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Finals > Emergency > Flashcards

Emergency Flashcards

1
Q

Paracetamol Poisoning

what may toxic dose lead to

A
  • severe hepatocellular necrosis

- renal rubular necorsis

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2
Q

Paracetamol Poisoning

presentation

A
  • early feature: N+V

- hepatic necrosis: R subcostal pain + N+V after 24h

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3
Q

Paracetamol Poisoning

what is the max body weight to use when calculating the total dose of paracetamol ingested

A

110kg

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4
Q

Paracetamol Poisoning

mnx within 1h

A

activated charcoal

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5
Q

Paracetamol Poisoning

mnx up to 24h

A

acetylcysteine (most effective given within 8h)

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6
Q

Paracetamol Poisoning

what is an acute overdose

A

ingestion of a potentially toxic dose of paracetamol in 1 hour or less.

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7
Q

Paracetamol Poisoning

when to refer pts to hospital if >6y

A
  • self-harm
  • symptomatic
  • ≥75mg/kg in <1h
    or time uncertain but dose is ≥75mg/kg
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8
Q

Paracetamol Poisoning

when to refer pts to hospital if <6y

A
  • symptomatic
  • ≥150mg/kg in <1h
    or time uncertain but dose is ≥150mg/kg
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9
Q

Paracetamol Poisoning

when can plasma-paracetamol concentration be measured from time of ingestion

A

from 4hr

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10
Q

Paracetamol Poisoning

when should acetylcysteine be commenced

A
  • plasma-paracetamol concentration falls above the treatment line on the paracetamol treatment graph
  • present within 8 hours of ingestion of more than 150 mg/kg of paracetamol if there is going to be a delay of 8 hours or more in obtaining the paracetamol concentration after the overdose
  • present 8–24 hours after ingestion of an acute overdose of more than 150 mg/kg of paracetamol even if the plasma-paracetamol concentration is not yet available
  • present >24h after ingestion of an overdose if they are clearly jaundiced or have hepatic tenderness, high ALT, INR>1.3 or paracetamol conc is detectable
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11
Q

Paracetamol Poisoning

what is therapeutic excess

A

the ingestion of a potentially toxic dose of paracetamol with intent to treat pain or fever and without self-harm intent during its clinical use

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12
Q

Paracetamol Poisoning

therapeutic excess: when should pts be referred to hospital

A
  • symptomatic
  • > licensed dose + ≥75 mg/kg in any 24-hour period
  • > licensed dose but <5 mg/kg/24 hours on each of the preceding 2 or more days.
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13
Q

Paracetamol Poisoning

what is a staggered overdose

A

ingestion of a potentially toxic dose of paracetamol over more than 1 hour, with the possible intention of causing self-harm

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14
Q

Paracetamol Poisoning

staggered overdose: when should pts be referred to hospital

A

all pts and treat with acetylcysteine without delay

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15
Q

Paracetamol Poisoning

what is the standard 21-hour regimen for acetlcysteine

A

acetylcysteine is given in a total dose that is divided into 3 consecutive intravenous infusions over a total of 21 hours

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16
Q

pt presents with fever, headache, altered mental status, personality change, focal neurological deficits and convulsions. What could it be

A

encephalitis

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17
Q

mnx of encephalitis

A

Aciclovir covers for HSV-1 and HSV-2.

Cefotaxime is a 3rd generation cephalosporin and covers for most causes of bacterial meningitis

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18
Q

Digoxin poisoning

presentation

A
  • hyperkalaemia
  • Yellow-green colour disturbance
  • Dizziness, N + V
  • Palpitations (due to arrhythmias)
  • Bradycardia typically without hypotension
  • Visual haloes
  • Confusion
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19
Q

Digoxin poisoning

mnx

A
  1. Immediate digoxin level
  2. IV fluids
  3. Correct electrolyte abnormalities
  4. Continuous cardiac monitoring
  5. Give digibind if:
    - Level >15ng/ml after 6 hours of last dose
    - Level >10ng/ml within 6 hours of last dose
    - Symptomatic
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20
Q

