EM Cases Flashcards
What are the components of Hartmanns?
Sodium (131 mmol/L) Chloride (111 mmol/L) Potassium (5 mmol/L) Calcium (2 mmol/L) Bicarbonate (29 mmol/L) --> actually lactate -> metabolised to bicarb
What are the components of 0.9% saline?
Sodium (154 mmol/L)
Chloride (154 mmol/L)
Assessment in wound care
- mechanism
- site
- time
- place
- allergies, current meds
- tetanus status, implants
- occupation, hobbies
- hand dominance
Wound assessment: look
- measurement of wound: length, width, depth
- wound bed: type of tissue visible (necrotic, granulation)
- evidence of contamination - foreign bodies, non-viable tissue
- condition of surrounding skin
- signs of infection
- involvement of deep structures
- type and amount of exudate
- odour if present
- swab if taken
- if overlying a joint must be considered to be communicating with joint -> Rx antibiotics
Wound assessment: Feel and Move
Feel
test sensation
pain status
Move
muscle fxn
tendon fxn
Length of stay for sutures
general: 7 days
face: 4-5 days
lower limbs, extensor surfaces of joints: 2 weeks
Features of Lidocaine, Bupivocaine and Procaine
Lidocaine: lasts for ~1 hour
Bupivacaine: Long acting ~6 hours. More painful on admin, Greater side-effect profile and greater risk of toxicity
Procaine: Good alternative if allergic to amide LA like Lidocaine
Max dose of Lidocaine in adult
Lidocaine: -5 mg/kg without epi -7 mg/kg without epi duration of action: 30-90 mins 1% = 10mg/ml 2% = 20 mg/ml
300 mg = max adult dose
60 mL of 0.5%
30 mL of 1%
15 mL of 2%
Max dose Bupivacaine in adult
2.5 mg/kg without epinephrine
3 mg/kg with epinephrine
lasts 6-8 hours
0.5% = 5mg/ml
Onset of action of LA
2-5 minutes
Complications of LA: local & systemic
can affect wound healing
cardiac toxicity (arrythmogenic)
neurotoxicity
How to recognize CNS toxicity of LA
drowsiness numbness of tongue tinnitus visual disturbances muscle twitching dizziness convulsions coma apnoea
How to recognize cardiac toxicity of LA
arrhythmogenic
increase CO, HR, MABP
Myocardial depression at higher doses
what is 3 cubic cm in mls??
3 cc = 3ml
Cerebellar exam (from head to toe)
- Scanning speech “the british constitution” “happy hippopotamus”
- Nystagmus (test eye mvts -> see nystagmus with fast phase pointing toward side of lesion”)
- Truncal ataxia (vermis/flocular nodes stroke)
- Finger to nose for dysmetria
- Rebound phenomenon
- Disdiadochokinesia
- Pendular knee jerks & hypotonia (will see when testing for patellar DTR)
- Wide stance and ataxic gait (wide and staggering) lean towards side of pathology.
- Titubation (swaying while standing still)
Romberg test
Assess for propioception.
Removing visual input by closing eyes
Leaves dorsal column working to keep you up in space.
Epicritic pain sensation
fine touch, vibration & pressure.
Propioception
Dorsal column pathway
Protopathic pain sensation
contralateral temp, pain & crude touch
STT
Stemitil is what?
Anti-emetic
Prochlorperazine a D2-R antagonist
dose: 5 mg TDS (q8hrs) PO OR 12.5 mg IM
avoid in PD
side-effects: anti-cholinergic, EPS, postural hypotension
Maxolon is what?
Anti-emetic & prokinetic
Metochloperamide a dopamine antagonist
Side-effects: EPS, acute dystonic reactions, hyperprolactinemia
Procyclidine will reverse acute dystonia
Dose: 10 mg TDS PO/IV/IM
Domperidone is what?
Anti-emetic
Dopamine antagonist works in chemotehrapeutic trigger zone
Less likely to cause central side effects
Dose: 10 mg TDS (q8hrs) PO
Odansetron is what?
Anti-emetic
5-HT3 receptor antagonist
works at chemoreceptor trigger zone and peripherally
Dose: 8 mg TDS PO
Cyclizine is what?
Anti-emetic
H1 R antagonist
Side-effect: drowsiness & antimuscarinic effects
Dose: 50mg TDS (q8hrs) PO/IV/IM
