ED Flashcards
Management of hypertensive urgency/emergency?
D/w PICU
Hypertensive urgency
If medically stable, consider short acting oral agents while investigating cause
Nifedipine
Commence 0.25–0.5 mg/kg/day (max 20 mg) and titrate up as required to a maximum of 3 mg/kg/day (max 120 mg)
Hypertensive emergency
Intravenous therapy; discuss with renal team and retrieval/ICU team (IV sodium nitroprusside)
Aim to gradually reduce BP to the patient’s estimated 95th centile
Decrease BP by 25% of the original value every 24 hours till target BP reached. Reduce rate of decrease if patient becomes symptomatic
Seratonin syndrome Sx/Rx
Sweaty, crazy, jumpy
- Changed mental status: anxiety/agitation/delirium/disorientation
- Hyperthermia, tachycardia, diaphoresis (SNS)
- N&V, diarrhoea
- Tremor, muscle rigidity & hyperreflexia/clonus
Rx: benzodiazepines & supportive care, if fails consider cyproheptadine (antihistamine wih 5HT1A/2A antagonist/anticholinergic)
Compare serotonin syndrome/NMS?
NMS features/causes & Rx
Caused by dopamine antagonists
Prolonged
Crazy, stiff, hot
- Confusion/delerium/coma
- Lead pipe rigidity- generalized/extreme
- Hyperthermia
- Tachycardia/HTN/diaphoresis (SNS)
- Elevated CK, leukocytosis
Idiosyncratic- can occur after single dose or after years, rapid dose increase is a risk factor, concomittant lithium use
SSRI withdrawal syndrome
●Dizziness
●Fatigue
●Headache
●Nausea
Other common discontinuation symptoms include [1-4]:
●Agitation
●Anxiety
●Chills
●Diaphoresis
●Dysphoria
●Insomnia
●Irritability
●Myalgias
Stimulant overdose toxidrome
(cocaine, amphetamines, caffeine)
Wired, wide & hot
Hyper-alert/paranoid, hallucinations
Mydriasis (dilated)
Hyperthermia, tachycardia, tachypnoea
Diaphoresis, hyperreflexia, seizures
Anticholinergic toxidrome
(antihistamines, TCA, atropine, antispasmodics, Belladonna)
Hot, wide, dry & crazy
Agitation, delirium, myoclonus/choreathetosis
Dysarthria
Mydriasis (dilated pupils)
Hyperthermia, tachycardia, tachypnoea (SNS)
Dry, flushed skin & MM
Decreased bowel sounds & urinary retention
Hallucinogenic toxidromes (LSD, psylocybin, MDMA)
Weird, wide, hot
Perceptual distortions, depersonalisation
Mydriasis (dilated pupils)
Nystagmus
Hyperthermia, HTN, tachypnoea (SNS)
Opioid toxidrome
(heroin, morphine, oxycodone)
Drowsy, small & slow
CNS depression/coma, hyporeflexia
Miosis (constricted pupils)
Bradycardia/bradypnea, hypotension, pulmonary oedema
Opioid toxidrome
(heroin, morphine, oxycodone)
Drowsy, small & slow
CNS depression/coma, hyporeflexia
Miosis (constricted pupils)
Bradycardia/bradypnea, hypotension, pulmonary oedema
Benzodiazepine/hypnotic toxidrome
(BDZ, barbiturates, zolpidem, alcohol)
Drowsy, slow
CNS depression/coma, hyporeflexia
Pupils variable
Hypotension, bradycardia, bradypnoea
Cholinergic
(organophosphate, nicotine, edrophonium, pilocarpine)
Drowsy, small, wet & slow
CNS depression/confusion/coma, trismus, rigidity
Miosis (constricted pupils)
Bradycardia, hypertension/hypotension, tachy/bradycardia
Salivation/urinary & faecal incontinence, diaphoresis, flushing, bronchorrhoea
Ketamine- MoA & side effects
NMDA receptor inhibitor
- Dissociative anaesthetic, analgesic, amnesic
- Stimulatory CV effect (^ HR/ bradycardia & hypotension if compromied, bronchodilator)
- Risk - laryngospasm 0.5% (desat, agitation, vomiting)
- Rx: 100% O2/basic airway manouvres/cricoid pressure, deepen sedation, muscle relaxants
Management of SVT
Try vagal manouvre (if shock present then only if no delay)
If vascular access available/no shock- adenosine 100mcg -> 200mcg -> 300mcg (consider increments up to 400-500)
If not/shock present - 1J DC SYNCHRONOUS shock, , 2J
Spontaneous eye opening, localises to pain and confused
Calculate GCS
13
Opens eyes to voice, flexion & withdrawal to pain, inappropriate conversation.
Calculate GCS
10
Opens eyes to pain, abnormal flexion to pain, inappropriate conversation
Calculate GCS
8
No eye opening, incomprehensible speech and extension to pain
Calculate GCS
5
