Conditions Flashcards
Management of shockable rhythm
VF and pulseless VT
DC cardioversion
Adrenaline 1mg after 2nd shock and then every 2nd loop
Amiodarone after 3 shocks
Mx non-shockable rhythm
PEA/asystole
Adrenaline 1mg immediately then every 2nd loop
High risk features of community-acquired needlestick injury
Source known to be infected with blood borne virus
Deliberate assault
Deep large volume injection
Personal hx of IVDU
Needle directly into artery / vein
Device visibly contaminated with blood
Mx of community-acquired needlestick injury
Wash with soap / water
Dispose needle
If high risk -> refer to paed ID
If not high risk -> HbsAb, if <10mIU/mL then needs booster vaccine
-> Source; Hep B/C/HIV
Tetanus
HIV PoEP if high risk
Signs of vasovagal
Shallow breathing
Bradycardia
Weak peripheral pulse
Loss of consciousness
Generalised pallor
Cool clammy skin
Nausea/vomiting
Anaphylaxis mx
Remove allergen
Call for help
Lay flat with legs raised
Monitoring of vitals
Adrenaline 0.5ml 1:1000 mid-lateral thigh and repeat every 5min
- Paed; 10mcg/kg 1:1000 adrenaline IM and repeat after 5min if not improving
Non-sedating antihistamine - cetirizine
Salbutamol MDI/nebule if wheezing + resp distress
Observation
- 4hrs
- 12hrs; biphasic, hx of biphasic, poor asthma control, remote location, anaphylaxis to monoclonal Ab
D/c
- 2x epipen
- Medialert bracelet
- parent/patient information sheet for ASCIA
- Ensure asthma controlled
- referral to immunologist
Causes of syncope in children
Vasovagal
Breath holding spells
Orthostatic hypotension
Hypoglycaemia
Arrhythmia
Mimic; seizure, migraine, hysteria, hyperventilation
Clinical features of snake envenomation
Nausea, vomiting, diarrhoea, headache, abdominal pain
Coagulopathy (venon-induced and anticoagulant coagulopathy)
Neurotoxicity
Myotoxicity
Thrombotic microangiopathy
AKI
Cardiovascular; hypotension, cardiac arrest
Indications for early snake antivenom
Within 2hrs of bite
- Non-specific sx likely headache, vomiting
- Systemically unwell
- CVS collapse
- Ptosis/blurred vision
Funnel-web spider envenomation sx
Cholinergic/adrenergic; diaphoresis, salivation, lacrimation, piloerection, HTN, miosis/mydriasis, brady/tachycardia
Neuromuscular; paraesthesia, fasciculation
CVS: MI, HTN,
Resp; pulmonary oedema
CNS; agitation, anxiety, coma
Non-specific; vomiting, abdo pain, headache
Mx funnel-web spider bite
Bandage over limb
Immobilise
Urgent transport to ED
Tetanus
Anti-venom; suspect funnel-web spider + signs of sever envenomation
- Funnel-web spider antivenom 2x vials diluted 1:10 0.9% NS
Monitor for 24hrs until sx resolve
If nil signs of envenomation - monitor for 2hrs - if asymp or mild - then observe for 4hrs after bite and 2hrs post bandage removal then discharge
Box jelly fish mx
Emergency - sudden cardiopulmonary failure
Wash off tentacles with seawater
Vinegar
Cold pack
Monitor RR/ pulse
IV access
O2 therapy
Antivenom IV 1 vial diluted 1:10 0.9% NS
Lignocaine / fentanyl for analgesia
Sources of lead poisoning
Contaminated soil
Lead paint
Lead contaminated recreational drugs
Gun bullets
Occupation; mining, batteries, ammunition, car radiators
Home renovations
