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Emergencies Flashcards

1
Q

What essentially happens in DKA

A

Not enough insulin and high blood glucose so body runs out of insulin

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2
Q

What are the signs and symptoms of DKA?

A
  • acetone smell breath
  • dehydration, polydipsia, polyuria
  • abdo pain, vomiting
  • Kussmaul resp
  • shock, coma, death
  • drowsiness
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3
Q

What are the diagnostic criteria for DKA?

A
  1. BM >11.1mmol/L
  2. Blood ketones >3mmol/L or urine ketones on dipstick
  3. Venous ph <7.3
  4. Bicarbonate <15mmol/L
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4
Q

What are the signs of clinical dehydration?

A 
unwell 
irritable and lethargic
decreased UO
Sunken eyes
dry mucous membranes
reduced skin turgor
tachycardia and tachypnoea
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5
Q

What is the first step in treatment of DKA?

A

ABC

fluid resuscitation w 0.9% saline

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6
Q

Why do you need to be careful with fluids in resuscitation for DKA?

A

Too much puts at risk of cerebral oedema

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7
Q

What is the second step in treatment of DKA?

A

Rapidly confirm diagnosis, then formal Ix

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8
Q

what are the next steps of treatment of DKA once fluid resuscitation has occurred?

A
  1. Assess dehydration, work out volume of fluid to be replaced and give at constant rate for 1st 48hr
  2. give IV insulin 1hr after IV fluids
  3. reduce insulin when glucose <14mmol/l
  4. stop insulin when ketone <1.00mmol/l change to subcut
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9
Q

How is fluid replacement worked out in DKA?

A

MAINTENANCE + DEHYDRATION DEFICIT - FLUID GIVEN IN RESUSCITATION

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10
Q

What shouldn’t be given as part of treatment of DKA and why?

A

bicarbonates as they increase risk of cerebral oedema

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11
Q

Explain the different fluids that are given in DKA and when

A
  1. 9% saline + 20mmol KCl/500ml when BM 14mmol/l

0. 45% saline + 20mmol KCl/500ml + 5%glucose after 12 hr if plasma Na stable

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12
Q

When does cerebral oedema usually occur following treatment of DKA?

A

4-12 hrs

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13
Q

What are the most common precipitating factors of DKA?

A

Infection
Missed insulin doses
MI

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14
Q

What is the mortality of meningitis?

A

5-10%

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15
Q

what are the causes of meningitis n neonates -3m?

A

GBS
E.coli
Listeria monocytogenes

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16
Q

What are the causes of meningitis in 1m-6y?

A

neisseria meningitidis

strep. pneumoniae
h. influenzae

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17
Q

what are the causes of meningitis in >6yr

A

N. meningitidis

s. pneumoniae

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18
Q

What are the general signs/sx of meningitis?

A 
fever
headache
lethargy/drowsiness
poor feeding/vomiting
irritability
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19
Q

What are neurological signs of meningitis?

A

hypotonia
LoC
seizures
shock

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20
Q

What are characteristic signs of meningitis?

A

non-blanching rash
photophobia
neck stiffness
Brudzinski’s/Kernig’s sign

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21
Q

What sign of meningitis is seen in infants?

A

bulging fontanelle

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22
Q

Give the ix for meningitis

A 
FBC, U&amp;Es, LFTs
Blood, throat, urine, stool cultures 
LP!!!
Blood glucose/gas for acidosis
Coag screen
CRP
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23
Q

What imaging can be used in meningitis ix?

A

CT/MRI

EEG

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24
Q

Explain the pathophysiology behind meningitis

A

Infection of meninges usually follows bacteraemia
Host response causes damage - release of inflammatory mediators and leucocytes w endothelial damage
Subsequent cerebral oedema, ICP + cerebral blood flow

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25
Q

What is the management of meningitis with non-blanching rash or meningococcal septicaemia/ in the community?

A 
parenteral benzylpenicillin IV or IM
<1yr - 300mg
1-9yrs - 600mg
>10yrs - 1200mg
dexamethasone to reduce risk of long term complications
26
Q

what feature is suggestive of meningococcal infection?

A

non-blanching rash

27
Q

Which meningitis is LP contraindicated in and why?

A

MENINGococcal septicaemia as coning of the cerebellar tonsils may follow

28
Q

What is management of meningitis without a non-blanching rash in the community?

A

benzylpenicillin
cefotaxime
chloramphenicol

29
Q

What are early signs of septic shock?

