 mins) If normotensive pt (0.01ml/kg of a 1:1000 solution by IM injection) CI: IHD, Severe HTN, Pregnancy, Pt on B Blockers
  • Glucagon IV 1-5mg over 5mins followed by 5-15ug/min infusion
  • Diphenhydramine 25mg IM/IV
  • Nebulized Bronchodilators(Salbutamol) 2:2 via nebulizer
  • Hydrocortisone 200-300mg IV bolus
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8
Q

What is cellulitis?

A

Acute, subacute, chronic infection of dermis and subcut tissue characterized by edema, erythema and pain. Most often at the legs and near sites of trauma/surgical wounds usually in DM/Immunocompromised pts

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9
Q

What is the mgmnt of cellulitis?

A

1) Demarcate area of redness
2) Invg:
-Bloods: FBC, U/E/Cr, CRP, +-Blood cultures
3) Rx:
PO Augmentin, Amoxicillin, Erythromycin
If serious: IV Cefazolin

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10
Q

What is Nec fasc?

A

Group of rapidly progressive bact infections of soft tissues causing extensive tissue necrosis. Organisms-Group A Step, Staph aureus, Polymicrobial

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11
Q

What are the clinical features suggestive of Nec Fasc?

A

1) Tenderness out of proportion to clinical picture
2) Hemorrhagic blisters/bullae
3) Subcut emphysema
4) Toxic, febrile and hypotensive

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12
Q

What is the LRINEC scoring system?

A

1) WBC
2) Hb
3) CRP
4) Sodium
5) Creatinine
6) Glucose

Score>6 and above is suggestive of Nec Fasc

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13
Q

What invg would you order in Nec Fasc and what is the definitive mgmnt?

A

Bloods: FBC, U/E/Cr, CBG, CRP, Blood Cultures, GXM, PT/PTT
Imaging: Xray of affected limb

Antibiotics: IV Penicillin, Clindamycin, Ceftazidime STAT
Refer to Ortho

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14
Q

What is dengue fever?

A

it is an acute febrile infectious disease spread by female Aedes Aegypti mosquitoes causing an abrupt increase in capillary permeability, leakage of plasma, hemoconcentration and non-hemorrhagic hypovolemic shock.

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15
Q

What is the incubation period and duration of the DF?

A

4-7 days and it may last up to 2 weeks. It should come to the mind of the doc when fever persists beyond 3 days.

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16
Q

What are the 2 features suggestive of an impending shock?

A

Abdominal pain and hemoconcentration

17
Q

What are the usual clinical features of DF?

A

1) Fever
2) Headache
3) Retro-orbital pain
4) Marked muscle and joint fever(break-bone fever)
5) Non-specific petechial rash(islands of sparing)
6) N/V, diarrhea
7) URTI symptoms
8) Hemorrhagic manifestations (bleeding gums, menorrhagia)

DF pts will have marked constitutional symptoms as opposed to normal viral fevers.

18
Q

What is DHF and DSS and the clinical criteria?

A

Dengue Hemorrhagic Fever most serious manifestation of dengue virus infections and a/w circ failure and shock.

4 features by WHO criteria are:

1) Fever lasting 2-7 days
2) Thrombocytopenia20% increase in Hct/ascites/Pleural effusion
4) Hemorrhagic tendency(positive tourniquet test) or spontaneous bleeding

DSS is the 4 criteria + shock

19
Q

What are the RFs for the devt of DHF?

A

1) Extremes of age
2) Good nutritional status (as malnourished pts have poor cellular immune response)
3) Viral genotypes with increased pathogenicity
4) Repeat dengue infections

20
Q

What are the clinical indicators of impending DSS?

A

1) Severe abdo pain
2) Hepatomegaly
3) Change from fever to hypothermia
4) Sweating
5) Restlessness/lethargy
6) Persistent vomitting

21
Q

Some notable atypical presentations of DF?

A

1) Myocarditis
2) ARDS
3) Hepatitis
4) Myositis
5) Encephalitis
6) Acute Pancreatitis
7) Febrile diarrhea

22
Q

What is the mgmnt of pts with DF?

A

1) ABC
- Establish 2 peripheral IV lines
2) Aggressive Fluid Resus with 1-2 L of crystalloids
3) Invg:
- FBC( in all pts with pers high fever with no abvious focus of infxn)
- U/E/Cr(dehydration and AKI, Hyponat)
- LFT(AST)
- PT/PTT
- Dengue Tests
- Serology(IgM levels if fever>5 days)
- Dengue viral PCR(if fever 2-3 days)
4) Anti-pyretic(Paracet) Don’t use NSAIDS.
5) Transfusions
- Platelet tranx only indicated if sig bleeding occurs
- PCT/Whole blood only indicated if blood loss>10% or hemorrhagic shock not responding to fluid rx

23
Q

What other infections are ddx for thrombocytopenia?

A 
Measles
Rubella
Meningococcemia 
Malaria
SARS
24
Q

What is neutropenia?

A

Abnormally low levels of neutrophils

25
Q

What invg and mgmnt should be instituted in neutropenic fever?

A

1) ABC
2) Look for source of infection(abdo, chest, urine, skin)
3) Invg:
-FBC
-U/E/Cr
-LFT
-Blood culture X2 sets
-CXR
-Urine dipstick and culture
4) Antibiotics:
Iv cefepime 2g
5) No PR exam
6) Isolation bed with positive pressure

26
Q

What are the indications of whole blood transfusion?

A

1) Acute hemorrhage(despite normal Hb/Hct)
- Following blood loss, the 2 parameters may remain normal for >1hr. Loss of 20% blood vol can be safely corrected with crystalloids
2) Blood Loss>25%
3) At risk pts
- CAD, Valvular Hrt dz, CCF, Hx of TIA, thrombotic strokes developing signs and symptoms such as syncope, SOB, postural hypotension, tachycardia, angina, TIA

27
Q

What are the indications of RBC PCT Tnsx?

A

1) Slow continuous blood loss
2) Acute and chronic leukemia
3) Chronic anemia due to bone marrow failure, uremia, severe symptomatic Iron def
-Whole CI in chronic anemia because of risk of overload
1 unit of RBC—raise non-bleeding adult’s Hb by 1 g/dL

28
Q

Indications for FFP transx?

A

It contains all clotting factors

1) Replacement of single clotting def when specific or combined conc not available
2) Immediate reversal of warfarin effect in pts with life threat hemorrhage

29
Q

What is cryoprecip?

A

1) Factor 8
2) Fibrinogen
3) vWF

30
Q

What are some cx of blood transfusion?

A

1) Acute hemolytic reaction
- pt complains of burning in the IV site and with fever, chill, low back pain and joint pain.
- Give IV hydrocort and fluid rx
2) Febrile non-hemolytic reaction
3) Blood-borne Bacterial infection
4) Anaphylaxis
5) TRALI
6) Cardiac overload

31
Q

What kinds of lab abnormalities do you find in DF?

A

1) Thrombocytopenia50%
4) U/E/Cr -hyponat
5) LFT-abnormal liver enzymes
6) PT/PTT

Guide to Essentials in Emergency Medicine (10 decks)

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