Emergency Flashcards
When can activated charcoal be given?
Those who present within 1hour, fully conscious and protected airway
In potential trauma - initial steps
1) Airway
2) Cervical spine immobilisation
What is an appropriate Ix for cervical spine fracture?
CT scan of neck
In pt who is hypotensive + tachycardic, but adequately (overloaded even, e.g., pulmonary oedema) what is the most appropriate next treatment?
IV noradrenaline
Mx for TCA overdose
IV sodium bicarbonate
Mx beta blocker OD
glucagon
Ix to confirm anaphylaxis
elevated mast cell tryptase
Initial mx anaphylaxis
0.5mg of IM 1 in 1000 adrenaline
+ remove source of reaction
+ monitor >6h due to risk biphasic reaction
What is pathophysiology behind anaphylaxis
- Sensitisation phase
- Immune system encounters allergen & produces allergen specific IgE
- asyx - Reaction phase
- Re-exposure to allergen -> cross links w IgE on surface of mast cells
- Degranulation of mast cells -> histamine release
Fever + rash + lymphadenopathy + deranged LFTs + eosinophilia
Drug reaction w eosinophilia and systemic syx (DRESS)
- basc a v severe drug reaction
Hypersensitivity types
Type 1 - Anaphylaxis: Ig E; e.g., allergy
Type 2 - antiBody: IgG; e.g., goodpastures
Type 3 - immune Complx: IgG/IgM; e.g., SLE
Type 4 - Delayed: T-cell; e.g., contact derm
Type 5 - autoimmunE: IgG/IgM; e.g., Graves, MG
Sepsis 6
3 in
- high flow O2
- Fluid challenge
- IV abx
3 out
- Bloods incl lactate
- Blood culture
- Urine output
Primary care mx if suspected meningococcal disease
IM benxylpenicillin 1.2g
Mx if contact w pt who has meningococcal meningitis
Ciprofloxacin 500mg STAT
Encapsulated yeast on india ink staining of CSF
cryptococcal meningitis (seen in HIV)
Neutropenic sepsis abx mx
Tazocin
Meningitis mx
Cefotaxime
(+ampicillin if risk listeria)
Flushed + dry + tachy + dilated pupils
Anticholinergic syndrome
Reduced GCS, pupillary changes + cardioresp depression
Sedative - opioid, benzo
dilated pupils, tachycardia, hypertension, hypertonia
serotonin syndrome/toxicity
Opiate OD mx
Naloxone
Benzos OD mx
Flumazenil
Iron OD mx
Desferrioxamine
Signs of basal skull #
- haemotympanum
- peri-orb bruising
- battle’s sign - bruising behind ears
- CSF leakage from ears/nose
Factors for CT head <1h, <8h
- <1h
- GCS <13
- GCS <15 at 2hr post injury
- Open/depressed skull #
- Signs of basal skull #
- >1 vomit - <8h
- None of above
- on anticoag
- >65
- dangerous mode of injury
!! if deterioration -> immediate assess ± repeat imaging
Facial N palsy following head injury
Basal skull #
Unilateral ptosis (drooping lid) + down and out eye + fixed dilated pupil
Surgical/traumatic 6th N palsy
Cocaine OD mx
Benzodiazepine
Low GCS + dilated pupils + tachy + brady + prolonged QRS!!
TCA overdose