Acute lead poisoning sx
CNS; fatigue, weakness, headache, encephalopathy, cerebral oedema, coma
GIT; abdo pain, vomiting, constipation
Other; haemolytic anaemia, hepatitis
Chronic lead poisoning
CNS; poor concentration, headache, aggression, intellectual impairment in children
GIT; abdo pain, constipation, weight loss
Renal; nephropathy, AKI
CVS; HTN
Other; chronic anaemia, arthralgia, reduced fertility
Ix of suspected lead poisoning
Blood lead concentration
FBC; normochromic normocytic anaemia
LFT
U+ E
Iron
Zinc + Copper
Causes of lithium toxicity
Interaction; ACEI, thiazide, NSAID
Dehydration
Nephrogenic diabetes insipidus
Acute illness
Thyroid dysfunction
Acute lithium toxicity sx
Vomiting/diarrhoea
Tremor/seizures/hyperreflexia/myoclonus
Hypotension, bradycardia
Chronic lithium toxicity sx
Tremor, hyperreflexia, rigidity, myoclonus
QT prolongation, bradycardia
Nausea, vomiting
Serotonin syndrome signs
SHIVERS
Shivering
Hyperreflexia
Increased temp
Vital instability
Encephalopathy
Restlessness
Sweating
Serotonin syndrome mx
Mild; supportive, cease drugs
Moderate
- Diazepam 5-20mg and repeat 30min later - max 120mg per day
- If no improvement -> cyproheptadine 12mg PO stat as antidote
Toxic paracetamol dose
10g or 200mg/kg in pt under 50kg over 24hrs
How to mx drug seeking patient
Check Qscript
Contact prev GP
Contact pharmacy to confirm frequency of dispensing
Follow practice policy
Explain limitation on Schedule 8 prescribing in non-judgemental manner
Offer opioid contract
Plan tapering or ceasing oxycodone
Opioid toxicity mx
Monitor vitals
O2 if <90%
Naloxone 0.2mg IV/IM every 2-3min OR 1.8mg nasal spray each nostril
Drug-seeking behaviours
Asking specific drugs
Injecting oral formulation
Doctor shopping
Resistant behaviour; refusing other drugs
Manipulation; claiming they can’t afford other treatment
Mx of amphetamine toxicity
IV sedation with benzo
Fluid resuscitation
Hyperthermia tx
Signs of nicotine dependence
<30min of waking
Withdrawal sx
>10 cig per day
Harms of smoking
Child; SIDs, asthma
Adult; everything!!
Pregnancy
- low birthweight
- preterm
- Perinatal death
- Placental abruption
Smoking mx general steps
Quit date
Strategies for smoking triggers
Motivational interviewing
Social support
NRT mx
<30min awakening
- <=10/day; 21mg/24hr patch PLUS 2mg gum
- >10 cig/day; 21mg/24hr patch PLUS 4mg gum
>30min awakening
- <=10/day; 2mg gum
- >10/day; 21mg/24hr patch PLUS 2mg gum
Aim to stop tx by 12 weeks by reducing strength of patches
Bupropion for smoking
Bupropion 150mg 3/7 -> 150mg BD 9/52
Contra; seizure, eating disorder, MOAI
Quit date after 2/52
Varenicline for smoking
Varenicline 0.5mg 3/7 -> 0.5mg BD 4/7 -> 1mg BD for remainder of 12/52 course
- can repeat 12/52 if relapse
Function; reduce craving/withdraw, reduce rewarding effect
ADR; nausea
Monitor if have pre-existing mental illness
Avoid pregnant/breastfeeding/adolescents
Nortriptyline for smoking
Nortriptyline 25mg up to 75mg daily
ADR; arrhythmia, dry mouth, nausea
Haematological complications of alcohol use
Macrocytic anaemia
thrombocytopaenia
AST:ALT >2
elevated GGT
Folate/B12 deficiency
Elevated INR
ETOH intoxication signs
Nystagmus
Incoordination
