Emergency Flashcards
Usual adult doses >12years for anaphylaxis drugs?
0.5ml 1/1000 adrenaline IM
10mg Chlorphenamine IM or IV
200mg Hydrocortisone IM or IV
Investigations in anaphylaxis to confirm?
Tryptase ↑
What is septic shock?
Hypotension induced by sepsis which continues despite adequate fluid resuscitation.
Pathophysiology of septic shock?
Vascular permeability ↑ NO↑ = dilatation and ↑ lactate due to hypoxia
Causes of cardiogenic shock?
MI, Valvular rupture, septal problems
Features of cardiogenic shock?
Tachy, basal crackles, gallop rhythm, ↑ JVP, Oedema.
Fluids in cardiogenic shock?
Caution, start with 250ml and reassess
Definition of cardiogenic shock?
Heart is unable to meet demands of body in terms of perfusion. (mechanical impairment)
Hypovolaemic shock define?
Anything provoking a major reduction in blood volume- this can be absolute or relative.
Types of respiratory failure and values?
1 = ↓Pao2 <8 on air. 2=↓Pao2 with ↑CO2 >6.5
Causes of type 1 respiratory failure?
Pneumonia, Lung collapse, Pneumothorax, Asthma, Fibrosis, contusion.
Type 2 respiratory failure causes?
Reduced respiratory drive, Obstruction, Severe asthma, Peripheral muscular disease -myasthenia and Guillain Barré. (exhaustion- all type ones too). Skeletal abnormalities (kyphosis)
Management of type 1 respiratory failure?
Give O2, via face mask, may need assisted ventilation if Pao2 <8 despite 60% O2
Management of type 2 respiratory failure?
Titrated oxygen therapy, starting at 24%, check ABG’s may need NIPPV if no improvement after an hour.
When is amiodarone given during cardiac arrest?
After 3 shocks
When should adrnealine be given in a cardiac arrest?
Immediately if PEA/Asystole then every 2 cycles
Shockable rhythm shock first then resume CPR and give adrenaline every 2 cycles.
4 H’s and 4 T’s?
Hypothermia, Hyperkalaemia, Hypovolaemia, Hypoxaemia
Tension, Tamponade, Thrombus, Toxins
How would you define a paracetamol overdose?
> 4g in 24hrs
Acute overdose of paracetamol defined as?
> 4g or >75mg/kg in 1 hour
What is a staggered paracetamol overdose?
> 4g over >1hr
Signs and symptoms of paracetamol overdose?
RUQ pain, Vomiting, AKI, Jaundice or simply initially asymptomatic.
When to treat a paracetamol overdose?
Level above treatment line at 4hrs post ingestion, If staggered overdose. Or any overdose ↑150mg/kg.
How is NAC given?
150 mg/kg over 1 hour, 50 mg/kg over 4 hours, then 100mg/kg over remaining 16hours all in glucose.
Blood gas disturbances in salicyclate overdose?
Initially resp alkalosis which become a metabolic acidosis.
Management of salicylate poisoning?
Charcoal, can try correct acidosis with bicarb and urinary alkalination If very severe consider haemodialysis especially if if shocked
Salicylate poisoning symptoms?
Tinnitus, sweating, N&V
Treatment of TCA overdose? at what QRS ?
Charcoal if <1hr of ingestion. If QRS >100ms consider IV bicarb, hypoxaemia and electrolytes should be corrected
TCA overdose symptoms?
tachycardia, drowsiness, a dry mouth, nausea and vomiting, urinary retention, confusion, agitation
Investigation of choice in TCA overdose?
ECG for QRS and Blood gases for acidosis
Iron overdose treatment?
Lavage within 1 hr of ingestion otherwise desferrioxamine 15mg/kg/hr
Recovery of spinal shock heralded by which reflexes?
Babinski and perineal.
AKI stage one defined as?
Creatinine rise of 26 micromol or more within 48 hours
Rise in creatinine 50-99% 1.5-2 x baseline (if known) in 7 days
Urine <0.5ml/kg/hr 6hrs
AKI stage two defined as?
Rise in creatinine 100-199% 2-2.99 x baseline (if known) in 7 days
Urine <0.5ml/kg/hr 12hrs
AKI stage three defined as?
Rise in creatinine 200% 3 x baseline (if known) in 7 days
Urine <0.3ml/kg/24hrs or anuria
Pre-renal causes of AKI?
Usually hypotension and dehydration/volume depletion, renal artery stenosis also heart failure and cirrhosis
Intrinsic causes of AKI?
Glomerulonephritis, Interstitial nephritis and tubular necrosis (often rhabdomyolysis)
Post renal AKI causes?
Infection, ureteric stones, bladder problems, BPH
Imaging in AKI?
An ultrasound scan of the kidneys, ureters and bladder is required in severe cases of AKI, especially if there is no response to initial management, in order to evaluate for any obstructive causes.
Potential drugs to stop in AKI?
ACEi and ARBs
NSAIDs
Aminoglycoside antibiotics
Potassium-sparing diuretics (due to increased risk of hyperkalaemia)
5 W’s of post op fever?
Wind-Chest infection (2 days) Water- UTI (3-5 days) Walking- VTE (5-7 days) Wound- Infection (~ day 7-10) Wonder Drugs- Iv cannula sites or blood transfusion reaction
Over 40 and first unprovoked DVT no signs of cancer on bloods or CXR what investigation to consider?
CT abdo pelvis
How is salbutamol used in hyperkalaemia?
5mg nebs back to back over 30mins 10-20mg in total
Dose of glucose and insulin for hyperkalaemia?
50ml of 50% glucose infused over 5-10 mins with 10units of actrapid
Calcium gluconate dose for hyperkalaemia?
30ml of 10% calcium gluconate, can repeat after 5-10mins if ECG does not change
ECG features in hyperkalaemia?
Widened QRS, tented T waves, small P waves
When is hyperkalaemia deemed significant?
Greater than 6mmol
Causes of hyperkalaemia? three ways?
Increased k+ intake (rare)
Decreased excretion- drugs potassium sparing
Entry in cells reduced such as beta blockers digoxin and low insulin levels
