Emergency Flashcards
What is the antidote for:
Paracetamol
B-blockers
TCAs
Para: N-AC
B-blockers: IV atropine / IV glucagon + dextrose
TCAs: sodium bicarbonate (if VT/SVT)
What are the features of salicylate (aspirin) overdose?
What is seen on ABG
Tachypnoea Vomiting Sweating Tinnitus/vertigo ABG: resp alk → metab acid
What are the features of TCA overdose?
What is seen on ABG
Dilated pupils / blurred vision Urinary retention Seizures / Reduced GCS Dysrhythmia / Tachycardia ABG: metal acid ECG: wide QRS
What are the features of digoxin toxicity? (3)
Nausea / anorexia
Confusion
Hallucinations (yellow haloes over lights)
How is opioid overdose managed?
400ug IV naloxone
1min fail: 800ug
2min fail: +800ug (repeat until breathing adequate)
NB short t1/2 (needs repeating)
What are the features of BZD overdose (6)
How is it managed?
↓GCS / ↓Tone / ↓Reflexes
↓BP
Ataxia
Dysarthria
Flumenazil 200ug (in 15s) (+100ug every 1min)
What are the features of stimulant overdose (E/Cocaine/Amphetamine)
What is seen on ABG
How is it managed
Thirst Dilated pupils Agitation / confusion / tremor ↑HR / ↑BP / ↑Temp ABG (cocaine): metab acidosis
IV diazepam (if halluc/convulsing) External cooling
What are the complications of acute alcohol intoxication?
How is it managed?
Hypoglycaemia** (esp children)
Severe: resp failure / coma / death
IV glucose (glucagon ineffective) Haemodialysis (if conc >500)
List the reversible causes of arrest (8)
Hypothermia
Hypoxia
Hypovolaemia
Hypo/hyperkalaemia / metabolic
Thrombosis (cardiac/pulmonary)
Tension pneumothorax
Tamponade (cardiac)
Toxins
List the different types of shock (7)
Hypovolaemic
• Haemorrhagic
• Non-haemorrhagic
Distributive:
• Septic
• Anaphylactic
• Neurogenic
Cardiogenic:
• Direct (MI/Arrhythmia/Electrolytes/Valve)
• Indirect (obstructive)
Which types of shock cause ‘cold shock’ and ‘warm’
What are the features of each
‘Cold shock’ – hypovol/cardiogenic
• Cold / pale / clammy
• Thready pulse / narrow PP
‘Warm shock’ – septic
• Hot / flushed / sweaty
• Bounding pulse / wide PP
What are the new Sepsis (2016) criteria (ARUHSS)
Appears Really Unwell, Heading to Septic Shock
- Altered mental state (new)
- RR >25 (or new need for O2)
- Urine not passed 18hrs (or <0.5ml/kg/hr 2hrs)
- HR >130
- SBP <90 (or 40+ under usual)
- Skin: ashen/mottled/cyanosed/non-blanching
What are the different classes of haemorrhagic shock and how is each managed
All: Titrated fluids / Transexamic acid
Class 1: HR >100 → fluid (crystalloids)
Class 2: HR >100 + Narrow PP → consider blood
Class 3: HR >120 → give blood + consider surgery
Class 4: >40% lost → surgery
List some specific aspects of management in cardiogenic shock
If pulm oedema → withhold fluids
Consider: Swan-Ganz / Central / A-line
Consider: ‘renal’ dose dopamine to protect
PCWP low → plasma expander
PCWP okay → ionotropes (dobutamine)
What is the ‘triad of death’?
Post-massive transfusion bleeding disorder:
• Coagulopathy
• Hypothermia
• Metabolic acidosis
What circumstances in burns might you suspect an airway issue?
Fire in enclosed space
Stridor Harsh cough Carbonaceous sputum Tachy/dyspnoea Burnt nasal hair Facial burns
Outline the immediate management in burns (5)
Outline the systemic management in burns (5)
Remove clothing (contains heat) Cold water tap Cling film (removes pain) Fluid resus (if >15% SA adults / >10% children) Assess severity (depth etc)
IV opiates Hartmann's Catheterise Systemic Abx (if evidence infection) Nutrition (early parenteral if enteral not poss)
What are some complications of burns (6)
Contractures
Sepsis (e.g. wound / inhalation-related chest)
Acute peptic ulceration (Curling’s ulcer)
AKI (hypovol / Hb / myoglobin)
Psychological
What are the indications for specialist burns referral? (7)
Indications for outpatient management
Burns >30% total SA Partial thickness >10% (5% children) Full thickness >1% Circumferential burns Assoc inhalation injury Chemical/electrical burns Age extremes
Outpatient:
Adults partial thickness <10%
Children partial thickness <5%
Full thickness <1%