Ataxia
Memory impairment
Disinhibited behaviour
Hypotension/tachycardia
Resp depression
ETOH withdrawal sx
Minor (12hrs post last drink)
- Anxiety
- Tremor
- Insomnia
- Vomiting
Major
- Visual/auditory hallucinations
- HTN
- Diaphoresis
- Seizures 48hrs
Indication for inpatient detoxification ETOH
Prev withdrawal seizures / delirium tremens
Risk of suicide
Inadequate social support/supervision
Prev drug misuse
Severe liver disease
Advanced age
Disulfiram for ETOH
Disulfiram 100mg 2/52
Can’t have any ETOH
Must have supervising person
Blocks alcohol metab -> flushing, sweating, tachycardia, impending sense of doom
cardioresp failure as rare risk
Acamprosate
Acamprosate 666mg TDS
Reduce withdrawal sx
Naltrexone for ETOH
Naltrexone 50mg PO daily
Blocks euphoria - but doesn’t avoid impairment
Signs of CO poisoning
Headache
Dizziness
Drowsiness
Nausea/vomiting
Palpitations
Mood swings
SOB
chest pain
Ix; carboxyhaemoglobin VBG, breath test to measure CO
Mx bone pain in pall care
1st line; opioids
Bisphosphonates good for breast Ca + myeloma
Opioids in pall care
1st line
- Morphine IR 2-5mg q1hrly max 6 doses / 24hrs
- Consider Morphine MR 5mg daily
Oxycodone; good if delirium/cognitive impairment
Transdermal; buprenorphine patch or fentanyl patch
FIVE core medications of pall care
- Morphine 2.5-5mg subcut q1hrly
- Metoclopramide 10mg subcut q4hrly
- Haloperidol 0.5mg subcut q4hrly PRN for agitation/delirium
- Clonazepam 1mg injection agitation
- Hyoscine butylbromide 20mg subcut q4hrly PRN
Indications for syringe driver
Persistent n/v
Dysphagia
Bowel obstruction
Coma
Poor absorption of oral drugs
Patient preference
Mx bowel obstruction pall care
Freq mouthcare to relieve dehydration or dry mouth
Dexamethasone 6mg to help reverse obstruction
NBM and slow escalation after 24hrs to modified diet (free fluids is good)
NGT on free drainage
Subcut analgesia
PEPSI COLA pall care
Physical; sx management
Emotional; mood, coping, sleep
Personal needs; culture, religion
Social support; carers, welfare
Information; MDT, records
Control/Autonomy; capacity to decide, AHCD
Out of hours; plan for care
Living with your illness; rehab support, referral to other agencies, end of life planning
After care; bereavement, funeral arrangement, family support
Mx of anxiety in pall care
Emotional support
Adequate explanation of current and future tx
Address fears and concerns
Relaxation techniques
1st line; SSRI
Short term; oxazepam 7.5mg PRN
PO iron supplementation
Dose
- 100-210mg elemental iron
- 3mg/kg/day child
Empty stomach
Co-admin with vitamin C
Duration; 3-6/12
ADR; nausea, bloating, constipation, diarrhoea
Absorption reduced by Ca, PPI, H2 antagonists
Causes of B12 deficiency
Pernicious anaemia
Gastritis
Gastrectomy/bariatric surgery
Coeliac disease
Vegan/vegetarian diet
PPI/H2 antag
B12 deficiency blood results
Macrocytosis
Pancytopaenia
Hypersegmented neutrophils
B12 deficiency mx
Hydroxocobalamin 1mg IM alternate days 2/52 then every 3/12
Monitor level 3/12 after therapy
CLL 4 classic signs
Fatigue
Weight loss
Fever/night sweats
Lymphadenopathy
Causes of lymphadenopathy
Cat scratch
toxoplasmosis
Lyme disease
HIV
TB
Lymphoma
