Emergencies

Question 1

What overdosed drugs indicate the need of haemodialysis?

Answer 1

BLAST

Barbiturates
Lithium
Alcohol
Salicylates
Theophylline

Question 2

What is the reversing agent in an overdose of benzodiazepines?

Answer 2

Flumanezil (if iatrogenic)

Question 3

What is the reversing agent in an overdose of opiates?

Answer 3

Naloxene

Question 4

What is the reversing agent in an overdose of paracetamol?

Answer 4

N-Acetylcysteine

Question 5

What is the reversing agent in an overdose of aspirin?

Answer 5

Sodium bicarbonate

Question 6

What is the reversing agent in an overdose of TCA?

Answer 6

Sodium bicarbonate

Question 7

What is the reversing agent in an overdose of beta blockers?

Answer 7

Atropine (low HR), glucagon (low BP)

Question 8

What is the reversing agent in an overdose of ethylene glycol (antifreeze)?

Answer 8

Fomepizole

Question 9

What to do if patient develops a rash due to NAC in paracetamol OD?

Answer 9

stop, restart at lower rate (± chlorpheniramine)

Question 10

What level of PT indicates transplant in paracetamol OD?

Answer 10

if >180 seconds on day 4 will need transplantation

Question 11

Signs and symptoms of salicylate overdose

Answer 11

Specific - Tinnitus, hyperventilation, vertigo
Non-specific - vomiting, dehydration, sweating

Question 12

Dose-related response to salicylate overdose

Answer 12

150mg/kg (mild)
250mg/kg (moderate)
>500mg/kg (severe)
>700mg/kg (fatal)

Question 13

How do you calculate fluid resuscitation in burns management?

Answer 13

Fluid resuscitation –> Parkland’s formula; 14/16G cannulae in each ACF – even if through a burn site

Parkland formula = 4 (mL) x weight (kg) x % burn = mL Hartmann’s in first 24 hours (50% in 1st 8 hours)

I.E. 70kg adult with 23% burns = 4 x 70 x 23 = 6,440mL (3,220mL in first 8 hours)

Question 14

What fluids do you use in burns management?

Answer 14

Crystalloid (e.g. Hartmann’s)

Question 15

Causes of dominant R wave in V1/2

Answer 15

Posterior MI
PE
RBBB
RVH
Duchenne Muscular Dystrophy
Dextrocardia
WPW

Question 16

Causes of raised JVP

Answer 16

○ Right-sided heart failure
○ Cardiac tamponade/pericardial effusion
○ TR
○ Complete heart block
○ SVC obstruction

Question 17

Cough-initiated headache
Worse in the morning or bending forward

Answer 17

Raised ICP
Venous thrombosis

Question 18

Unilateral headache and ipsilateral symptoms

Answer 18

Migraine
Tumour
Vascular

Question 19

If a patient takes an overdose and has been stabilised - what next?

Answer 19

Perform a risk assessment for ongoing suicidal ideation and organise a review by the Psychiatric liaison service
If you have a “vulnerable adult support team” ask them to see the patient
Is the patient safe to be in the CDU/Short Stay Ward?
Does the patient have capacity? What if the patient wants to leave?