Emergencies Flashcards
Bloods in anaphylaxis
and what to give with cannula in
Mast cell tryptase
+ IV 0.9% normal saline may be needed, titrate to BP
early vs late phase anaphylaxis
within minuutes: mast cell degranulation and histamine/tryptase release
+ leukotrienes incr vasc permeability and induce bronchial constriction
Late phase: 2-24hrs
- eosinophils recruited, release enzymes and stimulate mast cells
- amplify and sustain initial response
Drugs in anaphylaxis
And paeds variation
Anaphylaxis 0.5ml 1:1000 repeat every 5 mins
Chlorphenamine 10mg IV
hydrocortisone 200mg IV
salbutamol nebs if wheeze
Adrenaline paeds doses
6-12: 300mcg
6months - 6: 150mcg
<6mo: 100-150mcg
Narrow complex tachycardias definition
differentials
RAte >100bpm
QRS < 120ms
Sinus tachy
AF, flutter, atrial tachy
AVNRT
AVRT
Adverse signs considering cardioversion
BP <90
heart failure
reduced consicousness
HR>200
Always seadte and cardiovert
no adverse features SVT management
- vagal manoeuvres (carotid sinus massage, valsalva) to transiently block AV and unmask underlying atria rhythm
- adenosine 6mg IV bolus as transient AV block unmasks atrial rhythm and can cardiovert AVNRT/AVRT
- adenosine 12mg, then another 12
- unsuccessful? one of: digoxin, amiodaone, verapamil, atenolol
- cardiovert
Contraindications to thrombolysis
(for STEMI)
Aortic dissection
GI bleeding
Allergic reation prev
Major surgery last 14 days
Cerebral neoplasm
Stroke history
Severe HTN >200
Trauma
STEMI drugs for everyone
Aspirin
Ticagrelor (anti platelet)
Unfractionated heparin if going for PCI
O2 if hypoxic
ECG changes in STEMI
Early: peaked T wave, raised ST
within 24hr: inverted T waves, ST returns to normal
Within days: pathological Q waves
STEMi diagnositic if ST incr >1mm 2 consecutive leads
or >2mm V2/V3
STEMi locations
I, aVL, V5, V6 = lateral
II, III, aVF: inferior
V1, V2 = septal
V3, V4 = anterior
PCI timing vs thrombolysis
If possibly within 120 mins onset of pain
Should be considered for all presenting within 12 hours
If PCI not available within 120 mins, give thrombolysis eg streptokinase - most effetive within first hour, but can be up to 12 hours
Opiate overdose reversal
Naloxone
competitively binds opiod receptors
Half life is shorter than opioids, so need to continue monitoring
Typically in presence of CNS and resp depression
Benzo overdose reversal
Flumenazil is reversal agent, competitively binds benzos
Reduces sedative/drowsiness effect.
Half life shorter so multiple doses may be needed
Beware long term benzo abusers, can induce withdrawal seizures
Benzo overdose symptoms
Agitation, euphoria, blurred vision, slurred speech, ataxia, slate-grey cyanosis
Signs of aspirin overdose
Tinnitus, lethargy, dizziness, nausea and vomiting
More serious: dehydration, sweating, bouding pulse, deafness, breathlessness, glucose disturbance, confusion
Life threatening: pulmonary oedeam, metabolic acidosis
500mg/kg is severe
Management of aspirin overdose
Activated charcoal if >125ml/kg ingested <1hr ago
Gastric lavage if >500mg/kg ingested <1hr ago
Consider glucose
Incr alkalinity o urine to incr salicylate.
Haemodialysis for severe cases
Sympathomimetics overdose symptoms
Eg cocaine, amphetamines
tachycardia, mydriasis, euphoria, formication (insects crawling), agitation, tremor, dilated pupils, tachycardia, arrhythmias, convulsions
Give benzos
Cannabis overdose symptoms
Dry cough, increased appetite, social withdrawal and paranoia, altered perception of time
Carbon monoxide poisoning symptoms
Headache
Tachycardia, reduced reflexes, pulmonary oedema, shock, metabolic acidosis, flushed cherry pink skin, coma
Give hyperbaric oxygen
Antidote for antifreeze (ethylene glycol) poisoning
Ethanol
Antidote for cyanide poisoning
Dicobalt edetate
Antidote for lead poisoning
Sodium calcium edetate
Antidote for organophosphate poisoning
Eg farmers with fertilisers or chemical weapons
Atropine