Malignancy
Leukaemia
EBV
Multiple myeloma CRAB diagnosis
Calcium; hypercalcaemia; abdo pain, constipation, polyuria
Renal failure; uraemia, overload
Anaemia/cytopenia; leukopenia/neutropenia, thrombocytopenia
Bone pain/fractures
Multiple myeloma Ix
Serum protein electrophoresis
Serum free light chains
Urine Bence Jones protein over 24hr
Bone marrow aspirate
Imaging
- 1st line; whole body XR or CT
Multiple myeloma tx
1st line
- Bortezomib IV with cyclophosphamide and dexamethasone
Autologous stem cell transplant
Radiation; good for plasmcytoma
May need aspirin 100mg as VTE prevention when on immunomodulators
Causes of polycythaemia
Dehydration
Polycythaemia vera
COPD
High altitude
Red flag sx of polycythaemia that need urgent inpatient mx
Hypoxia
Transient visual disturbance
MI
Peripheral artery occlusion
VTE
Polycythaemia initial ix
Pulse oximetry
LFT
UEC, BUN, glucose
EPO level
Urinalysis
Mx polycythaemia
aspirin 100mg
Phlebotomy
Cytoreductive therapy if >=60yo or hx thrombosis
- Hydroxyurea PO
CML 3x classic signs
Fatigue
Fever/night sweats
Abdo fullness (splenomegaly)
Neutropaenia causes
Constitutional
Drug
Infection
Nutritional deficiency
Rheumatological disorders
Myelodysplasia
Work up of neutropaenia
Blood smear
B12/folate
LFT
Hepatitis/HIV serology
EBV/CMV
ESR/CRP
Haemochromatosis complications
Cirrhosis/HCC
Arrhythmia
DM
Bronze skin
Restrictive cardiomyopathy
Hypogonadism
Impotence
Joint arthralgia
HFE genotype interpretation
C282Y homozygote; highest risk
Compound C282Y/H63D heterozygote; only 1% develop HC- monitor iron 2-5 yearly
282Y carrier, H63D homozygous, H63D carrier - 1/8 population has this - keep looking
Mx haemochromatosis
Therapeutic venesection 500ml every 2/52 until ferritin 50-100
Causes of bleeding disorder
vW disease
Haemophilia
Platelet function defect
Liver/renal disease
NSAID
Bone marrow failure
Mx vW disease
TXA 25mg/kg max 1g QID daily for minor procedures
Causes of thrombocytopenia
ETOH
B12/Folate deficiency
Pregnancy
Doxycycline
SLE
ITP
Chronic liver disease
HIV/hep B + C
ITP sx
Bruising + oral bleeding + epistaxis
Petechial rash
Preceding viral infection or live vaccine
ITP mx
Observe if plt >30
Prednisolone 0.5mg/kg/day
IV immunoglobulin
Refractory; splenectomy, rituximab
ITP patient education
Written information
Avoid contact sports
Avoid NSAID
Safety net red flags; bleeding, signs of ICH
Mx subtherapeutic INR
INR 1.5-1.9
- Increase weekly dose by 10%
INR 4.5-10 without bleed
Low bleed risk; cease warfarin, INR in 24hr and resume once therapeutic
High risk; cease warfarin, Vitamin K 1mg PO and repeat INR in 24hr
INR >10 without bleed
Low bleed risk; cease warfarin, Vitamin K 3mg PO, check INR in 24hr
High bleed risk; cease warfarin, VK 3mg PO, Prothombinex-VF 15IU/kg and check INR in 12hr
INR >=1.5 with life-threatening bleed
Cease warfarin
VK 5mg IV
PTX-VF 50IU/kg
FFP 150ml
Repeat INR in 20min
INR >=2.0 with clinically significant bleed
Cease warfarin
VK 5mg IV
PTX-VF 35IU/kg OR FFP 15ml/kg
Repeat INR 20min
INR >4.5 with minor bleeding or any INR with minor bleeding
Low bleed risk; cease warfarin and repeat INR 24hr
High risk; cease, VK 1mg PO and repeat INR in 24hr