Digoxin poisoning

ECG signs

A

reserve tick ST depression

with first degree heart block

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21
Q

resus in paeds

A

5 rescue breaths then 15 chest compressions
then
2 rescue breaths: 15 chest compressions

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22
Q

mnx of choking child if conscious and coughing

A

encouraging them to cough may help dislodge the obstruction

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23
Q

mnx of choking child if conscious but unable to cough

A

alternate between giving 5 back blows and 5 chest (infant)/abdominal (child) thrusts

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24
Q

mnx of choking child if unconscious

A

5 rescue breaths should be given before immediately starting CPR.

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25
Q

when should the Heimlich manoeuvre be performed in a choking child

A

if back slaps fail and only if the child is large enough (as it can cause significant damage to intra-abdominal organs in a small child).

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26
Q

what are the reversible causes of cardiac arrest

A 
4H's and 4T's
hypoxia
hypokalaemia/hyperkalaemia
hypothermia/hyperthermia
hypovolaemia

tension pneumothorax
tamponade
thrombosis
toxins

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27
Q

in patients with poor renal function, what should happen to the dose of furosemide

A

increased so that an increased concentration reaches the glomerulus and tubules to achieve the desired effect

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28
Q

CO poisoning

presentation of carbon monoxide poisoning

A

Confusion
Nausea and vomiting
Cherry red skin
Tachycardia

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29
Q

CO poisoning

why is pulse oximetry 100% if they have CO poisoning

A

because it only measures saturation of non-affected haemoglobin molecules

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30
Q

CO poisoning

diagnostic inx

A

VBG/ABG: A carboxyhaemoglobin concentration >20%

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31
Q

CO poisoning

mnx

A
  1. 100% oxygen via face mask - helps unbind CO from the haemoglobin molecule
  2. Hyperbaric oxygen
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32
Q

what is the most important adverse effect of tricyclic overdose

A
  • QRS prolongation
  • PR and QT interval prolongation
  • can easily progress to heart blocks and ventricular arrhythmias
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33
Q

what murmur is associated with aortic dissection

A

aortic regurg

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34
Q

what other features apart from tearing chest pain is aortic dissection associated with

A
  • paraparesis (carotid or spinal artery involvement)
  • anuria and loin pain (renal artery involvement)
  • abdo pain (mesenteric artery involvement)
  • acute limb ischaemia (subclavian or femoral artery involvement)
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35
Q

Management of acute spinal cord compression if metastatic aetiology is suspected

A
  • dexamethasone 16mg PO asap (to reduce tumour size and therefore relieve pressure)
  • urgent whole spine MRI
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36
Q

Management of Ethylene Glycol Poisoning (anti-freeze)

A
  1. Gastric lavage or NG aspiration if <1 hour since ingestion
  2. Fomepizole (competitive inhibitor of alcohol dehydrogenase) - prevents metabolism of ethylene glycol into toxic metabolites.
  3. ethanol if Fomepizole is unavailable.
  4. Haemofiltration can be used in severe cases
37
Q

which abx can cause prolongation of the QT interval, which can lead to polymorphic VT aka torsades de points

A

Clarithromycin

38
Q

blood glucose level is 1.7 mmol/L (4-7 mmol/L). IV access is obtained. what do you give

A

100ml of 20% glucose IV

39
Q

when to consider PCI for a STEMI

A

within 12 hours of symptom onset and within 2 hours of medical contact

40
Q

STEMI

Patients who present within 12 hours of symptom onset but after 2 hours of medical contact can be offered?

