emergency Flashcards

Question

mx neutropenic sepsis

Answer 1

start IV abx asap - piperacillin with tazobactam (TAZOCIN) do not wait for blood test results switch to oral if improving after 24-48 hrs IV tx if no imp after 48 hrs add 2nd line abx e.g. meropenem+/- vancomycin if no imp after 5 days look for opportunistic infections e.g. fungal

Answer 2

lung breast prostate myeloma

Answer 3

BACK PAIN - the earliest and most common symptom - may be worse on lying down and coughing - worsening do not weight for neuro deficit if px has this lower limb weakness sensory loss + numbness neurological signs depend on the level of the lesion. - above L1 -> UMN signs in the legs and a sensory level - below L1 -> LMN signs in the legs and perianal numbness. - tendon reflexes tend to be increased below the level of the lesion and absent at the level of the lesion

Answer 4

whole MRI spine within 24 hours of presentation

Answer 5

high-dose oral dexamethasone (w PPI + monitor BMs as they can increase) urgent oncological assessment for consideration of radiotherapy or surgery (once established this sld be done in 24hrs) VTE proph + pressure sore prevention

Answer 6

correct dehydration - 0.9% saline IV bisphosphonates - zolendronic acid / pamidronate - inhibit osteoclasts so reduce bone turnover if persistent / relapsed - denosumab (inhibs RANK ligand)

Answer 7

dyspnoea chest pain - often at rest cough neck + face swelling arm swelling dizzy, headache, visual dist, nasal stuffy, syncope dilated veins over arms, neck + anterior chest wall oedema of upper torso, arms, neck + face cyanosis engorged conjunctiva convulsions + coma

Answer 8

superior vena cava obstruction (by tumour) usually provides the venous drainage for the head, neck, upper limbs + upper thorax when obstructed, collateral pathways form to provide an alt route for blood to return to the RA

Answer 9

elevations of the head + O2 therapy for sx relief high dose steroids endovascular stenting anticoag if central vein thrombosis tx of tumour that caused it

Answer 10

occurs during, or up to 24 hours following, blood transfusion

Answer 11

increase in temperature by 1-2°C above baseline, or absolute temperature ≥ 38°C in isolation (mild) An increase in temperature >39°C or a rise ≥ 2°C from baseline (moderate) may also have chills/rigors isolated rash (mild) angioedema, dyspnoea, hypoxia, urticaria (moderate) allergic features + airway comp/haem unstability (severe) hypotension

Answer 12

rise in temp pain at infusion site anxiety if severe: hypotension, decreased UO, spontan bleeding due to DIC dx confirmed by lab testing - evidence of haemolysis w falling Hb in the presence of a red cell antibody

Answer 13

resp comp (exc allergy/anaphylaxis) pulmonary oedema unexpected changes in cardiovasc status - HTN, tachy, increased JVP, enlarged heart CXR, peripheral oedema objective signs of left atrial hypertension - new/worsening cardiac failure on echo, NT-proBNP 1.5x risk on pre and pst trans sample (normal excludes TACO) fluids - imp in resp status after diuretic tx , was the fluid balance signif +ve

Answer 14

Transfusion assoc circulatory overload (TACO)

Answer 15

a clinical syndrome in which there is acute, noncardiogenic pulmonary edema associated with hypoxia that occurs during or after a transfusion usually due to HLA antibodies in the donor

Answer 16

px devs acute dyspnoea w hypoxia + bilateral pulmonary infiltrates during, or within six hours of, transfusion

Answer 17

characterised by respiratory distress, not due to the patient’s underlying condition, within 24 hours of transfusion and does not meet the criteria of TRALI, TACO or allergic reaction

Answer 18

rare and bacterial contamination is usually the only TTI to present as an acute reaction sx v shortly after trans: Rise in temperature, rigors; Hypotension; Tachycardia.

Answer 19

A fever; and/or a failure to increment to the transfusion as expected (i.e. minimal rise or subsequent rapid fall) in Hb; and/or otherwise unexplained increase in bilirubin. dx lab testing (evidence of haemolysis in the presence of a red cell antibody)

Answer 20

severe but rare immune mediated complication which can occur 5-12 days after transfusion of red cells or platelets Any unexplained platelet drop > 50% following transfusion should be discussed with a haematologist

Answer 21

In patients with impaired T cell function, lymphocytes from the transfused blood can engraft, mounting an immune response against the recipient's cells. >95% mortality and multi-organ failure can occur from a few days up to a few months following transfusion Risk: Transfusing irradiated blood to patients with impaired T cell immunity (e.g. post stem cell transplant, but not patients with HIV), prevents proliferation of lymphocytes and thus TA-GvHD.

Answer 22

PAUSE TRANSFUSION CALL FOR URGENT MEDICAL ASSISTANCE VIA YOUR EMERGENCY NUMBER. Initiate resuscitation – ABCDE. Is haemorrhage likely to be causing hypotension? If SO - CONTINUE transfusion. If not- disconnect transfusion (keep indicated units). Maintain venous access. Frequent vital signs monitoring.

Answer 23

If likely anaphylaxis/severe allergy - follow anaphylaxis pathway. If bacterial contamination likely, start antibiotic treatment. Use BP, pulse, urine output (catheterise if necessary) to guide intravenous 0.9% saline administration. Inform transfusion laboratory. Return unit to transfusion laboratory. If bacterial contamination suspected, contact transfusion laboratory to discuss recall of associated components. Perform relevant investigations (as recommended on the transfusion reaction form). Contact haematologist if required. Document outcome/action taken in notes. Complete adverse event report form. Transfusion Practitioners refer to MHRA/SHOT, as appropriate.

Answer 24

Treat mild pyrexia with oral paracetamol; Treat mild allergic reactions with antihistamines; If the reaction is confirmed as mild, you may restart the transfusion at a slower rate following a full clinical review (including patient ID/component label check) with close observation. may be start of more severe reaction, observe px closely

Answer 25

Manage the patient symptomatically and according to severity of symptoms e.g. with paracetamol, antihistamines and if needed for respiratory symptoms, inhaled short-acting beta-2 agonists and/or oxygen. The transfusion may be restarted if: A full clinical review by medical staff (including patient ID/component label check) has been undertaken; and either: The patient recovers with only symptomatic intervention or; There is an obvious alternative explanation for the symptoms/signs. If the transfusion is resumed, the patient must be closely observed.

Answer 26

Give fluid resuscitation; Send samples for FBC, PT/APTT/fibrinogen, renal function, G&S; Monitor urine output closely; Contact ITU for early review for inotropic, renal, and/or respiratory support; Discuss urgently with haematology re further treatment e.g. steroids +/- intravenous immunoglobulin. If checks show ABO incompatibility due to transfusion of a unit intended for another patient, contact your transfusion laboratory immediately to prevent a further incident.

Answer 27

where there is destruction not just of transfused blood but the patient’s own as well

Answer 28

DIC hypocalcaemia hypothermia TACO VTE hyperkalaemia

Answer 29

agitation, confusion, delirium hyperthermia tachycardia hypertension arrythmias ACS + strokes

Answer 30

benzo supportive CCVs (verapamil), labetalol

Answer 31

increased BP bradycardia irregular breathing physiological response that is seen in the context of raised ICP

Answer 32

4 “Hs” and 4 “Ts" hypoxia hypokalaemia/hyperkalaemia hypothermia/hyperthermia hypovolaemia tension pneumothorax tamponade thrombosis toxins

Answer 33

IV 20% lipid emulsion