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ED + Tox + Pall care + Haem > Conditions > Flashcards

Conditions Flashcards

1
Q

Management of shockable rhythm

A

VF and pulseless VT
DC cardioversion
Adrenaline 1mg after 2nd shock and then every 2nd loop
Amiodarone after 3 shocks

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2
Q

Mx non-shockable rhythm

A

PEA/asystole
Adrenaline 1mg immediately then every 2nd loop

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3
Q

High risk features of community-acquired needlestick injury

A

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

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4
Q

Mx of community-acquired needlestick injury

A

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

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5
Q

Signs of vasovagal

A

Shallow breathing
Bradycardia
Weak peripheral pulse
Loss of consciousness
Generalised pallor
Cool clammy skin
Nausea/vomiting

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6
Q

Anaphylaxis mx

A

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

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7
Q

Causes of syncope in children

A

Vasovagal
Breath holding spells
Orthostatic hypotension
Hypoglycaemia
Arrhythmia
Mimic; seizure, migraine, hysteria, hyperventilation

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8
Q

Clinical features of snake envenomation

A

Nausea, vomiting, diarrhoea, headache, abdominal pain
Coagulopathy (venon-induced and anticoagulant coagulopathy)
Neurotoxicity
Myotoxicity
Thrombotic microangiopathy
AKI
Cardiovascular; hypotension, cardiac arrest

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9
Q

Indications for early snake antivenom

A

Within 2hrs of bite
- Non-specific sx likely headache, vomiting
- Systemically unwell
- CVS collapse
- Ptosis/blurred vision

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10
Q

Funnel-web spider envenomation sx

A

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

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11
Q

Mx funnel-web spider bite

A

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

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12
Q

Box jelly fish mx

A

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

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13
Q

Sources of lead poisoning

A

Contaminated soil
Lead paint
Lead contaminated recreational drugs
Gun bullets
Occupation; mining, batteries, ammunition, car radiators
Home renovations

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14
Q

Acute lead poisoning sx

A

CNS; fatigue, weakness, headache, encephalopathy, cerebral oedema, coma
GIT; abdo pain, vomiting, constipation
Other; haemolytic anaemia, hepatitis

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15
Q

Chronic lead poisoning

A

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

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16
Q

Ix of suspected lead poisoning

A

Blood lead concentration
FBC; normochromic normocytic anaemia
LFT
U+ E
Iron
Zinc + Copper

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17
Q

Causes of lithium toxicity

A

Interaction; ACEI, thiazide, NSAID
Dehydration
Nephrogenic diabetes insipidus
Acute illness
Thyroid dysfunction

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18
Q

Acute lithium toxicity sx

A

Vomiting/diarrhoea
Tremor/seizures/hyperreflexia/myoclonus
Hypotension, bradycardia

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19
Q

Chronic lithium toxicity sx

A

Tremor, hyperreflexia, rigidity, myoclonus
QT prolongation, bradycardia
Nausea, vomiting

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20
Q

Serotonin syndrome signs

A

SHIVERS
Shivering
Hyperreflexia
Increased temp
Vital instability
Encephalopathy
Restlessness
Sweating

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21
Q

Serotonin syndrome mx

A

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

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22
Q

Toxic paracetamol dose

A

10g or 200mg/kg in pt under 50kg over 24hrs

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23
Q

How to mx drug seeking patient

A

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

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24
Q

Opioid toxicity mx

A

Monitor vitals
O2 if <90%
Naloxone 0.2mg IV/IM every 2-3min OR 1.8mg nasal spray each nostril

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25
Q

Drug-seeking behaviours

A

Asking specific drugs
Injecting oral formulation
Doctor shopping
Resistant behaviour; refusing other drugs
Manipulation; claiming they can’t afford other treatment

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26
Q

Mx of amphetamine toxicity

A

IV sedation with benzo
Fluid resuscitation
Hyperthermia tx

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27
Q

Signs of nicotine dependence

A

<30min of waking
Withdrawal sx
>10 cig per day

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28
Q

Harms of smoking

A

Child; SIDs, asthma
Adult; everything!!
Pregnancy
- low birthweight
- preterm
- Perinatal death
- Placental abruption

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29
Q

Smoking mx general steps

A

Quit date
Strategies for smoking triggers
Motivational interviewing
Social support

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30
Q

NRT mx

A

<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

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31
Q

Bupropion for smoking

A

Bupropion 150mg 3/7 -> 150mg BD 9/52
Contra; seizure, eating disorder, MOAI
Quit date after 2/52

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32
Q

Varenicline for smoking

A

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

33
Q

Nortriptyline for smoking

A

Nortriptyline 25mg up to 75mg daily
ADR; arrhythmia, dry mouth, nausea

34
Q

Haematological complications of alcohol use

A

Macrocytic anaemia
thrombocytopaenia
AST:ALT >2
elevated GGT
Folate/B12 deficiency
Elevated INR

35
Q

ETOH intoxication signs

A

Nystagmus
Incoordination
Ataxia
Memory impairment
Disinhibited behaviour
Hypotension/tachycardia
Resp depression

36
Q

ETOH withdrawal sx

A

Minor (12hrs post last drink)
- Anxiety
- Tremor
- Insomnia
- Vomiting
Major
- Visual/auditory hallucinations
- HTN
- Diaphoresis
- Seizures 48hrs

37
Q

Indication for inpatient detoxification ETOH

A

Prev withdrawal seizures / delirium tremens
Risk of suicide
Inadequate social support/supervision
Prev drug misuse
Severe liver disease
Advanced age