A

thrombolysis

41
Q

STEMI

If patients present more than 12 hours of symptom onset

A

pharmacotherapy provided they are stable

42
Q

Contraindications to thrombolysis in MI

AGAINST

A 
Aortic Dissection
GI bleed
Allergic reaction
Iatrogenic: recent surgery
Neuro: recent stroke (within 3m), malignancy
Severe HTN (>200/120)
Trauma, including recent CPR
43
Q

when should mast cell tryptase samples be taken after an anaphylaxis reaction

A

during, 4h and 12h post reaction.

44
Q

what will the ABG show in salicylate poisoning (e.g. aspirin poisoning)

A

respiratory alkalosis early on then resp acidosis

45
Q

why is there respiratory alkalosis then resp acidosis in salicylate poisoning (aspirin)

A

activation of respiratory centres in the brain

then wasting of bicarbonate ions due to the ingested acid load - this is often mixed with the respiratory alkalosis

46
Q

mnx of aspirin overdose

A
  1. Activated charcoal if ingestion <1 hours ago

2. IV fluid, sodium bicarbonate and potassium chloride

47
Q

Cushing’s triad for raised ICP

A
  1. increased BP
  2. bradycardia
  3. irregular breathing
48
Q

stepwise mnx of suspected choking

A
  1. encourage pt to cough
  2. 5 back blows followed by 5 abdo thrusts repeated
  3. unconscious: CPR
49
Q

Criteria for performing a CT head scan within 8 hours following head injury

A
  • Age 65 years or older.
  • Any hx of bleeding or clotting disorders.
  • Dangerous mechanism of injury
  • > 30 min retrograde amnesia of events immediately before the head injury
50
Q

Criteria for performing a CT head scan within 1 hour of head injury (7)

A
  • GCS <13 on initial assessment in A&E
  • GCS <15 at 2h after the injury on assessment in A&E
  • Suspected open or depressed skull fracture.
  • Any sign of basal skull fracture (haemotympanum, ‘panda’ eyes, cerebrospinal fluid leakage from the ear or nose, Battle’s sign).
  • Post-traumatic seizure
  • Focal neurological deficit
  • > 1 episode of vomiting
51
Q

which drugs can cause serotonin syndrome

A

SSRI
MAOI antidepressants
ecstasy
amphetamines

52
Q

which score predicts the 6-week risk of major adverse cardiac event

A

the HEART score

53
Q

mnx if HEART score 0-3

A

discharged

54
Q

mnx if HEART score 4-6

A

admit

55
Q

mnx if HEART score ≥7

A

50-65% risk of adverse cardiac event

56
Q

in a patient with a suspected cervical spine injury but an airway is needed to be managed, what is the best option

A

jaw thrust

but if a life-threatening airway obstruction, head tilt should be performed incrementally until the airway opens (patent airway takes priority over potential cervical spine injury).

57
Q

initial trx if alcoholic has an acutely altered mental status and is agitated

A

IV diazepam

58
Q

what type of shock may patients with cardiac tamponade have

A

tamponade prevents heart from filling adequately, causing an obstructive shock

59
Q

signs of opiate overdose

A
  • constricted pupils
  • Drowsiness
  • Confusion
  • Decreased respiratory rate
  • Decreased heart rate
60
Q

signs of opiate withdrawal

A
  • Sweating
  • clammy/cold
  • pallor
  • N+V
  • diarrhoea
  • abdo pain
  • tachycardia
61
Q

GCS response is different in each hand. how are they scored

A

on their best response

62
Q

how is lactic acidosis initially managed

A

a fluid bolus

63
Q

mnx for hypotension during surgery (after fentanyl, fluid bolus doesn’t work)

A

Metaraminol is an alpha agonist

64
Q

causes of type I resp failure

A 
Decreased atmospheric pressure
Ventilation-perfusion mismatch
Shunt
Pneumonia
ARDS
Pulmonary embolism
65
Q

causes of type II resp failure

A 
COPD
Brain stem disease/lesion
Bronchitis
Motor neuron disease
Deformity e.g. ankylosing spondylitis, kyphoscoliosis
66
Q

soot in nasal cavity and hoarse voice. What mnx?