A 
pale/mottled skin
cold hands and feet
prolonged ccap refill 
tachycardia
tachypnoea
30
Q

Who should be notified in cases of meningitis?

A

Public Health Authority

31
Q

What should be given to close contacts for prophylaxis of meningitis?

A

rifampicin/ciprofloxacin - eradicates nasal carriage for meningococcal meningitis and H. inflenzae

32
Q

When is LP contraindicated in meningitis?

A
  • cardiorespiratory instability
  • focal neurological signs
  • signs of raised ICP
  • coagulopathy
  • thrombocytopenia
  • local infection at site of LP
33
Q

what are cerebral complications of meningitis?

A 
Hearing loss
Local vasculitis
Local cerebral infarction
Subdural effusion (h. influenzae)
Hydrocephalus
Cerebral abscess
34
Q

What are ix for meningococcal septicaemia?

A

Blood cultures and PCR

35
Q

What is rx of meningitis in >3m in secondary care?

A

IV ceftriaxone

36
Q

What is rx of meningitis in <3m in secondary care?

A

IV cefotaxime + amoxicillin or ampicillin

37
Q

What changes would you expect in the CSF in meningitis?

A

appearance - turbid
predominant cell - polymorphs
glucose level - <2/3 of blood
Protein increased mean approx 300mg/dL

38
Q

What changes would you expect in the CSF of tubercular meningitis?

A

appearance - fibrin web
predominant cell - mononuclear 10-350/mm^3
Glucose level - <2/3 of blood
Protein increase

39
Q

what are the complications of meningitis ?

A 
secondary abscesses
subdural effusion
hydrocephalus
ataxic paralysis
deafness
lowered IQ
epilepsy
40
Q

What is the cause of toxic shock syndrome?

A

toxin producing staph. aureus and group a strep

41
Q

What are the features of toxic shock syndrome

A 
fever >39
hypotension
D&amp;V
renal and liver impairment 
clotting abnormalities and thrombocytopenia
altered consciousness
42
Q

What are skin changes in toxic shock syndrome?

A

diffuse red macular rash

desquamation of palms and soles after 1-2 weeks

43
Q

What is the management of TSS?

A

Intensive care - manage shock
debridement
ABx - 3rd gen cephalosporin + clindamycin
IVIG to neutralise toxins

44
Q

What is a complication of TSS?

A

Panton-Valentine leucocidin toxin can lead to necrotising fasciitis due to causing recurrent infection

45
Q

What is necrotising fasciitis?

A

severe subcut infectie down to the muscle

46
Q

What are the causes of necrotising fasciitis?

A

staph aureus and group a strep

47
Q

What are the main features of necrotising fasciitis?

A

severe pain

systemically unwell

48
Q

what is the rx of necrotising fasciitis

A

§abs
surgical intervention and debridement of necrotic tissue
+/- IVIg

49
Q

What is the route of administration of adrenaline in anaphylaxis?

A

IM

50
Q

What is the dose of adrenaline/hydrocortisone/chlorphenamine IM in <6m old in anaphylaxis?

A

0.15ml
25mg
250micrograms/kg

51
Q

What is the dose of adrenaline/hydrocortisone/chlorphenamine IM in 6m-6yr in anaphylaxis?

A

0.15ml
50mg
2.5mg

52
Q

What is the dose of adrenaline/hydrocortisone/chlorphenamine IM in 6-12yr in anaphylaxis?

A

0.3ml
100mg
5mg

53
Q

What is the dose of adrenaline/hydrocortisone/chlorphenamine IM in adolescent/adults in anaphylaxis?

A

0.5ml
200mg
10mg

54
Q

What can be given as well as adrenaline in anaphylaxis?

A

hydrocortisone

55
Q

If there is no improvement after the initial dose of adrenaline, what is the next step in management of anaphylaxis?

A

repeat adrenaline dose after 5 mins (repeat every 5 mins if necessary)
high flow O2
crystalloid
remove the trigger

56
Q

What is the best site of IM injection of adrenaline in anaphylaxis?

A

anterolateral aspect of the middle third of the thigh

57
Q

What are common causes of anaphylaxis?

A

food
drugs
venom

58
Q

What should be given if bronchospasm is a feature of anaphylaxis?

A

salbutamol

59
Q

What are dd of anaphylaxis?

A

asthma
septic shock
breath holding
panic attack

60
Q

How can you confirm a diagnosis of anaphylaxis?

A

serum tryptase levels

remain elevated for up to 12hrs in acute episode of anaphylaxis

Paeds (15 decks)

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