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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
What is the management of meningitis with non-blanching rash or meningococcal septicaemia/ in the community?
``` parenteral benzylpenicillin IV or IM <1yr - 300mg 1-9yrs - 600mg >10yrs - 1200mg dexamethasone to reduce risk of long term complications ```
26
what feature is suggestive of meningococcal infection?
non-blanching rash
27
Which meningitis is LP contraindicated in and why?
MENINGococcal septicaemia as coning of the cerebellar tonsils may follow
28
What is management of meningitis without a non-blanching rash in the community?
benzylpenicillin cefotaxime chloramphenicol
29
What are early signs of septic shock?
``` pale/mottled skin cold hands and feet prolonged ccap refill tachycardia tachypnoea ```
30
Who should be notified in cases of meningitis?
Public Health Authority
31
What should be given to close contacts for prophylaxis of meningitis?
rifampicin/ciprofloxacin - eradicates nasal carriage for meningococcal meningitis and H. inflenzae
32
When is LP contraindicated in meningitis?
- cardiorespiratory instability - focal neurological signs - signs of raised ICP - coagulopathy - thrombocytopenia - local infection at site of LP
33
what are cerebral complications of meningitis?
``` Hearing loss Local vasculitis Local cerebral infarction Subdural effusion (h. influenzae) Hydrocephalus Cerebral abscess ```
34
What are ix for meningococcal septicaemia?
Blood cultures and PCR
35
What is rx of meningitis in >3m in secondary care?
IV ceftriaxone
36
What is rx of meningitis in <3m in secondary care?
IV cefotaxime + amoxicillin or ampicillin
37
What changes would you expect in the CSF in meningitis?
appearance - turbid predominant cell - polymorphs glucose level - <2/3 of blood Protein increased mean approx 300mg/dL
38
What changes would you expect in the CSF of tubercular meningitis?
appearance - fibrin web predominant cell - mononuclear 10-350/mm^3 Glucose level - <2/3 of blood Protein increase
39
what are the complications of meningitis ?
``` secondary abscesses subdural effusion hydrocephalus ataxic paralysis deafness lowered IQ epilepsy ```
40
What is the cause of toxic shock syndrome?
toxin producing staph. aureus and group a strep
41
What are the features of toxic shock syndrome
``` fever >39 hypotension D&V renal and liver impairment clotting abnormalities and thrombocytopenia altered consciousness ```
42
What are skin changes in toxic shock syndrome?
diffuse red macular rash | desquamation of palms and soles after 1-2 weeks
43
What is the management of TSS?
Intensive care - manage shock debridement ABx - 3rd gen cephalosporin + clindamycin IVIG to neutralise toxins
44
What is a complication of TSS?
Panton-Valentine leucocidin toxin can lead to necrotising fasciitis due to causing recurrent infection
45
What is necrotising fasciitis?
severe subcut infectie down to the muscle
46
What are the causes of necrotising fasciitis?
staph aureus and group a strep
47
What are the main features of necrotising fasciitis?
severe pain | systemically unwell
48
what is the rx of necrotising fasciitis
§abs surgical intervention and debridement of necrotic tissue +/- IVIg
49
What is the route of administration of adrenaline in anaphylaxis?
IM
50
What is the dose of adrenaline/hydrocortisone/chlorphenamine IM in <6m old in anaphylaxis?
0.15ml 25mg 250micrograms/kg
51
What is the dose of adrenaline/hydrocortisone/chlorphenamine IM in 6m-6yr in anaphylaxis?
0.15ml 50mg 2.5mg
52
What is the dose of adrenaline/hydrocortisone/chlorphenamine IM in 6-12yr in anaphylaxis?
0.3ml 100mg 5mg
53
What is the dose of adrenaline/hydrocortisone/chlorphenamine IM in adolescent/adults in anaphylaxis?
0.5ml 200mg 10mg
54
What can be given as well as adrenaline in anaphylaxis?
hydrocortisone
55
If there is no improvement after the initial dose of adrenaline, what is the next step in management of anaphylaxis?
repeat adrenaline dose after 5 mins (repeat every 5 mins if necessary) high flow O2 crystalloid remove the trigger
56
What is the best site of IM injection of adrenaline in anaphylaxis?
anterolateral aspect of the middle third of the thigh
57
What are common causes of anaphylaxis?
food drugs venom
58
What should be given if bronchospasm is a feature of anaphylaxis?
salbutamol
59
What are dd of anaphylaxis?
asthma septic shock breath holding panic attack
60
How can you confirm a diagnosis of anaphylaxis?
serum tryptase levels | remain elevated for up to 12hrs in acute episode of anaphylaxis

Paeds (15 decks)

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