A

signs of smoke inhalation

Early intubation as the rapidly developing swelling and oedema may quickly lead to total airway obstruction and a difficult or failed intubation.

67
Q

Local anaesthetic toxicity pathophysiology

A

blockade of sodium channels

68
Q

signs + symptoms of local anaesthetic toxicity

A 
Numbness or tingling around the mouth
Restlessness/agitation
Tinnitus
Shivering
Vertigo/dizziness
Subtle tremors of the face and extremities
Hypertension
Tachycardia
Decreased consciousness
Respiratory depression
Hypotension
Apnoea
Seizures
Sinus bradycardia
Ventricular arrhythmias
Asystole
69
Q

mnx of local anaesthetic toxicity

A
  • Stop administration of local anaesthetic!
  • ABCDE inc ECG
  • Lipid emulsion (20% intralipid) 1mL/kg every 3 minutes up to a dose of 3mL\kg
  • Initiate lipid emulsion infusion at a rate of 0.25mL\kg\min
  • Maximum total dose = 8mL\kg
70
Q

what may ECG show in TCA (amitriptyline) overdose

A

QT interval prolongation which can precipitate a cardiac arrythmia

71
Q

1st line for TCA (amitriptyline) overdose

A

IV bicarbonate

72
Q

why does bicarb work for TCA overdose

A

Alkalisation favours the neutral form of the drug thus reducing the amount of active cyclic antidepressants

73
Q

what does bogginess of skull on palpation suggest

A

a depressed skull fracture. This is a ‘high’ risk factor for intracranial haematoma.

74
Q

well-recognised side effect of epidural anaesthesia

A

hypotension due to local anaesthesia of sympathetic nerves

75
Q

what is malignant hyperthermia

A

a life-threatening syndrome triggered by inhalation anaesthetics or suxamethonium

76
Q

most common cause of malignant hypothermia

A

autosomal dominant mutation in the ryanodine receptor 1

77
Q

presentation of malignant hyperthermia

A

typically present at the induction of general anaesthesia with:

  • increased body temp
  • muscle rigidity
  • metabolic acidosis
  • tachycardia
  • increased exhaled CO2
78
Q

mnx of malignant hyperthermia

A
  • stopping triggering agent
  • administer IV dantrolene (a ryanodine receptor antagonist)
  • restore normothermia
79
Q

name 3 other conditions which presents like paracetamol overdose

A
  • Acute hepatitis
  • alcoholic liver disease
  • steroid induced ALF
80
Q

complications of paracetamol overdose

A
  • liver failure
  • encephalopathy
  • hypoglycaemia
  • CKD
81
Q

what formula can be used to calculate the amount of fluids required (mnx of burns)

A

Parkland formula:

4 x weight (kg) x %burn = ml fluid required in the first 24 hours

82
Q

what is the most accurate method of assessing the extent of the burn

A

Lund and Browder chart

83
Q

what is Wallace’s Rule of Nines to assess the extent of the burn

A
  • head + neck = 9%
  • each arm = 9%
  • each anterior part of leg = 9%
  • each posterior part of leg = 9%
  • anterior chest = 9%
  • posterior chest = 9%
  • anterior abdomen = 9%
  • posterior abdomen = 9%
84
Q

4 mechanisms to sustain a burn

A
  • thermal
  • electrical
  • chemical
  • Non-accidental injury
85
Q

pt given painkillers. Hour later, he is seizing. What was given to him

A

tramadol (lowers seizure threshold)

86
Q

what medication can be used to temporarily raise a pt’s BP

A

Fludrocortisone

87
Q

which medication is CI’d when taking viagra (Sildenafil)

A

nitrates

88
Q

what strong painkiller to give if got renal disease

A

tramadol or oxycodone

89
Q

initial mnx for superior vena cava obstruction

A

dexamethasone

Finals (47 decks)

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