38
Q

Disulfiram for ETOH

A

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

39
Q

Acamprosate

A

Acamprosate 666mg TDS
Reduce withdrawal sx

40
Q

Naltrexone for ETOH

A

Naltrexone 50mg PO daily
Blocks euphoria - but doesn’t avoid impairment

41
Q

Signs of CO poisoning

A

Headache
Dizziness
Drowsiness
Nausea/vomiting
Palpitations
Mood swings
SOB
chest pain
Ix; carboxyhaemoglobin VBG, breath test to measure CO

42
Q

Mx bone pain in pall care

A

1st line; opioids
Bisphosphonates good for breast Ca + myeloma

43
Q

Opioids in pall care

A

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

44
Q

FIVE core medications of pall care

A
  • 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
45
Q

Indications for syringe driver

A

Persistent n/v
Dysphagia
Bowel obstruction
Coma
Poor absorption of oral drugs
Patient preference

46
Q

Mx bowel obstruction pall care

A

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

47
Q

PEPSI COLA pall care

A

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

48
Q

Mx of anxiety in pall care

A

Emotional support
Adequate explanation of current and future tx
Address fears and concerns
Relaxation techniques
1st line; SSRI
Short term; oxazepam 7.5mg PRN

49
Q

PO iron supplementation

A

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

50
Q

Causes of B12 deficiency

A

Pernicious anaemia
Gastritis
Gastrectomy/bariatric surgery
Coeliac disease
Vegan/vegetarian diet
PPI/H2 antag

51
Q

B12 deficiency blood results

A

Macrocytosis
Pancytopaenia
Hypersegmented neutrophils

52
Q

B12 deficiency mx

A

Hydroxocobalamin 1mg IM alternate days 2/52 then every 3/12
Monitor level 3/12 after therapy

53
Q

CLL 4 classic signs

A

Fatigue
Weight loss
Fever/night sweats
Lymphadenopathy

54
Q

Causes of lymphadenopathy

A

Cat scratch
toxoplasmosis
Lyme disease
HIV
TB
Lymphoma
Malignancy
Leukaemia
EBV

55
Q

Multiple myeloma CRAB diagnosis

A

Calcium; hypercalcaemia; abdo pain, constipation, polyuria
Renal failure; uraemia, overload
Anaemia/cytopenia; leukopenia/neutropenia, thrombocytopenia
Bone pain/fractures

56
Q

Multiple myeloma Ix

A

Serum protein electrophoresis
Serum free light chains
Urine Bence Jones protein over 24hr
Bone marrow aspirate
Imaging
- 1st line; whole body XR or CT

57
Q

Multiple myeloma tx

A

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

58
Q

Causes of polycythaemia

A

Dehydration
Polycythaemia vera
COPD
High altitude

59
Q

Red flag sx of polycythaemia that need urgent inpatient mx

A

Hypoxia
Transient visual disturbance
MI
Peripheral artery occlusion
VTE

60
Q

Polycythaemia initial ix

A

Pulse oximetry
LFT
UEC, BUN, glucose
EPO level
Urinalysis

61
Q

Mx polycythaemia

A

aspirin 100mg
Phlebotomy
Cytoreductive therapy if >=60yo or hx thrombosis
- Hydroxyurea PO

62
Q

CML 3x classic signs

A

Fatigue
Fever/night sweats
Abdo fullness (splenomegaly)

63
Q

Neutropaenia causes

A

Constitutional
Drug
Infection
Nutritional deficiency
Rheumatological disorders
Myelodysplasia

64
Q

Work up of neutropaenia

A

Blood smear
B12/folate
LFT
Hepatitis/HIV serology
EBV/CMV
ESR/CRP

65
Q

Haemochromatosis complications

A

Cirrhosis/HCC
Arrhythmia
DM
Bronze skin
Restrictive cardiomyopathy
Hypogonadism
Impotence
Joint arthralgia

66
Q

HFE genotype interpretation

A

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

67
Q

Mx haemochromatosis

A

Therapeutic venesection 500ml every 2/52 until ferritin 50-100

68
Q

Causes of bleeding disorder

A

vW disease
Haemophilia
Platelet function defect
Liver/renal disease
NSAID
Bone marrow failure

69
Q

Mx vW disease

A

TXA 25mg/kg max 1g QID daily for minor procedures

70
Q

Causes of thrombocytopenia

A

ETOH
B12/Folate deficiency
Pregnancy
Doxycycline
SLE
ITP
Chronic liver disease
HIV/hep B + C

71
Q

ITP sx

A

Bruising + oral bleeding + epistaxis
Petechial rash
Preceding viral infection or live vaccine

72
Q

ITP mx

A

Observe if plt >30
Prednisolone 0.5mg/kg/day
IV immunoglobulin
Refractory; splenectomy, rituximab

73
Q

ITP patient education

A

Written information
Avoid contact sports
Avoid NSAID
Safety net red flags; bleeding, signs of ICH

74
Q

Mx subtherapeutic INR

A

INR 1.5-1.9
- Increase weekly dose by 10%

75
Q

INR 4.5-10 without bleed

A

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

76
Q

INR >10 without bleed

A

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

77
Q

INR >=1.5 with life-threatening bleed

A

Cease warfarin
VK 5mg IV
PTX-VF 50IU/kg
FFP 150ml
Repeat INR in 20min

78
Q

INR >=2.0 with clinically significant bleed

A

Cease warfarin
VK 5mg IV
PTX-VF 35IU/kg OR FFP 15ml/kg
Repeat INR 20min

79
Q

INR >4.5 with minor bleeding or any INR with minor bleeding

A

Low bleed risk; cease warfarin and repeat INR 24hr
High risk; cease, VK 1mg PO and repeat INR in 24hr

ED + Tox + Pall care + Haem (1 decks)

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